If you’ve followed my blog, you know I broke my ankle on the 2nd of January. I thought it was sprained so I put off having it checked for two full weeks. My bad.
I didn’t want to go to an urgent care only to spend a couple hundred bucks to tell me it was sprained, and to just R.I.C.E. So I just did R.I.C.E. at home, for free.
But then, after two weeks, it was time. It wasn’t getting better at all. The pain and symptoms were too much, so I may have conceded to defeat, shed a tear or two, and got packed into the van to go to an urgent care.
I’m not here to give you any medical advice, but I want to share things I’ve learned in this latest medical “crisis.” I have found information very difficult to find, and I believe that no matter what your insurance is, it’s powerful to be informed.
One of my biggest fears/annoyances is paying for a doctor only to have them refer you to someone else. And that’s exactly what happened. I went to the urgent care where they took xrays. The nurse who took care of me 80% of the time (the other 20% was a P.A.) said “do you want to see the xrays?” Of course we (my wife was with me) did. “See that? That’s obviously a break.” Ugh… it didn’t look very small “Let’s go talk to the P.A.”
The P.A. basically said “you have to talk to an orthopedic doctor. We have one in our network…”
That cost $119.
45 minutes later we were checking into another urgent care to meet with the ortho. He basically said “You have to have surgery. If it were 2 millimeters separated I like to avoid surgery, but you are almost 10 millimeters.” I asked “how much do you think this will set me back?” He responded “I don’t know, but I’m guessing between $7,000 and $12,000.” He gave us a few surgeon referrals to call.
Because we didn’t have the first urgent care put a splint on (because they said we would just have to do xrays at the next place, and I thought they’d just do it there), they charged us an extra $80 to make a splint. That was a bad choice on our part.
That cost $119 for the ortho to get surgery and $80 to make a splint (that would have been included in the first urgent care trip).
I spent a couple of days calling surgeon offices… that was not fun at all. But one office stood out, night and day, from the others. The office staff sold me on using their surgeon, not because they were in sales mode, but because they were very nice (even after knowing I was self-pay, or “pay in cash, before the service”). Learn more about those phone calls, and what I learned for job seekers, here.
On that Tuesday I had made an appointment for the following Monday (which was the earliest they could get me in), and possibly surgery that afternoon, but then I got a call asking if I could come in on Thursday. I was elated to get in earlier.
With the 20% self-pay discount, that appointment cost $200.
The purpose of this post isn’t to be a surgery-log… I want to give you an idea of how I got to a surgeon I liked, and how much it cost. So far we are up to about $520… just to get referred to the right person, and for him to say “okay, I’ll cut you.” Aside from a splint, so far there’s be no medical care (but hey, the xray and diagnostics is worth something).
In my experience, a surgery will generate at least three bills: the surgeon, the hospital (or surgery center), and the anesthesiologist. What do you figure each of those cost?
Four years ago I had emergency gall bladder surgery. I went into the emergency room at 2:30 am and had surgery a few hours later. No shopping around. I was pretty much doped up from 3am until I came out of my anesthetics, with some big nurse over me telling me to “BREATHE!!”
I wrote about the costs here… can you believe that the surgeon, after his 50% off cash pay discount, cost only about $800? The guy in charge, the guy calling the shots, the guy doing the cutting and repairing… $800. That seems awfully low to me, especially when the total cost of surgery and ER was over $20,000. The surgeon’s got less than 5% of the total payments.
Well, here’s how ankle repair surgery came out, for me. Mind you, this was a “pretty simple” surgery, with two screws and no plates.
Surgery center: $1,305 (after a 75% discount!!)
Surgeon’s office: about $1,400 (I can’t find the exact number, but it was after a 40% discount)
Anesthesiologist: $600 (apparently this was only a discount of $40. I’ve never gotten a good discount from the anesthesiologist)
90 days followup visits with the surgeon are included, although I’ll have to pay for xrays and extras. And I’ll have to have physical therapy, which I’m hoping isn’t more than $500. Altogether, this misplaced kick-resulting-in-broken-ankle is costing a little less than $3,000.
