Dear Interviewer

Dear Interviewer,

I don’t know your name or even very much about your business. I take my heating and air-conditioning for granted, though my husband has spent a couple of nights a week studying these systems so he could learn a trade, any trade, to make him employable. You’ll meet him tomorrow. You are one of the first to even give him a second glance, and that is my fault. He is a good man, a smart man. He has abilities and skills that are very different from mine. 

You see, years ago, he recognized that I had some talents and abilities that were going to waste. He was in school at the time, and he went to talk to his dean about getting me into classes despite the fact that I was in default on a federal student loan after having dropped out of college when my mom died. And that I was being held back simply because I didn’t have enough money to resolve the issue. And that dean called me in and we came up with a plan to get me out of default, and I learned that I can still shine. I didn’t look back. And my generous, kind, loyal husband put his goals on the back burner so I could continue to shine. 

And then we moved when I found a good job far away, causing him to abandon those goals he had set for himself. And I made a decent living. But when expensive childcare became an issue, he listened to me when I said, “It would be so much easier on us, financially and physically, if you would just stay home with the kid.” And he did. He put away his old-fashioned ideals of the manly-man supporting his family, and he became about the car-riders’ line at the local elementary school, Cub Scouts, karate lessons, and any other thing that comes with having a young child. When people would have the knee-jerk action of turning to the dad first to ask what he did, he would say he was a stay-at-home dad. But even I could notice that his shoulders always slumped just a little when he said this.

And then we moved again, where I had an even better job and higher education opportunities. And he enrolled in a school for this or that, taking a class at a time. I think he just needed something for himself. Anything. But still he kept that role of homemaker so I could do well, better, best. First, it was so I could pursue my dream of going to medical school, then there was another baby. His days were no longer only filled with carpools and extracurriculars, but again with diapers, keeping me in clean breast pump parts, teething. Still, he kept on.

Then it was, “John, I think I want to go to business school instead.” And his reply, that he would support me in whatever I wanted to do. And there was a BBA. When I decided I wanted an MBA, he was there cheering me on. He told me I could do it, that I was awesome. He stayed with the kids, washing my scrubs in preparation for my weekend shifts at the hospital while I sat in accounting/ finance/ marketing/ whatever classes. And he picked me up. On test days, he’d always have a motivational song on cue for when I would get into the car.

And all of this time, it was one class at a time for him. Scheduled around my work and class schedule, of course, because he always put me first. And then he was finished, but somehow even that was dwarfed by my completion of grad school one week later. And he never complained.

So tomorrow, you will meet him. He really wants this job, and I want him to have it. You are going to see his resume and application and ask about the 7-year gap in employment. Like most others, you will probably ask why a man didn’t work to support his family. It seems that, despite how progressive we think we have become as a society, we are still very much old-fashioned. And John, well, he just isn’t good at singing his own praises. This is what I would want him to tell you:

He worked. He worked harder than he ever has in his life. He honed time-management skills. He learned cleaning. He learned to keep others happy, multitasking. He perfected the art of motivational speaking, of problem-solving, of making sacrifices for the improvement of the team. And he was successful in all of those roles. After all, with him backing me, I did everything I set out to do.

So, Interviewer, tomorrow, I hope for a couple of things. I ask that you look at him as the man he is: the man who was brave enough to serve his country, put in his 40 at a job he hated in order to pay the bills, and the man selfless enough to give up what he wanted for his wife and kid(s). I ask that you not be like all of the others and you give this loyal, hard-working, awesome man a chance instead of simply seeing a long period of unemployment.

If you could see him like I do, you would know that you would not be sorry.


John’s Wife

Lament of the Non-Nurse


Healthcare is all about nursing. I understand this. With 77% of non-physician roles in U.S. healthcare being those of the nursing variety, I can understand. They are the backbone of our hospitals. I am not a nurse. I had the option years ago, and I decided that, with poop being my Kryptonite and all, it would not be a wise career choice for me. I opted, instead, to help people breathe for a living. Thus I became the respiratory therapist. That choice has come back to haunt me in several ways.

