1.5 Year Report

The evolution of our medical startup continues, but it’s hard to know when the term “startup” no longer applies. Technically, we’ve been earning more than we spend for over a year now, and the early stressors are pretty much gone. We’ve met many neighbors thanks to Pre-R too.

We’ve also found our stride in matters related to licensing, insurance, billing, accounting, charting, and just describing what we do over the phone. Now it’s basically patient care and marketing. My med school was good for the former, but lousy for the latter. BTW Have you shared our website and fb page with friends lately?… Pretty please??:)

However, while the early business stressors are gone, there’s no way that our income will cover Max’s rapidly increasing intake from now through high school. So I continue to work in emergency departments to fill the fiscal gaps. Even if Pre-R was ringing off the hook though, I’d probably continue to work shifts, since ER and Pre-R seem to go pretty well hand in hand. Because of my hospital connections I can help my sicker Pre-R patients to navigate hospital systems more easily. And for my ER patients who don’t have PCPs, it’s nice that I can just hand them my number in case they have questions or need close follow up.

Money aside, Pre-R still remains my favorite kind of medical practice, so we’ll just carry on. Here are a few more Pre-R updates and perspectives:


Vanessa has added a products page to our website. This has been a great way of pulling a variety of past projects under the Pre-R umbrella. Our multidoser and its video are my favorite.

  • The doser isn’t lucrative, but it’s really nice to give parents with sick kids. Plus it saves me lots of time trying to explain dosing for pediatric meds. Goodbye nomograms or calculations.

  • The “STS” traction splint for broken femurs is gaining traction too thanks to Rescue Essentials, with Boston, Dallas, LA and Cal Fire being recent adopters.
  • Our rescue harness is a tougher sell, however, because it’s just hard to convince adults that they can carry other adults. At least Max loves it.

We’ve got 45 posts in our Anxiometer page now and the added benefit is that I can point patients to them when they call wondering how anxious they should be. Vanessa does the same when I’m at work and unavailable.

How anxious should I be?

Even if our Anxiometer and Musing posts are like many blogs read by nobody, typing has become a therapeutic outlet when insomnia strikes after Max and Vanessa finally fall back to sleep at 3am.

Direct Pay:

We’re more committed than ever now to steer clear of taking payment through insurance. It’s just headaches and lost life. Rarely do patients request superbills either, and when they do, few get reimbursed anyways. Simply put, nobody wins. When insurance is applied to the bumps and bruises of life, it just injects complexity and cost. For our patients who are struggling financially, we just help them out, thanks in part to a few very kinds donors.


We’re much better at just naming a price now when folks ask, though we also point them to our suggested fees on our website. It seems to be less stressful for everyone. It’s also clear that our main clientele are patients with high deductibles or no insurance.

As an aside, I recently worked with a nurse who wanted to get her post-op steri strips changed without “stealing” them from the hospital. She actually checked in to the ER to do everything properly. She thought she was “fully insured.” But at the end of the day her bill was $300 for which her insurance paid $100. From her vantage point she paid $200 for steri strips. Her new nickname is “sticky fingers Sally.”
Know your copays and deductibles!


Vanessa continues to work on a Pre-R app, while el jefe Max continues to work against it.
Stay tuned!

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