Not fun, but definitely better than the guess of $7,000 to $12,000.
How might you get an expensive medical procedure for such a low (or “reasonable,” or “affordable”) cost?
You shop around. Let them know you are self-pay and ask if they have a discount. Don’t argue, just ask. You aren’t negotiating, you are simply gathering information.
Now here’s the interesting thing: After the first frustrating day of calling surgeons the doctor recommended, I called the surgery center and asked them who they work with, or recommend. That was my short list for calling the second day.
I’m not saying that not having insurance is awesome. Not at all. But for those of you who can’t get insurance, you need to know that not all hope is lost.
Oh yeah, for those of you wanting to do the math… assuming I paid $1,000 a month in insurance, with a $10,000 deductible, I still would have had to pay for this entire surgery out of pocket. Just saying.
Those are just some of the big ones. There are gobs of little layoffs.
As I talk to job seekers and JibberJobber users I realize that many of them have the same feeling that I had in my job search: why work so hard just to land a job that you might not like, at a company that might have a crummy culture, working for a boss who really should be your employee, and having the promise of job security that is as solid as vapor.
Let’s reconsider what a job is. A job is simply one revenue/income stream. We really should have multiple income streams. When you have, say, three income streams, and you lose one, it hurts, but it doesn’t hurt as much as much as losing one income stream… if you only have one!
When I was hitting rock bottom during my job search, I came to terms with this idea. I figured what I really needed was money to pay my bills. I didn’t care if that mean I got a paycheck every other week, or once every 10 years… as long as it was legal, moral and ethical, I was open to it.
Realizing this helped me realize that any future jobs I would have would mean I had another revenue stream… but that that didn’t have to be my sole revenue stream.
See where I’m going with all of this?
HOW CAN YOU CREATE OTHER REVENUE STREAMS? I guarantee you that the people who have multiple revenue streams have different feelings, and are further ahead, than people who don’t have other income streams, when the layoffs come.
I’m not talking about job security, which to a large degree is out of our control. I’m talking about income security.
I’m not saying that entrepreneurship is the new job security, I’m saying that thinking like an entrepreneur is the new job security.
I think having a job is simply one revenue stream. It might be your only revenue stream, or it might be your biggest of multiple revenue streams. But it’s just one revenue stream. In the olden days, when there was such a thing as job security, you would not worry about whether you were going to have a paycheck come in the next two weeks… it would automatically come.
Entrepreneurs don’t usually think that way. They are always concerned about the top line (revenue), the bottom line (profit, or how much might end up in your pocket), and cash flow (when you can pay your own bills).
Today, we need to think about top line income (how much money we bring into our household), bottom line (how much we get to keep after taxes and all of the bills), and cash flow (when the money hits our account, and how that matches up with our bills).
We need to have the financial mindset that entrepreneurs have. This means:
We think about our revenue streams more than we had to before.
We think about our pipeline… who are the prospects that we are courting (or should be courting).
We think about our current income streams, and how long we’ll have them.
We look at our competition and the market, and try to make decisions based on where things are headed.
We think about our product (aka, ourselves): are our skills outdated? What can we do to be more market-worthy?
We think about our relationships, and who in our network could help us, and how we can help them.
The stuff I wake up thinking about is the stuff that every person who needs to make money should think about. Your degree ain’t going to cut it, nor is it going to be the thing that gets or keeps you that job. I got a CIS undergrad and an MBA, neither of which (a) saved me from getting laid off, and (b) helped me get another job.
What is it that will provide you INCOME security?
How are you positioning yourself to create income security?
Those are two of today’s new career questions that we need to get serious about.
When I started JibberJobber I learned a little about how venture capitalists and angel investors fund businesses. It was a fascinating journey into a world that seemed exciting and a little dirty/sleazy. I learned about the Four F’s… have you heard about these? These are the four sources of funding that an entrepreneur should look at before they go to a VC or an angel. They are:
I used two of these sources to fund the early days of my business. It was necessary, and I’m forever grateful to have had those sources of funding to help JibberJobber get onto it’s own two feet.