The first of these started when I wanted somewhere to go from here. Nurses have so many avenues they can take to do this: become an instructor, a case manager, management at their facility, become an NP. What can the respiratory therapist do? Well, aside from becoming a Registered Respiratory Therapist from the entry-level Certified Respiratory Therapist, which I did the month after I graduated from respiratory school, there is nothing. Bachelors programs in respiratory are just starting to emerge, but a BS in respiratory gets us no more job perks, no more pay. You just get to say you have it. The majority of my bachelors-having coworkers got theirs in “health sciences”. Whatever that means. So instead, I opted to finish my BS in business administration with the added concentration of healthcare management. But then what? If there are only a handful of BS programs, there certainly are no masters programs. But my BS is in business anyway, so the MBA was a no-brainer.

So here I am. I am one of the more educated in my department, even in the hospital. My MBA is complete. I did well. I did it. So now what? Now I find a job.

I thought this part would be easy. Well, not really easy, but not this difficult, either. Let’s discuss my situation: I have spent the past eight years of my life working in the toughest in my field–adult critical care, and eventually NICU. To the layperson, let me explain further: I am a member of a critical care team who responds the emergencies in the hospital. We are called in when you or your loved one is at their sickest. We bring our skills, experience, and knowledge to you, make recommendations to the physician based on all of the above. We communicate with other members of the team, with family members, with patients. We assess and decide, then act. Repeat as often as necessary to the point that it is second nature to us.

So what does this tell you about me? Well, it tells you I can effectively communicate with anyone. I have non-English-speaking patients, when I am most certainly unilingual. I have deaf patients, blind patients, patients who are intubated and cannot talk, trached and cannot talk. My job is to find out what is going on with them rapidly enough to act. I have become, over the years, a master lip-reader. But that’s not all. The people with whom I interact each and every day have been anyone from a PhD-holding professor who was ill, down to a man whose education was limited to elementary school before he was put to work out in his family’s fields. On our professional team, we have everyone from housekeepers and registration clerks, who may only have a high school education, all the way up to senior management and physicians with advanced degrees. I. Can. Effectively. Communicate. With . Anyone.

Now for my work. It may involve looking at lab values that seem to others to have nothing to do with the lungs, but actually do. Watching vitals. Seeing how the patient breathes. Assessing vital signs. Looking at patient history to see what clues I can find. Listening to family members who may not speak the same lingo I speak. Look at x-rays, watch for clues. And I look at all of this, and since the physician is not there, I have to decide when we need to be concerned, when to call for more help, what I can do to help. So in a split-second, I have to take in this information from multiple sources–complex information at that, compare it to the knowledge stored in my brain, and formulate a plan on how best to proceed.

And under stress. The patient is either having trouble breathing, or even has stopped breathing, when I have to do all of this. Maybe their heart has stopped. Maybe their oxygen saturation is low. Regardless, I don’t often have the luxury of being able to take my time. I need to make a decision and act now, now, now. And while nurses have anywhere from 2 to 6 patients to care for, when I go into work, I have the respiratory histories of at least a few floors’ worth of patients in the back of my mind or in notes in the margins of my printed work assignment. If you figure the average respiratory rate is 10-20 breaths per minute, and there are usually 30 patients per unit, that it 36,000 breaths for which I am responsible in one hour of work on just one floor of the hospital. And I May have three or four floors. That’s a lot of responsibility and a lot of stress.

And I have done this for years of my life.

And then I got an MBA. So I understand finance and strategy, management and business law, marketing and accounting. I have been educated thoroughly in all of the above from a nationally-ranked program at a well-respected university. Add that to the ability to communicate with anyone, the ability to work under stress, the ability to extract complex information from multiple sources to formulate a plan….Nothing should stop me, right?


Because I am looking through these jobs, and seeing that many of the leadership opportunities are asking for someone with a nursing background. Why? No idea. We respiratory therapists go everywhere. A nurse may be hired to work in one specific unit. I can go anywhere in a single night, giving me intimate knowledge of the work flow of every patient care area of the facility, from behavioral health up to the ICUs. And I know healthcare. And I know business. At first, I noticed this trend, and I was a little discouraged, but I figured that I would find the right role  But today, I came across a posting for a pulmonary unit. They need a director. Perfect. Except, as I scrolled down reading the job posting, toward the end, it listed a RN as one of the qualifications. They want someone with my clinical experience, an MBA….and a RN.

