It is time to reflect on our lives, our families, and our communities:
I am truly blessed, with a deep sense of happiness and satisfaction born of following a life path and calling that fulfills the goals I think we all share as we travel through life, following our faith, fulfilling our life's calling, and enjoying all the beauty and gifts life can present to us, while sharing the strength of family and faith to endure the hardships.
Most importantly to me personally, I have been incredibly fortunate to find my wife and life-partner in life early on (why on Earth she settled for the scroungy hippie-looking idiot I was then I'll never know), and God seems to have facilitated a good match. Most women would have killed me in my sleep long before now (even now, I have good life insurance, so there's still time for her
). I submitted some plans to my wife, which she used to bear four kids who turned out healthy and she raised them to become strongly moral and intelligent human beings. Three have married young men who I respect and I believe will be good to them. My son is still trying to figure out the Puzzle of the Female Gender, but is working diligently to do so. Two grandkids on the way, and nobody even got pregnant before getting married - unusual these days, for sure... My wife submitted some plans to me, and I built her a house and made gardens and livestock pens and so on. A close second to me personally, and more importantly to the world in general, is that I have been blessed with skills that enabled me to acquire the education needed to provide high quality medical care to the 'middle class' of health care; those who are not so wealthy that they can just access every specialist they need for every little thing (and honestly, that isn't really 'good' health care, because it is so fragmented, and the pricey and prestigious doctors out there may be great within the discipline of whatever thing made them famous, but they actually often stink at the basics), and those who aren't perpetual-Medicaid patients, so they can't get everything 'free' (again, that of course isn't very good health care, but they will get their most basic needs met if they try).
The 3/4ths of us in the middle of the healthcare spectrum just need someone who will speak our language, and understand our life circumstances by living them along with us, instead of just checking their electronic medical records system for 'cultural differences' to consider and check boxes on. We need someone who understands our goal is not just to live to be 100, drooling on ourselves in some nursing home watching TV game-shows, but to live as long as we can while being active, productive, socially-contributory, fun-having human beings. That includes deer-hunters and vegans, macho dudes and lesbians, McDonalds servers and computer programmers. Most of them never get access to really decent health care - they get a glossy brochure, a 'plan', and the low-copays that will make them feel like they are getting a 'deal' with their health care, provided from the local hospital/insurer cartel. That's like getting a gift coupon for a Raven 25 ACP that claims it will do anything a Remington 700 heavy-barrel package in 25-06 will do (...it fires the same diameter bullet...
) The sad thing is that even many educated professionals believe the glossy healthcare marketing the hospitals put out, and spend way too much money on really superficial health care. Personally, the path hasn't been easy. Growing up with a family income of $3,500/year or so in the 1970's, with a 'single mom' who was a 'single mom' because my dad died in his 40's, versus the way it is now, when most 'single moms' are intentionally single, made things a challenge, but back then enough people were 'working poor' that we just accepted that, just like those growing up in the midwest in the early 20th century accepted outdoor plumbing in the winter. Being nerdy enough to study and read a lot, I got full scholarships to what was actually a 'rich-kids' school, and managed to keep up the GPA to sustain them. Not sure why I opted for medical school after pharmacy school, as the pharmacy path would have netted me a lifetime income of as much as five to ten million dollars IF I had worked the 70-80 hour weeks I've averaged all these years (would require juggling two salaried retail jobs most likely; easier said than done). I think it was because I wanted to interact with patients more, and decide on the treatment plan versus only administer it. Still, I have a huge respect for the pharmacists (and nurses, and physical therapists, and so on) who help our shared patients.
I am too darned stubborn to EVER let some pencil-pushing sphincter tell ME how to treat patients, and I used to see that attitude prevail among the more talented physicians back in the 1970's and 1980's while in training; some of those physicians were arrogant jerks who were annoying, but they did have the good quality their arrogance facilitated - they would defy ANYONE who dared to interfere with what they felt was the best patient care. I suppose that's why God steered me towards primary care, and independent practice, because I'd last about 60 seconds under the thumb of some hospital administrator....
Today's physicians have become much more docile, and dare not argue with insurance companies or hospital administrators, because they have forsaken Hippocrates' advice of having patients pay directly for their health care - that would mean having to actually charge REASONABLE fees, providing better service, and doing what is best for the PATIENT, both short term, as well as long term. Since health insurance is now provided by employers, so the plan changes every couple years, and since Medicare provides the long-term 'dumping ground' for every patient, the health insurance makes their money providing glossy-brochure 'coverage' for whatever is cheapest, but NOT what is most useful, and is more interested in putting band-aids on things then dumping the results on the next insurer to take over, or ultimately, Medicare.
