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.
I love this post. I was with Debbie at a Writers Retreat a couple of years ago, and I love what she writes, so I was glad to discover this. I lived in DC 27 years and when I moved to the “simpler” life of Northern Alabama I missed it (and still do) terribly. It is so interesting to read a post from a successful physician, with a house in Georgetown, who didn’t find it fulfilling any longer. I am going to get the book–you have my curiosity up on “Overdiagnosed” and read the other posts. Thanks for sharing this!
Thank you Susan. So great to hear from you! Was it the Sedona Writing Retreat with Pam Slim??
Susan, thank you. I am sure that you will find Over Diagnosed to be worth the effort. We need to “right size” medicine. Sam
What a well-written description of the “malfunction of our health care system.” My mother used to say something to the effect that she was fine until she went to the doctor and they “always find something wrong!” I eat organic, locally grown food, minimal amount of meat (also local), get out every day with my dog, and have an active and engaged circle of good friends. This is my “medicine” and I look forward to continuing to live well and be healthy for many years to come. thank you, Sam, for a great post.
Sam, this is a beautiful and terribly sad post. As I read it, I thought of my dad, an internist who died 21 years ago. He felt that he experienced the “golden age of medicine” during and after World War II and was outraged about the transition he was witnessing in the 80s and early 90s.
Thank you, Dale. I enjoyed a few of those golden years myself. Then commercialism hijacked the profession as it has hijacked college football, higher education, some areas of journalism, and even some aspects of religion. I will try to comfort myself (not) with the college football playoffs on this New Year’s Day. Sam
Sam, I very much enjoyed this post. A few years ago I downsized from a single family to an apartment in a triple decker across the street. It was a lot harder to let go of all the sentimental “stuff” than I had imagined, but having shed it (lugging boxes of beloved books down three flights of stairs, across the street and then up three flights of stairs quickly cured me of that love affair – I gave many away and frequent the library more!), I find my 1,100 square feet more than enough room for me. It’s nice to get unstuck. I have better sunsets and more trees out my windows – and my move was literally across the street. Still, it felt and feels a world away. A happy, welcome, simpler world away.
We can agree, simpler is better.I enjoyed the image of your book move. If people were required to carry their possessions up three flights of stairs on a regular basis the world would be a better, and less cluttered, place.
Hello Sam…I thoroughly enjoy your comments. I am a newly minted (November 29th) 75 year old retired internist living in Riverton, Wyoming…a town of about 10,000, situated in the Wind River basin…Tetons the next range to the west. After 3 years of solo practice in Garland (Dallas metro area), we moved to Riverton in 1977…Many of our friends thought we were moving to a “territory”…Wyoming was so remote. “How are you going to make a living”?..was the question. In a sense, we did our gap year (years) in reverse. Had a young family, outdoor oriented, and became enchanted with the mountain west, after three summers in Estes Park, Colorado, Internal Medicine review courses. I felt that reading the tea leaves (medical politics) 20-30 years down stream, I pretty much knew what the future held…the life style out here is much less stereotypical than the traditional environment back in our native state of Texas…Doctors playing golf at the same country club on Wednesdays, wives in the same bridge groups, etc. Out here, in a sense, I think what I have done, has mattered more, because there are not 20 internists lined up, etc.
We have a community college (Central Wyoming Community College)…my wife being a retired political science professor after 24 years of service.
I retired (officially) in September, 2012…after doing locum tenens for 5 years…really thinking it would be a way to phase down, have more freedom, travel to interesting places. The only problem, the phone started ringing regarding needs locally, and I never got out of Fremont County.
I would still be working, but for some of the same reasons you have cited….although your practice (and living) experience in Washington was obviously different than mine out here in the Wild West.
I would be disingenuous if I didn”t say that I do miss the doctor/patient relationship. When the PROCESS of medicine becomes more important than the PRODUCT, something is terribly wrong.
Roger, I misread the tea leaves but was able to enjoy my patients, nonetheless. I “fired” two patients in thirty-two years. It was a pleasure to help the others. Sam
Thank you for your honest explanation of why you are leaving DC and your medical practice there. I totally understand what you are going through. I’ve been a leadership consultant with a generalist practice centered on fixing organizational problems and change. The recession wiped out my client base in a few short weeks, and since then, I’ve served in two interim leadership positions. One ended disastrously, and, the other pleasantly. I live in Asheville, NC, where consultants are proliferating like rabbits. In addition, the ending of my 30 year marriage has brought me to a place of freedom where I can actually change everything. I’m ending my consulting work, and moving into full time writing until I get the book that is in me done. I’m also moving to Jackson, Wyoming, a place that I love and brings with it the right kind of distractions. I wish you and Debbie well in this new chapter in your lives. I hope you are as excited about as I am for mine. Blessings and peace for you and your family this holiday season.
Thank you, Ed. Let’s both enjoy our new freedoms in 2015. Sam
Hi Sam, I just spent an hour enjoyable hour scanning through your writings. Came upon this quite by accident but am so glad I did…..so much truth and insight into medicine today. I have subscribed to your blog site and look forward to reading your articles regularly.
Bob and I are living in Colorado now. We left PA three years ago after the last of the parent generation passed on. We really like CO and the simpler life.
Joan, how nice to hear from you. I went to DC last month for a conference and had drinks with Hettie, Erika and Tom. My next post will be about Medicare For All. Stay tuned. Sam
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