It is what we all deal with everyday–we non-nursing patient care staff. We are skilled, we are experienced, we are valuable to patient outcomes, but this is the hand we are dealt, and frankly, it sucks. Part of me wants to just go to nursing school for a couple of years so I can say I did. But I shouldn’t have to do this. I have worked hard. I have done well, completing all three degrees with academic honors. I have the experience under my belt. This is just ridiculous.

Nursing is the backbone of healthcare, but I have yet to see a backbone accomplish anything without limbs, without muscle to hold it upright, support it and ensure it can move and flex in the ways needed. And it’s high time that the rest of the body gets some respect.

The To-Do List

This is what I have to do this week, so you can understand my level of insanity:

For my health law and ethics elective:

  • A 12-page paper–I chose to do mine on the lack of OSHA regs in healthcare.
  • A matching presentation on the above to be presented to my classmates

For my social media marketing elective:

  • Plan a social media marketing for a local business with whom I have partnered, including an execution plan and integration with existing promotions and events
  • Read two books
  • Write a blog post and watch 2 2-hour videos
  • Present above plan to my class

For my finance class:

  • Get through another 100 pages of text
  • Get through a study guide and over 100 practice problems
  • A case study to be completed in a group
  • Get ready for what is sure to be the most difficult final exam ever.

For my capstone:

  • One more round of decisions for my fake company I have been running all semester (which has a 120% growth  in profits, thankyouverymuch!)
  • An online exam
  • 2 10-page papers
  • A review of the above operations of the fake company
  • Another simulation of a shorter duration
  • The ETS exam required of all MBAs from AACSB-accredited programs in the country

That’s this week. And I work two nights in the middle somewhere.

Now you get it, right? Because nobody in my life right now seems to understand what I am talking about when I try to explain my current stress level.

These are the Days

16 Days. Of course I type that while I am supposed to be awake putting together a 45-minute multimedia presentation on integrated marketing practices for class tomorrow. My final project for a marketing elective to round out my requirements for the almighty advanced degree. John, in his awesomeness, brewed the strong coffee for me before turning in for the night. And I can’t quit thinking. I can’t quit thinking, not of integrated marketing as I should be, but of the uncertainty of my life right now. Have you ever been in a place where the things you spend your days doing no longer feel like they are what you should be doing? Where you feel like maybe your real life awaits you, if only you can survive this short little interim? That is this place. These are those days.

My views may possibly be skewed. I realize this. There are people who have devoted their entire lives to do what I have done for the past eight years. They keep doing it, content with their contribution to the world. There is absolutely nothing wrong with that. It is honorable. I’m not selfless enough. I feel like I have spent the past eight years paying dues to the world, to my being in general. To the spirit of my mother, who died from lung disease. I’ve been a good girl, and I have been good at my job. There are, in all honesty, people who are breathing today because of the work I have done. I have been there to help babies who could not help themselves. I have been there when families have said goodbye to parts of themselves. I have wiped brows of the dying, delivered tough love when necessary, compassion when it was needed. I have put myself and my family last. And now, after all of these years of doing that, I want to do something different, and in my warped mind, I have earned that. Not because I will, in just 16 days, have a piece of paper with my name in beautiful calligraphy saying I have completed some requirement set forth from society, but because I have paid my dues in other ways.

People ask me what it is I want, and I always answer with a “we’ll see” kind of shrug. I love healthcare, am passionate about healthcare. And I want to leave some sort of mark on this industry that is on a higher level than the one I am currently leaving. And I want to do so in a way that allows time for me, time for my family.

Lately, I have been thinking a great deal about my path through higher education as a non-traditional student. Evan was about 2 when I put on a  backpack for the first time since my mom died, which was eight years before that. Evan is 12. I will finish this long road about 2 weeks before the ten-year anniversary of that first time back. And I have thought about it. I have allowed myself the luxury of pondering just sucking it up, reaching deep, and going straight into a Ph.D. program or a JD, even. And then I think of them. Of Evan and Zach, of John. And what I want is no longer about a higher degree or prestige. Now, when I think of what I want, it isn’t grandiose at all. It’s simple stuff. Little things that aren’t luxuries to most, but have been to me in these years where I have tried to do it all.