Almost ALL primary-care physicians are now 'employees' of hospitals, and thus the path to success is playing the game....they can easily get paid $10,000 every two weeks by just making sure all they do is what is profitable (even if unnecessary) and avoiding what is necessary if it isn't profitable. Great ethics; maybe today's physicians aren't the arrogant ones of thirty years ago, but they have mostly sold their souls to the highest bidder.
At least some of the specialists can make decent money and still be ethical, but for primary care it just isn't possible to even make as much as your lowest paid employee if you do the job the way you should. Again...not whining; it is just reality - we all have to make choices, and I made mine, and lived with it. Barely a choice for me anyway; I wouldn't have done well at all choosing the other path. Life isn't just about money, contrary to the way the younger 'progressive' self-anointed 'liberals' value everything (...note that definitions have completely turned around - most people who I grew up with and identified as 'liberals' or 'progressive' would NOW actually be labeled 'conservative'
- it confuses everyone, and gives people the shudders when they realize their political identity has been hijacked and they now are on what they would have considered the 'enemy' side...)Anyway, so many people today are so lost in 'ranking' and judging everyone according to race, genitalia, religion, sexual preference, and income, that their lives must be miserable – they certainly seem to want to share that misery and vent their anger with violence and hatred these days; just look at college campuses and you can see how intolerance and violence has become acceptable...! Fortunately I have had the opportunity to associate with a wide variety of people of ALL ethnicities, incomes, religions, sexual preferences, and interests, and grew up with an antiquated 'conservative' value system that judges people not by their skin color or other superficial things, but rather by their integrity and character – in other words the positive impact they have on society, instead of their social 'status' or other virtue-signaling nonsense. Real, down-to-earth people, of all types, all incomes, and many diverse interests. People who don't obsess about getting rewarded in this life financially or socially for playing the game, but who assume there is a more cosmic reward somewhere for a life well-spent. Some of them are on paths that do in fact garner them great wealth, but it isn't what they live for, and they typically use that wealth to benefit others far more than those who judge them.
As I reflect on this holiday season, and the days soon to start becoming longer as the Sun comes back to rescue us from the cold of winter, I head out to the deerstand for a couple hours, with freezing toes and knowing it isn't a good day to hunt weather-wise, or wind-wise, but one of the few chances I'll get this year. Working 85 hour weeks lately hasn't made for a good hunting season (one time I got paged just as I ascended the stand at 5:45 a.m., and you can't exactly return a call without spooking the deer, so I just gave up and headed back home
). However, as I look over the area where turkeys have scratched up the snow and leaves, and wait to see if at least a doe who is too dumb to spot me will wander by, I realize how awesomely beautiful the experiences I have gotten to enjoy are. The land I hunt on is 'family' land, where as a child in the 1880's, my grandmother would come and sit in the tent reading while her father hunted and fished here when he had vacation time, and over a hundred years ago, she was married, and bought the place from the owner who had allowed them to hunt and fish here. My main goal now, other than helping raise some grandkids and trying to be a decent husband to my wife as we grow older, is to keep from losing the family property due to my financial failings. The heady days of finishing college and the 'unlimited potential' one has when successful academically seems just like yesterday, but the path I chose was not the lucrative one I could have chosen as a pharmacist or even after another hundred thousand in debt and seven more years of education to become a physician, nor was it the 'Peace Corps' type path that would garner accolades as one who 'sacrificed' to do such good things. My charitable path isn't tax-deductable nor does it have the status and benefits of a 'non-profit' corporation, but it is highly rewarding from a personal standpoint, as I provide the quality of preventative care that some patients want, but that is only given lip-service at the corporate level. It is probably the type path my ancestors would have respected, and hopefully a path that won't garner too much resentment for my descendants, as they may have to work to hold on to the family property that I had to borrow against just so I could work 80 hour weeks providing better-than-average health care to hopefully grateful and deserving patients. Will they see the many other 'family physicians' who managed lifetime earnings of ten million dollars or so, and think their success must surely reflect something far better done in their careers, not realizing that that path required a willingness to cut corners and do four-minute 'physicals' or ignore problems until they worsened and merited referral down a more lucrative specialty-clinic path that would garner them indirect income...?
Who knows. All I know is that today I got some time in the deerstand, and although if I could just cut to 60 hour weeks I'd feel like I was perpetually on vacation (...imagine 20 more hours every week to catch up on home repairs, cleaning, or just sleep...!!!), it makes the fun-time I do get all the more valuable. Perhaps the guys who have more free time don't get quite the exhilaration I enjoy - scarcity of anything makes it more appreciated. So many people out there running small-businesses are dealing with the same thing, so I don't mean to whine - hopefully at least they find their lines of work fulfilling as I do. Still, I can't imagine the luxury of the guys I know who have great union jobs, where a 60 hour week would mean 70-hours of pay due to time-and-a-half; those of us who are self-employed aren't guaranteed that our businesses will break-even, much less that we will get a paycheck, regardless of how many 'overtime' hours we put in. Payroll is due tomorrow, and despite my not taking any pay recently, we are four thousand short of meeting that; hopefully a couple employees won't mind an IOU, but I've seen every patient I can, and been at the office from 6 am to 10 pm almost every day, so it is all in God's hands, and unfortunately, in Anthem, United, Principal, and ProHealth's hands – and they are all dishonest and corrupt. Nonetheless, time to turn off the worry, and just spend a couple hours in the woods pretending to deer hunt, listening to the nuthatches and watching the wild turkeys up on the next ridge.