But it bugged me that that is what I needed to do. I had this novel idea that my business should have been funded by… get this… people paying for it! That’s what you might call “self-funding.” Many companies are not self-funding… they rely on continual investments to fund their payroll, rent, parties, etc. Companies like Amazon, who seems to own the retail world, did this for years.
Anything wrong with self-funding?
For most of you, starting your own business, getting funding from VCs or angels isn’t the right route, and you might not be able to tap into the Four F’s. So how do you fund your venture (aka, pay your rent and buy food) in the early days?
The answer sits in understanding the basic nature of your business, and whether you are offering products (that you are creating) or services.
JibberJobber is a product, which meant that we spent months to develop it before we went live. A book is a product… you spend months writing and editing and preparing for the publisher, and then you have one, or a thousand, or a million. Your job is to take this *thing* and market it.
A service might be something where you charge an hourly rate to do something, like an hour of consulting, a day of speaking, doing a haircut, writing a resume, mowing a lawn. Typically, you can start doing a service, for money, right now, today, without any investment. I have plenty of ideas of things you can do in exchange for money today.
Is one better than the other? A product can require a significant investment up-front, with the idea that you could sell it when it’s made, or you could sell the company if you prove it successful. Expect to continue to invest in R&D. The payout could be crazy. The failure could be ruinous.
A service might take no money to start, and you could get gobs of money per hour immediately (for example, consulting for $250/hour, or speaking for $5k an engagement). But you might not be able to sell your company later, no matter how good it performs, because for a while, YOUR ARE THE PRODUCT.
When I started JibberJobber I had illusions of grandeur about how much money I was going to make. All the while, I required investment from family and my 401k. It took a couple of years before my company was in the black. A COUPLE OF YEARS. That was not in the business plan!
The same month I started JibberJobber, I had a friend, also laid off, who started a business, but his was a consulting business. He was billing clients in week 1, and every week since then. Where I was burning through lots of money, he had very low overhead and was bringing in more per hour than he had ever done.
Who was the fool? Was it me, for not self-funding, or was it him, for going down a path that would not have a big payday (acquisition) in the end?
I’d say neither were the fool. But looking back on it now, I wish that I would have figured out how to consult for one to two hours per day back in the early days. That would have been a way to self-fund.
I know a guy who was starting a business while working at the grocery store at nights stocking shelves. Glamorous? Hardly. But it worked for him and his family. It was his way of finding funding for his venture.
Let’s wrap this up… funding a business can be hard. But there are many, many options. You don’t have to just hope to get on Shark Tank, or get laughed out of one hundred VC offices. Be creative. Many of the businesses that we enjoy today were started in someone’s basement, garage, or even bathtub (ecolabs). Without funding. With a dream and hope and elbow-grease.
Just don’t be too proud to consult for a couple of hours a day, or to work at the grocery store at night. Eventually, your own little business will be self-funding.
Even though I wrote a book about alternatives to a job (51 Alternatives to a Real Job), and I talk about multiple streams of income, and I regularly present to youth and adults about starting their own business, and I think that being creators trumps being consumers any day, I know that being an entrepreneur is hard.
It’s not for everyone.
And at times, it’s not for anyone.
In a recent email from a JibberJobber user, I read: “One of the discoveries I made is that I am an entrepreneur at heart, but not at the moment.”
Not at the moment. Sometimes the timing is right, but that doesn’t mean the timing is always right.
A few months ago a close friend who has owned a software business for years closed shop and got a “real job.” The emotions in this type of transition has to include:
Elation beyond measure, to get a regular paycheck (no more high ups and low downs).
Sadness, because of having to move on from having built something that is just not buildable anymore.
Embarrassment and shame to quit on your dreams of so many years, and admit that you simply weren’t good enough to make it work.