I want to come home and not have to rush off to class, be able to eat dinner with my family at a normal hour around a table with food we prepared at home. I want to watch a movie with John without worrying about homework I should be doing or, better yet, am actually trying to do with said movie playing in the background. I would love to take the boys to a movie or park on a weeknight for no reason at all. Maybe even go on a weekend hiking trip. Maybe John and I could have a real date once in a while. Or I could read a book that has not a damned thing to do with academics at all. I want to blog more. Maybe I could revamp this one a little bit with all I know about social media marketing and content creation these days. I want to join a gym and be able to go–and not some lame attempt a a resolution where I don’t have the follow-through because, hey, thinking I would even have the time for a workout each day was optimistic at best, even closer to being the world’s dumbest idea. No, I want to actually go. And work on myself a little bit, and not just on cramming my brain with as much knowledge as possible.

It’s so strange to me. When I started this, I thought, “MBA: the CEO’s degree. I’m want to be loaded.” It isn’t about that anymore. It’s about enjoying life and having the means to do so comfortably. There is only one material possession I even want, and it is going to sound worse than it is: that new Mercedes CLA 250. Sounds greedy and ridiculous, right? No, because in reality, it is only about 3K more than I paid for our current car and I bought it used. And the current car is too big for me to feel comfortable driving with my vision issues. So sounds crazy, but really isn’t. But anyway, here I am at the end, and the salary isn’t the thing anymore. The job is, the career is, the comfort is, but the money isn’t. And I am saying this about 2 days before I have an interview for a position that would pay more money than I have seen in my life–about 5 times my current salary. And now I suddenly don’t care. Well, I mean, I care in that there is a minimum I can take. I worked hard and paid a lot of money for my MBA. I can’t just give it away. But money isn’t the key determinant.

So here I am. Sixteen days from the big finish. And it feels like everything in my current life is winding down so I can start the new one. So these are the days. The days of excitement, of anticipation. Of anxiety and uncertainty. Of endings and new beginnings. Of wrapping up and starting anew. Of sheer panic mixed with resolution and calm.

These are the days I have to let go and hope it all works out, that it proves to have been worth it.

And if it does work out, these are the days I get to lean back, prop up my feet, and tell myself that after ten years, I earned every damned bit of it.

Doing It

f8d17c34937d9c3215bfbbe00f6c78efI would love to give credit where credit is due for the above, but I have no idea where I got it. But this is the post where I finally talk about the other side. Of course, from the title of the post, you probably envisioned a juvenile describing the loss of their virginity, a la American Pie. Well, though I have my childish moments, I am not a juvenile and, though I hate to break this news, the whole virginity thing  went out the window a long time ago, folks.

No, this one is about setting a goal. One that seemed massive at the time. One that seemed highly unlikely. And then it is about reaching that goal. Or at least having the reaching of that goal so close that its taste is on one’s tongue.

I’m going to start the discussion off by telling you (or perhaps reminding you, in case I have mentioned it before and have just forgotten) that my first attempt at higher education was less than successful. My mom was sick. No, I mean, she was really sick, but she didn’t really reveal this to any of us.  So I spent my senior year of high school noticing how Mom was in and out of the hospital more and more. Somehow she convinced me to go to college anyway, but she kept getting put in the hospital.I was the first one in my family to go to college straight out of high school, to be labeled “the smart one”. She was proud, I think, and so I went. On several occasions, I would call home to discover that she was in intensive care. So there I was, a coddled kid away from home for the first time; a music major trying to study something I loved so much when really, I just loved to play and my mom was my biggest fan. And my mom was a home, dying. I couldn’t handle it. I didn’t do well at all. My grades were barely passing. I had gone from the smart kid in honors classes, to the one who couldn’t hack it. When mom finally dies about 2 weeks before final exams, I just dropped out. I couldn’t do it.

It scarred me. Mom’s death did, but the whole experience did also. When my life was calm enough, when I could look back on that time, I wondered about many things. Was I really just stupid? Was it the circumstances of the time in my life? Maybe I wasn’t college material after all. But I saw my life as it was unfolding, and I knew I could do so much more. And I met John, and he saw it, too. And he talked me into enrolling in some classes.

