“It matters not how straight the gate,
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul.”
Invictus
Epilogue to a new non-fiction tale “Swords and Saints – a Doctor’s Journey”
“Doctor Adams, when you’re finished with this patient, people from Human Resources want to speak with you. It looks like your last two patients are being moved to another provider,” stated my nurse with confusion in her voice.
I knew what was going to happen next. I was going to lose my job.
I paused to think back on the many enjoyable years practicing medicine in this town. We had moved here after the Army where I was welcomed as the town’s first full-service family physician. The practice had exploded with patients and began winning Best Medical Office awards. So, I went to our local bank and pledged everything I owned — or would ever earn – as collateral for a loan. Then with some physician partners, we built a new 14,000 square foot medical building on the main road through town.
Private practice had then become increasingly impractical due to cuts in physician insurance payments. The 1945 McCarran-Ferguson Act had exempted insurers from federal antitrust oversight. They could price fix and share pricing information. Medical insurance companies were exempted from the anti-monopoly laws, so I had happily sold my practice to a hospital group for one dollar and signed on as an employee. That decision was going to bite me today.
I recalled asking a large insurer, at a medical conference, why they were price-fixing and pushing out the independent doctors, the response caused an audible gasp.
“We are a monopoly.”
Medical systems management has lost touch with the most valuable resource in their organizations – providers like me. Doctors, nurse practitioners, and physician assistants generate one hundred percent of the income that pays their salaries, I recalled.
“You are being placed on administrative leave effective immediately while we investigate a reported statement you made,” began the management physician tasked with delivering this news. He did not appear happy about it.
This meeting with corporate HR was not unexpected. I had dealt with support staff using the human resources system to protect themselves by filing trivial complaints before. In each case, the complaining employees lost their jobs, but I was still held responsible and disciplined.
“Doc, please tell me you’re not going to retire before I see you again,” had asked many of my patients this last year.
“I promise you that I won’t retire until coming to work stops being fun,” I would always respond.
I am trained in fatal hand-to-hand combat techniques, lethal use of sticks, knives, and guns, and have maintained a fitness and weapons expertise that makes me a very unwelcome enemy. But the first two laws of combat if a fight is coming are, 1. walk away, and 2. walk away. If walking away is not possible, then the rule is – there are no rules!
“Even in a hero’s heart, discretion is the better part of valor,” (The Ghost, 1762), so I discussed the situation with my wife, shed a few tears, and contacted our CEO, a friend, to ask his permission to retire. He granted my request without question — so I walked away.
The cost to replace a physician is estimated to be $100,000 to $500,000. Our clinic had been actively searching for another MD for over a year with no success. My wife and family welcomed my retirement from the practice of medicine. It was mourned but accepted as well earned by my patients.
I enjoy driving by the five-million-dollar multi-specialty medical building that we designed and built with my cardiology and surgery partners. It stands as a shining monument to our calculated risk-taking and eventual success.
I run into my past patients frequently, and they hug me, pray for me, and wish me well. I anticipate significant changes in our future medical care systems. It is inevitable.
Primum non nocere
First, do no harm.