But circumstances shift, needs change, support from family changes, markets evolve. At the intersection where dreams meets reality, you learn just how hard it is to get something close to break even, much less highly profitable.
Your respect for those who founded and created businesses from yesteryear skyrockets as you realize that to get to what looks like an easy, privileged and exotic lifestyle, founders had to sacrifice health, relationships, and sanity.
I’ve seen this over and over.
I’ve seen entrepreneurs-at-heart pull the plug on their dreams and get a job.
And here’s what I think: THAT IS OKAY.
I read Seth Godin’s book, The Dip, and what I got out of it was you have to learn when to quit or change course. He’s not talking about quitting in a depression and giving up on life. He’s talking about figuring out when to change what you are doing, either in a big way (close your business) or a small way (change your strategy, offering, packaging, etc.). Change, re-evaluating, and some-might-call-it-failure, is OKAY. It’s necessary. It’s expected. It’s important.
You’ve heard that you should fail quickly, learn from it, and move on, right?
This is a really, really hard pill to swallow when it’s your idea, your business, your attempt. It’s your ego, and eventually, your identity.
Quitting means you don’t believe in yourself. You slip into a depression where you have validated, once again, that you weren’t as competent and qualified as you thought you were. Perhaps you will only amount to being a cog in someone else’s wheel. This is not the career you envisioned.
But in reality, you shouldn’t think that way. Whether you are a cog in someone else’s wheel, or you create the next Facebook, you have value. And as I mentioned earlier, circumstances change. Maybe your role as cog today will lead you to successful entrepreneur in the future. Or maybe you’ll be a great cog, with a great career, with financial stability and all the joys that can come from having a fulfilled life.
I admit that I have always wanted to be an entrepreneur, but I couldn’t figure it out until the idea for JibberJobber came. There were a few false starts with other businesses, but my heart wasn’t in it, and they weren’t the right path. I eventually pulled the plug on them. But when JibberJobber came, it was like a calling from God. And for parts of the last nine years, that calling has been hard to fulfill. I’ve done the stuff I’d heard about from other entrepreneurs: lived off of credit cards, borrowed ridiculous amounts of money from family, burned through my 401k, payed my employees for months without taking any salary, etc.
Glamorous? Only in the movies.
Hard? Indescribably hard.
Did I think about giving up? Many times.
Did I have any way out? I’ve had job offers and buyout offers over the years, but none of them were right.
For now, this is my calling. I’m blessed to have a wife who is all-in, and gets the vision of what I’m doing. Not to say that there haven’t been times when she wanted something different (like a paycheck every other week), but she gets it. She supports it. And that’s the reason why I can still be here, as an entrepreneur, fighting the fight, while I might otherwise get a high-paying job with benefits and vacation, and some facade of security.
Luckily we figured out the money part of this business, which is something that my ex-competitors can’t say.
I choose to fight this bloody, messy fight.
Getting a job? Pulling the plug on entrepreneurship? If it’s right, right now, then do it.
I think that’s only a step in the big journey of being an entrepreneur. After all, with the state of job security being what it is now, aren’t’ we all taking entrepreneurial risks?
I’ve run JibberJobber since 2006 and have found that January through March or April is the time when most people are (finally!) really serious about their own career management.
December feels like a month when you can’t really do anything… people complain that it’s a horrible month for the job search. Employees are out of the office, on vacation, and hiring decisions are left until the new year… so why try?
When I was in my job search I didn’t care what holiday it might have been, or whether it was a weekend or 3 am. I had anxiety, and I felt a great sense of urgency to do something to end my unemployment! I wasn’t doing the right things, but I certainly wasn’t going to celebrate anything (like a national holiday) simply because everyone else was. It’s hard to feel festive when you feel like an incompetent.
What’s more, many job search coaches say the holidays are definitely a time to do job search stuff, even if you employ different tactics. But let’s say you doing believe any of that stuff… what COULD/SHOULD you do between now and January 2nd?