Just a couple of classes. I read that line to him just now. He smiled. He knows what he did just as much as he knew what he was doing then. Just a tiny spark. At a tiny community college where they do more training for careers than anything else. But I had been to a large university before, so I could tell that the classes seemed to be of the same caliber. Still, self-talk does weird things to us. But I enrolled in their respiratory program. I took the weed-out classes that all nursing and allied health students have to take. These careers, these jobs are stable, so these programs are usually turning applicants away. They make some of the prerequisites really difficult to separate the candidates by who will most likely be successful. And I had to take those classes. I aced them all. My classmates would hate me because I would wreck the curve. I literally scored greater than 100% for a couple of them because my professor curved others’ grades and didn’t feel it was fair to not give me the same point advantage. Still, the self-talk continued.

“It’s just a community college, Andrea. When you were at the real university, you sucked. You’re not really smart.”

And so I finished that program. With honors. I was recognized at graduation. I took my boards. I got my license. I started working in my field. And some part of me wanted more.

I wondered if the old dream of medicine could really take flight. I wondered if it was just because it was a community college. And so I enrolled in pre-med classes, to finish my bachelor’s.

And I got pregnant with Zach. And put on bedrest. I had been doing well, too.

More self-talk. Telling me I was silly. Telling me I was foolish. And then I didn’t want to do it anymore. I wanted to ensure my children would grow up in complete financial security with their mother present. I realized I had been given a gift with each of them, and I was taking that for granted. So I did some soul-searching, determining what it was I wanted to do. What I really wanted.

And I enrolled in an undergraduate program. Straight A’s. It was community college all over again. I nailed everything I touched, and I finished summa cum laude. But I did it online. And so I thought to myself, “Yes, but was it really hard? Was it really a challenge? It was just an online program!”

And so I told John that I wanted to go on to my master’s. To my MBA. And I remember when I was telling him this, that my heart skipped a beat. I really wanted it. I meant what I said. But thus far, every attempt at what I have really wanted has either fallen through or been derailed by my own shortcomings. To speak of this out loud was unimaginable, because it gave life to what I wanted. It gave me some accountability to myself. So I looked, and I discovered that the university practically in my backyard had a nationally-ranked MBA program. I applied.

They weren’t supposed to actually accept me.

And on the eve of my first class, I was so nervous. Walking into my first class, I got butterflies. They were going to laugh me out of there. I wasn’t smart enough. More self-talk. That girl needs to learn when to shut her mouth.

Because I have nailed it. In a few weeks, I start my last semester, which includes my corporate governance capstone. On December 19, I will be able to put MBA behind my name. And for the first time, I can try and try to self-talk myself out of this all I want. The logic counteracts it. I am doing this. I am doing it. And as I prepare to enter my last semester, it is becoming more real. I hope my mom is watching. I hope she can see. Maybe what she saw in me all that time ago was more accurate than what I saw in myself. And I can kind of see what she was seeing.

The Admissions Mistake

This is such a strange time for me. Well, “surreal” would be a good word.

I am wrapping up my undergraduate education. I received my last shipment of textbooks from school this week, considering I tripled my classes again. You may recall that I tripled last session with the plan of doing it again this session, all to finish in time to start grad school. The idea of making me wait was to ensure the course load wasn’t too much for me. It wasn’t and I got straight A’s again. If I pull it off this session as well, I will honestly be able to say that I have not gotten a B at all. And I will have completed my BBA that way.

Hmm. Completing my BBA. Let me talk to you about my higher education. I was the first one to go to college straight from high school in my family. I was supposed to do great things. I had been in the gifted classes all through my education, and was contemplating pre-medicine as my major. The problem was that I played classical flute for years and years, and I was good. My second choice was a music major. My mother helped me make the decision, stating that medical school was for the wealthy. Full financial aid was not a likelihood back then as much as it is now. So I went with music. And where I was good, that was the biggest blow to my ego. Because they were all good. I was one of the worst of the really good ones, and even I knew that to create a career in music, you really have to be the best. That was immaterial, because I didn’t finish. Mom was at home, dying. I was treated for a horrible deep depression. The classes that were to be so easy ended up being the greatest challenge just to show up. When mom finally died, it was just too much and I dropped out.This gave my brothers and sisters in my dysfunctional family even more reason to gloat: Andi, the smart one, couldn’t cut it.

