Debbie asked me to comment on my part in our decision to sell our house in D.C. in light of a recent article in the New York Times: Selling the Family Home is Liberating for Many Retirees.
I would prefer to write about the Oxford comma. But that will have to wait for another day. In the meantime, I will punctuate correctly in this post.
Yes, I wanted to jettison our mortgage-free house for the reasons mentioned in the New York Times article (freeing up money, losing carrying costs, and increased flexibility). But the most important reasons for me were less financially motivated and more emotionally driven. I wanted to leave D.C. and the medical practice over which I had lost control. I wanted a new lifestyle that was less expensive, closer to nature, closer to my expanding family, less foolishly competitive, and simpler in its aspirations.
Chronology of losing control
Over my thirty-two years of patient care in D.C. I lost control over many aspects of my practice. First, the insurance companies made the reimbursements inadequate. Then the insurance regulators and the government regulators made the paperwork, rules, and regulations oppressive. Then the pharmaceutical and medical device companies began distorting the truth about the benefits of their products and pushing that information as “science.”
Finally, and this is the most important development, my competitors and my hospital progressively gamed the system to survive.
In my chosen field of internal medicine and gastroenterology, there are two practical divisions of clinical labor. The first area is the treatment of active illness. I enjoyed this enormously, although the stressors are great. The second area of practice is preventive and includes screening tests such as physical exams, blood tests, screening colonoscopies, and screening gastroscopies.
When I started my practice I genuinely believed that these preventive practices were the foundation of a great health system. Twenty years later I began to feel manipulated by the pharmaceutical companies, the professional societies, and my competitors into doing more for less money and less clinical benefit.
Coming to terms with a sense of betrayal
At the thirty-year mark of my practice (by 2012) I was convinced that our screening programs (breast, prostate, lung, colon, esophageal, stomach screenings, etc.) were largely failures. Annual physical exams have been proven to be worthless and potentially dangerous. Executive physicals (embraced by most academic centers and hospital systems) are a money-making scam.
Excessive screening led to overdiagnosis and overtreatment with multiple complications, massive expense, and minimal clinical benefit. (See my earlier blog posts here and here. And read Overdiagnosed: Making People Sick In the Pursuit of Health by H. Gilbert Welch, M. D.) The only people who were guaranteed to benefit were the clinicians performing the screening tests and the hospital systems, surgical centers, and radiology centers supplying the treatment and (excessive) follow-up.
Most of my former colleagues and all of the executives in major health care systems suffer from the blinders Upton Sinclair described:
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
– Upton Sinclair
Downsizing and simplifying
I explored re-inventing myself as a physician. I considered administrative work but could find none that was untainted by the zeal to deliver more and more “care.” I considered retraining as a hospice physician but paled at the thought of three years of residency. Ultimately, I decided to downsize, simplify, and truly re-invent myself.
Tom Ricks, author of Fiasco, and a Deer Isle neighbor, recently published a piece in the New Yorker: In and Out of Time in Iraq. In it he eloquently describes the power of nature to purify and nurture.
Power, money, and celebrity make life both interesting and miserable in D.C. as in only a few cities in the world. Superimpose the disappointing developments in my career path on the misguided self-importance of the professionals who live and work in the reflected glory of the Capitol and the White House and you will understand my redoubled desire to move on.
Time and space for a change
I am not suggesting that I have PTSD, nor was I unhappy in D.C. On the contrary, I had a wonderful career with many clinical highlights, many wonderful patient memories, many successes, and few failures. I am saying that I was done with that practice and, by extension, with D.C. My life trajectory and my career impasse intersected to create the time and space for a change.
I suspect many other “retirees” sell their homes not only for more financial flexibility but for the emotional benefit too.
Top photo: our D.C. house looking its best in April 2013.