Whether in a job search or not, smart, astute, “self-driven” professionals are going do something. It might be as baby-step simple as listing 10 – 20 people they need to talk to, or 10 – 20 companies they want to network into come January.
It might be something as in-depth and time-consuming as writing a book (even if it is a small ebook) with the purpose of establishing and enhancing their personal brand.
Depending on what your year (or last quarter) looked like, you might simply take this month off to do “nothing” – like read some books or articles you’ve been meaning to catch up on, take a real vacation and mentally, spiritually and physically recharge, to be ready for the next year.
Whatever you do, please don’t give up on December. Whether it is a strategic and very tactical job search to hopefully get some interviews or offers lined up in January, or a more long-term career management strategy, take the time to do something on purpose to finish out this year.
I can’t tell you what it should be – so you tell me… what will it be?
A few years ago I was inspired to write a post suggesting we don’t talk about or refer to “job security.” The idea was that there is no such thing as job security… of course. I proposed that we replace the phrase with INCOME security. That is, I am working on securing my income, which might come from multiple sources (not a single employer), might come sporadically (when I make a sale, or through quarterly royalties, or monthly rent payments, etc.).
Doesn’t that make sense? Shouldn’t we be working towards securing our INCOME, instead of chasing the 1900’s romantic idea of JOB security?
I thought it was brilliant, and wished I could come up with more of those ideas.
Last week I did. I was thinking of a friend of mine who lost his job as a programmer. My wife was concerned for him and his family (the sting of our unemployment can come right back when a loved-one starts their journey) but I told her I wasn’t worried about him at all. As a programmer of some hot languages, I was sure his job search would be very quick and easy. And it was. He has since landed and really has nothing to worry about.
As I was thinking about him, and his very short journey, I was thinking about the scariness, and stigma, of being unemployed. Or, of losing your job. Especially now, with the holidays near, where we’ll “have to” spend time with family and loved ones, and we all talk about what’s going on in our life… no one wants to be that one person who is unemployed. The token loser. Something must be wrong with you. Right? I know how it feels. I was there, for many months.
I was thinking, what if we go away from those stigmas (and assumptions) of “I lost my job,” and shift the mindset (or, have a “paradigm shift”)? What phrase would change the meaning and take away the sting? I came up with this:
“My contract ended.”
Think about it… a lot of people have contracts that end. And when the contract ends, you move on to the next contract. It’s not a horrible surprise (contracts are meant to end, whereas in some fantasy universe we tend to think that jobs aren’t supposed to end). Okay, sometimes the contract ends early, but not contractor believes their contracts will end when they are ready to retire.
Contractors should always prepare for the ending. They do this with:
fiscal responsibility (spend less than you make, save money for the bouts between contracts, etc.)
filling the pipeline (networking, putting bids out, etc.)
marketing themselves (know how to talk about your products/services, know when to talk about them, know who you want to talk to about them, etc.)
An employed person, though, who fears losing their job, doesn’t do these things the same way a contractor does. The employed person fears losing, the contractor prepares for the loss.
This phrase, when said out loud, changes the course of the conversation. Instead of “oh, you poor person who must have caused too much friction at work!”, it is more of a “Oh, sorry to hear that, what’s your next contract?”
This phrase, when you INTERNALIZE it, empowers you to be more in control of your career. You really do become the CEO of Me, Inc. You are no longer a victim of a bad boss, of HR, of the market, etc. You are empowered to prepare for the end of the contract.
Isn’t this awesome?
Many years ago I started working at a janitorial firm. In the first month or so of that job we lost a $5M contract. I went to work the next day a little nervous, wondering what kinds of cuts they might make at the corporate office. The CFO seemed happier than usual, and I somehow remember him whistling in the hallways as he went about his duties. Later I asked him to explain how they could lose such a big contract and still be happy, or not be overly worried.
He replied that the company had been in business for a long time, and that they had won and lost many contracts. It was no big deal, and there would be more contracts they would win. And in fact, they did win many more, and the company grew a lot while I was there.