Years later, John talked me into respiratory school. I needed a job that would pay what we needed. Suddenly, I was in the medical environment that I was fascinated with as a teen. And when it came to the advanced chemistries and physics, I still had it. I took to it like peanut butter to jelly. Maybe I had made a mistake listening to my mom from the beginning. Maybe medicine is where I belonged all along. So I took as many courses as I could, finished the respiratory degree–it’s just an associate degree–with twice the number of credits I needed to graduate, all because I knew that I wanted to go further. But life and bills got in the way, and my plans to immediately finish a premed degree fell through with the obstacles I encountered. It took several years before I got to the point where I could enroll. And I did. I was chugging along as a premed/ molecular biology major, prepping for my MCAT and working on med school applications when I got pregnant with Zach and bedrest happened.

So after all of this education I have had, I still do not have a bachelor’s degree. I am one educated bitch, in everything from music to the sciences to business, but no baccalaureate degree. That is all changing in about 6 weeks. It seems so strange to be getting a business degree, though. I never dreamed that this is where my life would take me. I would have never thought I would have an aptitude for this field. Honestly, I never thought I would love it. And I honestly thought I would never finish anything higher than my respiratory degree. For some reason, everything I tried has fallen through, and I thought someone was trying to tell me something. Of course this disbelief is compounded by the fact that I will not be donning a cap and gown. Since I completed it in an online program, graduation is across the country at the actual school, and I will not be traveling just for that.

Where I should be excited about finishing the degree, I am anxious. Five days after the end of these next classes, I start B-School. And I am seriously questioning my ability. I do really well at the role of big fish in a small pond. The times I have played the role of small fish in a big pond, something has happened to make me choke on the damned pond water. And I suspect that, even though I am going to a smaller, more elite private university, I am going to be the small fish. I’m afraid that I am the admissions mistake. You know what I’m talking about. The one, every year, that they let in by some fluke or flaw in their system of evaluating applicants. The one that really shouldn’t be there. I have so many questions, so many doubts.

Yeah, I produced the resume they loved. I’m the diversity factor. A woman. Coming from healthcare, not a business field. My application was amongst those of investment bankers and area business leaders, or simply new twenty-something college students fresh from the dorms and delaying the inevitable of going to find work by starting grad school immediately. So I can picture them going through the stack and thinking, “Hmmm. Respiratory Therapist? With an undergrad business degree?” Bizarre, yes. Then my transcripts. My 4.0, immaculate transcripts, with perfect grades in anything from music performance to human genetics. Psychology and Cardiopulmonary Anatomy and Physiology. Organic Chemistry and Corporate Fucking Finance. A’s. All of that shit. Well, you can think that this is one area in which you cannot argue. That was my point in sweating my grades so much through all of this. My grades will never limit me. I ensured that. But I have developed my own doubts. What if those grades are from schools that are too shitty to count? I have mastered the art of being a student, but other than Corporate Fucking Finance, none of it has really been a challenge. Well, maybe O.chem was, just because I hated the class, and now it doesn’t even matter that I did it. My point is, what if my GPA isn’t an indicator of my abilities at all, but an indicator of how easy the classes were?

What if I don’t belong there? What if I choke? What if I manage to navigate successfully and then there is no place in this world for a respiratory therapist with an MBA from a nationally ranked program? Then I am left with the most expensive piece of paper in the history of paper-making.

I guess I could have saved you the time you have spent in reading this by saying two simple words: I’m scared.

I don’t want to be the admissions mistake.

I Can’t Afford It: The Inevitable Rant About PPACA from the Inside

I don’t usually get all political up in here. It just isn’t my thing. I have read countless comments on Facebook about the Supreme Court’s decision about the Patient Protection and Affordable Care Act. That shit is everywhere. And everyone has an opinion. “Everyone is entitled to healthcare…” Yeah, okay. Great. Kumbaya, and all of that jazz. If you are disadvantaged and need medical coverage, and there is a way for you to get it, I am all for it. We have programs like that in the U.S. We have for decades. Yes, they suck a little more than the insurance one pays for electively. If I am out of food, and I go to a food bank to get food for my family, the items I get, though appreciated, are not of the same quality I would buy if I went to the grocery store and shopped for myself. You take what you can get. I’m sorry to sound so blunt, but it’s true.

