“There is no failure except in no longer trying. There is no defeat except from within, no really insurmountable barrier save our own inherent weakness of purpose.”   -Kin Hubbard

I’m on my way back from an unintentionally extended family trip to the Caribbean. Due to the BSOD caused update and some flat plane tires, we got sucked into the maelstrom of y2k in the year 2024.  We have enjoyed a great time together and coming home has become the only thing holding us together. 

There is always a time that clicks in at the end of family vacations when you are refreshed and frankly ready to come back.  I’d say that occurs around ten days.  My wife and I work together in our practice so being together has become familiar and even important to us.  But we each have different roles, obviously, as necessitated by the business of medicine. 

As physicians, we were always taught two important and untrue things.  First, how much student loan debt didn’t matter because we would “make a good living” to pay it off quickly and second, we should never discuss finances with patients, nor other doctors.  It would be gauche in the first instance and in the second, CMS considers it collusion.  Try not to do a spit take with your beverage on the second. 

I’ve been independent practice since 2011.  When I first decided with my wife to start our business, we had zero idea of how to do it. I bought a book on incorporating in California, and talked to other physicians, some of whom were frankly hostile. 

Neither of us had ever run a business on our own. The only model I had was my generous to a fault maternal grandfather, Morris (Morrie, Moishe, or to me, zaydie). My son’s Hebrew name is Moishe, after him.  He was a child of the depression, one of four children, son of poor immigrants, and fought in both theaters of World War II, helping liberate Bergen-Belsen. He had a successful run working for Mutual of Omaha as an insurance salesman, and was even featured on the cover of their trade publication, Mutterings.  I have a copy framed in my office with a pen and ink likeness of him on the cover, and some brat pack style black and whites of him on the inside, looking like a shorter Joey Bishop. 

He struck out in his own decades later, after having an achieved the highest distinction at Mutual, and had a signed stone in the walls of the corporate HQ in Omaha. For whatever reason, he left with the understanding he would be able to make a living. He did well, never become a mogul, but he and the family lived comfortably, nice house in good school district, and a new Caddy every two years. He didn’t want or need millions, just what they needed to be comfortable.

Many physicians had a similar dream, not being millionaires, but being comfortable.  To some that might mean a house that wasn’t flooding every summer during the August rains, or sending the kids to a religious or private school to give them an opportunity to get further in life, for others it was living in an area with less crime, or close to the water so they could surf or sail like they wished they had when they were kids.  I don’t think these are unreasonable nor unrealistic desires. 

With the latest Medicare cuts, fostered by a captured regulatory body and no political party having the gumption to acknowledge nor stop it, physicians

have faced about a 30% pay cut since I started my residency in 2001.  We have reached a point where “physician side gigs” is a real thing. Doctors are bought up and pushed into mostly untenable employment arrangements and beaten into believing they are modular cogs in some dystopian medical Hell we now find ourselves.  And still the price of healthcare rises.  In fact, the only nice thing about this cluster, which I pointed out in my last piece, is that the whole big lie about doctors’ fees driving the cost of care is truly and experimentally proven to be false.

Pundits and wonks testify in front of committees and tell stories, share data, and still it is Kafkaesque oblivion.  We are taught it’s always the “other side’s fault” and we point fingers, deride each other’s voting preferences, and delude ourselves into thinking our candidate or party has the answer.  It’s safe to say that’s crazy to expect anyone to save us in any of the three branches of government, regardless of party.  There is too much money left to be made in a broken system and the narrative to continue business as usual will necessarily change with the landscape, finding other scapegoats.

Where we find ourselves is in a quandary that physician administrators are unwilling and likely unable to help, for fear of endangering their pot o’ gold.  Yet, if we want to continue as physicians, in my case I kind of have to because I would make a lousy bricklayer, we have to pull our heads out of our rear ends. 

That may be a number of things – like calling out policy wonk lies in testimony, or most frequently on social media, helping others who are frustrated identify and name the sources of their pain and motivate them, and also forming collective units, such as groups or even guilds to effect agency. 

We as dogs in the fight are small, but each of us has gotten through the weed out college courses, the perils of medical school, and rigors of residency.  In each of these instances, I had my own trials.

In college, a grading error of 100 points on my organic chemistry, a notoriously evil class on my campus, nearly cost me a whole letter grade until I cajoled my reluctant TA to look at the grade again. They had missed a “1” in front of the “96” and had given me a 96/200 on my final, instead of my 196/200 – my actual score. 

After a near all nighter studying for a second year test, I was driving towards my parents’ home where I was to meet two of my colleagues at a local book store to study.  I dozed off and sent my car into a spin and nearly hit the median. I wasn’t hurt, and thankfully I glanced a pickup truck that redirected me from hitting the median on the Edens, saving me from being flung out of my windshield.  Miraculously, no one was hurt, But my car, a manual gray 1989 Ford Probe, my first car, was dusted.  Incidentally, my grandfather Morris was the first of my family on scene, in less than ten minutes. 

Residency was still one for the most difficult things I have gone through.  I’ve met personalities whom I would have never want to spend more than a blinking moment near, yet had to endure capricious demands, idiosyncrasies that boggle the mind, and endure losing not just my grandfather, but later my grandmother during that span of seven years. 

We all have stories like this, sacrifices, people and time lost.  What angers me the most is nearly no other profession demands this of anyone in their respective location. We go forward willingly, knowing these things we lose can and do happen. But we do so because like our parents, grandparents, and generations yon, want a better life for our children and descendants. 

We owe it to generations past to keep fighting.