That mentality is the same mentality that we, as CEO of Me, Inc., need to have.
A month ago, at this very minute (note: I started this post on Friday but took a very rare sick day during the post), I was laying in a hospital bed trying to “breathe through my nose.” I never disliked breathing more than that day.
You can read the entire story here (I need to clean it up because I wrote it when I was on narcotics… it doesn’t read as well as it should).
The purpose of this post is to talk honestly about what you can expect to pay if you have an emergency that requires you to go to the E.R.
There were five or six vendors or service providers involved in this. Below is what I was billed (approximations):
Hospital, including emergency room, operating room, recovery room: About $18,000
Operating surgeon: about $1,600
ER doctor: Bill amount: $888
Pathologist: To do what, I have no idea. Bill amount: $49
Anesthesiologist: Bill amount: $1,275.
Radiologist 1: Bill amount: $119.86.
Radiologist 2: Not sure if there was one, but was told there might be one.
Each of those are independent from one another, and no one would tell us what the bill might be, or even who to contact. It was either make calls and figure it out or wait for the bill to come.
There is a reason to make the calls immediately. Many medical vendors provide a discount for “self-pay,” which is the term you use if you don’t have insurance.
Why we don’t have insurance is for another post. Trust me, we tried to get it (more than once), but the insurance industry is so corrupt it is disgusting.
Anyway, if you are self-pay there are two things that happen:
1. You get offered a discount – up to 50% off. You can see the discount amounts below.
2. No one believes you will pay. The government and media has done a masterful job creating an image of uninsured people (aka, self-pay) that if you are self-pay people think you are going to not pay. Not true, but thanks to the gov’t and media, that’s a new stereotype to live under.
Here are the discounts we got:
Hospital, including emergency room, operating room, recovery room: About $18,000. They gave 50% off to self-pay if you pay within about 2 weeks. That meant our bill would be about $9k. We went in to talk about it, and when to pay, and the finance person lowered it another $1k (because much of the time billed was when I was in “recovery,” which didn’t really take the same resources as a bunch of people doding on me every minute. Total bill: a little shy of $8k (for about 55% discount).
Operating surgeon: about $1,600. When I went in for the post-op checkup they said they would offer a 50% discount if paid THAT DAY or a 30% discount within (I don’t remember how many weeks). We paid that day. I wish they could have given a little flexibility – perhaps 50% if paid in a week. It wasn’t fun to pay that day, considering the payment to the hospital was made in the same week. Total bill: I think it was almost $800. Are you blown away that the person who controls the operation gets only $800 (less whatever his company takes in overhead)? Crazy.
ER doctor: $888. I found their information and called them and learned they offer a 50% discount. I have to pay that by early March, which is about a 6 week timeframe. Very thankful for this discount and the extra time. Total bill: $444. Nice savings
Pathologist: To do what, I have no idea. Bill amount: $49. They offered a 30% discount, which we were thankful for. Ended up paying $34.
Anesthesiologist: Bill amount$1,275. I was highly disappointed in their discount, only 20%, to bring it down to about $1,000.
Radiologist 1: $119.86. 20% off put it down to (total bill) $95.89. Not liking the small discount but the amount was so small that it was sixes.
Radiologist 2: Not sure if there was one, but was told there might be one.
The total out of pocket for this emergency surgery was about $10,375.
Are you ready for that capital outlay right now?
I wasn’t either.
Aside from being on insurance, what can you do to get ready? I’m not talking about preventative because this could have been an ambulance ride from a car accident (and healthy eating usually doesn’t prevent that).
If you got a $10,000+ bill from the hospital, would you be in a world of (financial) pain?
You can prepare for medical emergencies. I recommend:
1. Regular insurance
2. Accident insurance
3. Robust and growing savings
4. Knowing who you can tap into to get help from (family, etc.)
It’s a scary time without this $10k bill, but being able to do it can come from planning and preparation. Start NOW!