I’ve said it before and I am going to say it again: I used to not have insurance. John worked at a job that paid him $8/ hr. and the benefits were almost $700 per month. Evan was a newborn. So I took an eq\ually crappy job as a housekeeper at a hospital where the insurance was about $400/ month. I essentially  worked for the insurance When the income got to be too little, I went to work on a degree that would pay me what we need, both in income and in benefits. And I’m not afraid to give you the straight dope, though it is poor etiquette. I gross over 8 thou a month. I bring home about 4K of that. What???? Why? Well, simple, really. I pay over half of my income on taxes and pesky little necessities like medical, dental, and vision insurance. Right now, that is the lay of the land. It is how the shit falls.

So while I am not too keen on spending even more of my very hard-earned money to support those who did not have the wherewithal to go out and do what I did–find a beter job, better benefits—I simply cannot afford it. I am not living high on the hog. We have one car. My husband rides his motorcycle in good weather to save on gas. We try to limit our dining out these days. I clip coupons. We live in a house that is way below our means because it is cheap despite being in a nice, white-collar neighborhood. And though I am off for my neck and shoulder right now, I work every God-forsaken hour my employer will allow me to work in order to make more, to pay more in taxes…you get the drift. I cannot afford more of my tax dollars to go to support your healthcare. I will take care of you when you are ill. I will risk contracting any infectious disease you are carrying because someone has to. But I am not willing to sacrifice the well-being of my children to pay for you and yours. I’m sorry.

And there are other misgivings I have about PPACA. This part is coming from a healthcare professional who works in the trenches, from someone who is wrapping up a degree in business \with a concentration in healthcare management. Hospitals rely on reimbursement. They do. The naional average for Medicare and Medicaid reimbursement revenue is around 60% of hospital revenue. The hospital I work for receives about 80% of their revenue from Medicare and Medicaid. That’s a big ol’ piece of the pie. The pie that determines the amount they can do for their community, the services they provide to their patients. And guess what! For added fun, those coffers are getting pretty shallow. Hospitals are fighting harder for less dollars. And we can expect more and more of these patients. This would seem like even more reason for the PPACA, right? Nope, and here’s why:
The PPACA also has implications for providers. More stringent guidelines to provide more cost- effective care. Nothing wrong with that. One of the yardsticks with which providers will be measured is their readmission rates. Currently, there are a few diagnoses where hospitals are penalized for excessive readmissions. As a part of the PPACA, four more will be added by 2015. One of these is COPD.

And that is whete the respiratory therapist in me gets all fired up.

COPD. The bain of my existence. My livelihood. But these are the worst patients that CMS can use to penalize hospitals for readmissions. I understand the concept: if we’re doing our job, the patient won’t be readmitted within a certain time frame. The problem is this: while some COPD patients are dream patients, I would say the majority of my patients are non-compliant. They won’t quit smoking while their alveoli fight with each other for every breath. They pick and choose which of their respiratory meds they take and when. (No, inhaled steroids are not going to work if you only take them as needed, and you should not stop taking them just because they don’t work as rescue inhalers.) And toward the end, they could be in and out of the hospital every week. So if hospitals stop getting reimbursed adequately for these admissions, they lose progressively more money as time goes on. That is the same money they use to attract and recruit higher-credentialed staff. The same money they use to provide indigent care. The same money they use to obtain equipment. To maintain equipment.

But my other problem? We all speak of the access to care. Well, if you live in the U.S., you have access to care. If nothing else, you can go to an ER where we have to evaluate you. That is access. What is truly lacking is a way to pay for it.

Is the U.S. healthcare system having trouble? Yep. I don’t blame hospitals or providers. I don’t blame insurance providers. Thete are many pieces of the puzzle, in my humble opinion. Lawsuits. Malpractice insurance. ER abusers ( by this, I mean drug-seekers, etc.). Doctors being forced to practice defensive medicine. (And if you don’t buy that, ask me and I’ll tell you the crackhead story.) Drug patents. And us. Yes, us. We want the latest and best. When a standard x-ray is sufficient, we still want the CT. When a cheap generic drug will work, we want the brand. And doctors are stuck. Patient satisfaction is a reimbursement buzz word, and if they don’t give us what we want, we get upset and don’t stop until we get it. Whatever it is, it may not be the most cost-effective, or even the most effective. We need to leave doctoring to doctors.

So, yes. I am a healthcare professional. I am hopefully a future hospital administrator. And for all of these reasons and more, I am completely against the PPACA. And I will vote accordingly in November.