Medicine and the New Slavery

My father was a small town country doctor and dentist.  He made house calls,  He set his own hours and determined his own time off.  As he got older, he limited his practice hours, and the type of dentistry he did in order to maximize proift per time worked.  At the most, he made $25,000 a year — enough to live comfortably, but not enough to completely pay his only child’s post graduate education.  He considered himself a free man.

I paid my way through a private Medical School by joining the Navy. After four years of college, four years of medical school, five years of Orthopaedic Residency and four years of payback time supporting the Marine Corps, I spent another year training to be a spinal specialist. That year, 1989, as a Board Certified Orthopaedic Surgeon, I grossed $15,000.

Finally, at age 34, I began making a decent living.  I worked in a small city which was underserved, was fully booked and did over 250 surgery cases a year. Nevertheless, after working as a highly trained spinal surgeon for five years, I recognized that I could not get financially ahead. I could pay my debts, but my overhead was escalating and my reimbursement (80% of which was set by the government) diminished over 40%. Any profit was taxed heavily. Unlike other businesses which can make up for diminishing profit margin by selling more widgets, physicians are true cottage industries. We make our money one patient at a time. I thought I could solve that problem by becoming a landlord and making money not dependant on my hands. (Aging surgeons cannot operate forever). My husband and I scrimped and saved for years to make a down payment on an office complex.  After a few years we began to see a little profit.  But then, the county passed bonds — new schools, new palacial buildings for the local community college, and a 57 million dollar library complex (a mausoleum to paper in a digital world).  Suddenly my rental business was losing money.  I was working 80 hours and seven days a week and taking home less and less.  I did not feel free.  I had become a slave to my government: federal, state and local.  

Enter the bailout.  The “stimulus.” I got no stimulus money, nor do I know any small businessmen who did. Worse than that, we are the target for the tax increases needed so other bigger businesses can be supported.  As 2009 progressed, the future seemed bleak.

So what was the answer? Was it to see more patients?  Of course not. The HMOs taught us at least one thing: You cannot make profit  in volume when you lose on every patient.  

So recently, I quit.  I sold everything, downsized my personal and professional life.  I moved to small town America, took a part time job with a hospital.  Now, I see less than half of the patients I once did, do no spinal surgery, and buy nothing but essentials and education for my children.  I once employed 2 full time and 5 part time employees.  I contributed significantly to the income of three factory representatives for the products I used in my practice. I was the only supplier of a critical surgical skill to a population of 360,000 people who now have no one.  Now, I mostly contribute to the statistics on unemployment.

What’s wrong with slavery?  Of course we all grew up with tales of the old South, with Massa beating his slaves, using the women, and separating  families.  But truly, these tales of the worst form of slavery do not describe the majority of Southern slave owners. Most took care of their  slaves because they were a high priced commodity.  If a slave is well fed, clothed and given medical care, allowed to live with his family, why would he object to being a slave?  Simple…he is not free.  His labor is not his own.  No matter how hard he works, the fruits of his labor go to someone else.  He is forced to live within the confines defined by the slave owner.  Those confines may be within a luxurious mansion, or within the limits of 136000 pages of medicare regulation, but he is always restricted to someone else’s limits.  The core evil of slavery is not in physical abuse — because that is not an intrinsic property of slavery — but in the limitation of economic and personal freedom.

I have left the plantation.  I still pay too much in taxes, but by working less I have less to tax, and lots more free time to spend with my family.  I can grow non taxable food, and give to charity through non-taxable volunteer time. I can use my skills with tools to build and renovate my own small house ( rather than treat patients, fight the government for reimbursement, give half or more back to the government then use what’s left to have someone else build me a house). Of course, President Obama, by declaring medical care a right, may  force doctors like me to work in his nationalized health service.  After all, if medical care is a right, the government may use force to insure that all people have that right.  But as every slave knows, “They can pretend to pay us, and we can pretend to work.”  Besides being immoral, slavery was not economically sound in 1840, and it is not any better in 2009.