Gosh......What to be thankful for, if the finances are so limited...??? It isn't like I'm just having a 'bad year', although I had been making at least half what a 'employed' physician would make, which is STILL good money, the bad years started after Obamacare, and the 'socialization' of healthcare got so much worse (the irony that the 'progressives' miss being that it not only decreased my income, and that of other physicians who practiced good, efficient, care, but it increased the profits of the insurance companies, and physicians who 'played the game' by milking the system – AND it increased the cost of, and decreased the quality of, the patient's care
). No – it has been a six-year trend now, so the overall 'system' we are up against (patients and healthcare-providers alike) will not likely change unless Trump gets a second term, and the Republicans not only take back the House, but grow some gonads and quit appeasing the Democrats.
Regardless, I think we can get back to something similar to before Obamacare - 65 hour weeks and for me half what the 'employed' FP's make; that's still lots of money. I finally have a talented and smart and dedicated and honest Nurse Practitioner in the boat with me (seriously - she is way better than most physicians), and unlike most MD's who want to exploit the NPs, I essentially split the spoils with them equally so once things get stabilized we should do well - I don't mind making less and skimming less off the NP versus the norm if it enables us to tag-team to provide top-notch health care. She will in turn gain experience and skills, and a potentially loyal patient base that will outlast me; a thousand or so patients who trust you and want to see you for their care is a blessing not just emotionally rewarding, but even in a screwed-up system, a source of livelihood less fickle than what an employing HMO clinic would assign you (and take away on a whim). I give prayers of thanks every day for the many patients whose trust I've earned, and who I think God may have used me to actually help over the years.
My prayers aren't that I'll start making money (I never pray for my OWN needs; I've always thought that selfish) - my prayers are for our nation and that indeed Trump, imperfections and all, gets another four years, without the constant obstructionism of the socialist crowd.
However.........There is LOTS to be thankful for this season:
Health – anyone who is healthy should be grateful; part of my job is to help people attain that, but despite the efforts of my peers, many people just won't have good health. I've had that so far, and even the aches and pains I have I regard as reminders that I'm still alive and kicking - a sore foot is nice....compared to those folks who have had theirs amputated; so I don't whine.
Family – having a good marriage, decent kids, and a family that gets along is also a precious thing and to be celebrated. Those who don't have these things know the heartbreak; those who do - please be thankful...!
Faith – whatever one's faith, if it gives them guidance and strength, it should be practiced and adhered to and celebrated as well. Those without a faith are often unhappy, and I hope they find one that can provide guidance and strength to them - many of us are willing to help share our faith if just asked.
Community – we live in a great nation, and so far it has withstood the ravages of wars, financial depressions, and civil unrest. Currently it is fighting the self-righteous ignorance, violence and hatred of the Left, but may withstand that as well (if we do our part to not only vote, but educate the low-information voters and college-kid types about how even 'socialism-lite' is immoral and dangerous to humanity). I pray that the used-to-be Democrats wake up and realize that their political party has gone off the rails and is now the enemy of the minorities, the enemy of the poor, the enemy of sound-science, the enemy of logical rational discussion, and has become the party of the wealthy 'elite' despite all their rhetoric. The supposedly-evil Republicans are far more 'inclusive' and 'tolerant' and supportive of the disadvantaged; yes we have some swamp-dwelling RINOs to eliminate, but at least we are trying - the Democrats have ceded leadership to their swamp-dwellers.
Material things – I bitch about my lot in life, but if I work until I'm in my mid-70's, I will have probably made about a million and a half dollars. Not much better than a file clerk, and less than a bus driver would make if they worked my hours, but I have yet to go hungry, have to pick up aluminum cans for gas money, or even go without an automobile of some kind. I don't get the prestige of someone of similar income who works for a 'nonprofit' or the Peace Corps, but my goal isn't the approval of others - just my family, my patients, and God. I have more firearms in my collection than I need, and if I ever can cut down to 60 hours a week at work, I might even have time to start selling some of them.
Life is good. 'Christmas presents' will not be a thing this year, but if the family can get together and have some good times together, what else is there* that is really important, anyway....?
P.S. (….*.well, there IS pumkin pie.....THAT had better happen...!
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I don't think I would survive in today's pharmacies...!