It’s Only a Bump: Overcoming Challenges in a Small-Town Medical Practice

It’s only a bump

Overcoming challenges in a small-town medical practice

Jona Gorra MD, FACP, CMD

Agio Publishing House

Smashwords edition

Agio Publishing House

Gabriola, BC, Canada V0R 1X4

© 2021, Jona de Castro Gorra. All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the publisher of this book.

Disclaimer—Nothing in this book should be construed as medical advice. You should consult with a qualified medical practitioner about your health concerns.

It’s only a bump: overcoming challenges in a small-town medical practice

ISBN 978-1-927755-93-8 (paperback). ISBN 978-1-927755-94-5 (ebook)

Cataloguing information available from Library and Archives Canada.

Agio Publishing House is a socially--responsible enterprise, measuring success on a triple-bottom-line basis.

Dedication

To DC Medical Services & Seaford Internal Medicine

Table of Contents

Acknowledgements

Foreword

Introduction

Part One: Medical residency in the U.S.

Chapter 1: On the fire escape

Chapter 2: Dreaming of learning the science of medicine from the best

Chapter 3: Laying a foundation

Chapter 4: Securing a U.S. medical residency

Chapter 5: Tear up a medical book & wait by the elevator

Part Two: Legalizing my stay in the U.S.

Chapter 6: Becoming a permanent resident

Chapter 7: Becoming a licensed doctor

Part Three: Starting and building my practice in Georgetown, DE

Chapter 8: Settling into a small town

Chapter 9: Understanding my patients

Chapter 10: Nursing the growth of my practice

Part Four: The business side of medicine

Chapter 11: Billing is the lifeblood of a practice

Chapter 12: Taking the bumps in stride

Chapter 13: Contracts and J-1 visas

Chapter 14: Breaking contracts

Chapter 15: A Marine became my office assistant & I hired Batwoman

Part Five: Affordable Care Act and COVID 19

Chapter 16: The hidden costs of the Affordable Care Act (ObamaCare)

Chapter 17: The doctor is in: Staying open during the pandemic

Chapter 18: COVID 19 and chicken processing plants

Chapter 19: Physician, Heal Thyself: Overcoming what I suspected was COVID-19 infection

Chapter 20: Business management during the pandemic

Chapter 21: A journey of 23 years

Afterword: About those bumps and challenges

Acknowledgements

There are many people who have helped me from the very beginning of my life, most notably my family. My mother was Natividad de Castro Gorra, and my father, Jose Gorra. My mother was a public school teacher in Camaman-an, Cagayan de Oro, Philippines. She walked to work every day for about two kilometers, in the dust and in the mud, from our house in Ramonal Village to her school and yet I never heard her complain. She did not have an easy life and never did she grumble about her sufferings or regret marrying my father, whose unfaithfulness added sorrow to her already difficult life.

She had a great sense of malasakit, the Tagalog term for sacrifice, for the sake of her 10 children. I use the word sacrifice, which is rarely heard nowadays, because it was the byword when my siblings and I were growing up. It indicated one’s willingness to give up one’s own pleasure so the person or persons you love will succeed. There were ten of us, so the sacrifice she and my father had to undertake were many times more than the average family. As my way of honoring her memory, I named my clinic DC Medical Services. The letters DC stand for her middle name, de Castro.

My father worked at the Land Transportation Office, similar to a Department of Motor Vehicles in the U.S. Prior to working there, he was the chief of police of Lagonglong in the province of Misamis Oriental, and even received the recognition of being the best chief of police in the province. However, his unfaithfulness to our mother created a deep wound in our family that scarred over the years but, at times, opens as raw as ever when memories are dug up and retold. Yet, he never failed in his commitment to have us acquire the best education. He worked hard to pay for our tuition. He helped secure documents to complete my requirements to come to the US. He was mischievous and had a great sense of humor. For example, one day he found a way to shorten his time in a long line by pretending he was having diarrhea. In many ways, I am obliged to be thankful to him. He was my father, and I was his daughter.

My older sister Fe Heinrich paid for my medical education, and her willingness to invest in my practice allowed me to get a visa to stay permanently in the U.S. Her husband, Manfred Heinrich, took time from his busy schedule as I was building up my practice to help me purchase my building.

My brother Rudy Gorra with whom I stayed when I was in Manila, did not mind waking up at the crack of dawn to drive me to the U.S. embassy so I could secure my visa. He also paid for my board and lodging when I was in college.

My sister Marita Vokinger financed my pre-medical schooling.

My sister Annie Gorra and her husband, Benny Rago, provided me a home in Fremont, CA as I awaited the results of my matching program in the U.S. I have always dreamt of having my own book someday, and I would like to appreciate my sister Annie for making this dream possible.

All my brothers—Simeon, Hector, Noe, Emmanuel and Merven—have helped me in small and big ways.

Dr. Alfred Ashford of the Harlem Hospital Center in New York City gave me a spot in the hospital’s matching program that opened a whole new life for me in the U.S.

I thank my friends Imelda Diaz, Rowena Dellosa and Dainty Daisy Villanueva who drove with me to Delaware. I will never forget how we sang along to country music in my old car, smoked cigarettes, and drove to Delaware from New Jersey on US Route 9. We were young, ebullient and so full of fresh hope as we were at the cusp of a new life in America. We were a bit unsure of where things would land but we knew that we will be fine because we have reached the legendary land of the free and home of the brave.

My immigration lawyer, Jeptha Evans, assisted me with converting my J-1 visa to H-1 status that ultimately led to my permanent residency in the U.S. I will forever appreciate his openness to my curiosity as I dug deep with questions on the different avenues possible to make the change.

My husband Ody has given me his loyalty, love and care through the years. He is an internal medicine specialist like me, whose opinion and intelligence I appreciate. He is also a wonderful home chef whose preparations of delicious ethnic foods give me comfort at the end of the day. My sisters said I will never find another like him, and they are right.

My cat, Oozy, I will always be fond of. He wiped the tears on our cheeks with his paws before we let him go to sleep.

To good old America, I have succeeded because of the freedom and opportunities you have given me, an immigrant in this country. As I write this book, the country, my country, is taking a big beating from activists of both extremes but let it be said that this is the same country that has given millions of immigrants big opportunities.

To all of you who are mentioned above, and so many others, I would not have reached my place in life now without all of you and your assistance, advice, and generosity along my life journey. Your kindness and hospitality were like a cup of water given to me when I needed it most. Please accept my heartfelt gratitude.

Daghang salamat. Thank you very much.

Foreword

This book will be different from the usual book written by medical doctors. It is not focused on illness and treatment, but on the business side of medicine. When we think of the practice of medicine, we often think first of patient care, as we should because patients come first. Our Hippocratic Oath binds medical doctors to give patients the best care and the best treatment possible. I am proud of how I care for my patients, but in order for me to give them excellent care, I also need to ensure that the business side of my practice is healthy. Just like any other career or vocation, good financials and good administration are necessary.

This book also reveals the human side of becoming a doctor, and developing a clinic. My story is told from the perspective of someone who came to America from the Philippines as a medical intern. I tell it because I want to share my experience in the hope that it will guide new graduates of medicine especially those who come from other countries and do their medical residency in the U.S. They come with a J-1 visa and if they choose to stay in this country, they have to seek a waiver to apply for an H-1 visa that will allow them to work in underserved areas of the U.S. I narrate my experience with this process later in the book.

I chose to set up my own practice. I hope that my story will help guide those who want to do the same or those who are not sure whether to be employed or to be independent. The options exist, and options lead to freedom