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By the number of years put in, I am nearing the end of my professional career, the setting sun in sight.  However, looking back, I see that the sun began to set long ago.

A career has a sense of permanence.  Mine became a job that changed over time, through the action of others, and in ways I could not control.

Did I help patients throughout the years?  Undoubtedly.  Many told me so.  But in terms of the physical and mental toll it took, was it worth it?

Life entails struggle, but my quality of life would certainly have been better if I could have approached that sunset with less grief.  To place all this in a medical context, I once heard it said that clarity after the fact occurs once we put on our retrospectacles.

Regarding my professional “career”, medical school was the first hurdle.  Top grades were the criterion.  I managed to snag only one interview.  Failing to gain acceptance, I went to school abroad.  After two years, I was accepted into the only domestic school that had previously interviewed me.

Those two years abroad were mostly about memorization.  By and large, critical thinking was not part of the curriculum.  Years later, it became apparent that physicians lacking that trait, the layman’s common sense, would do the public a great disservice.

After completing the final two years of medical school, I entered a one-year internship program.  Although I decided on a residency and had a few interviews, what was missing was offers.  While I was on call one night, my mother called the hospital operator, looking for me.  Cell phones were not a thing then.  A program that I had interviewed with had an opening.  I took my only option.

Over time, I realized that the program was not top-shelf.  The instruction was minimal, and a dispute broke out between the program director and the department chairman.  As chief resident, I walked on eggshells to keep a civil atmosphere among my co-residents and our bosses.  It was a small program, and due to the atmosphere, two residents would eventually leave, and the program closed.

A secret about medicine is that it is mostly self-taught.  It is an expensive trade school without the apprenticeship.  If you wait around to be taught, you will learn next to nothing.  By the end of residency, the hurdles were obtaining board certification in my specialty and practicing medicine.

Certification in your specialty board was once voluntary, billed as possessing knowledge that exceeded the average physicians.  With the allure of creating an enormous source of income, the medical specialty boards turned what was once voluntary into something almost mandatory.  Especially for new graduates, obtaining hospital staff privileges or employment would require that certificate within a couple of years of finishing residency.  Unless you “hung your own shingle” and avoided hospitals or were in practice long enough to be “grandfathered in” by the hospital committee, you had no choice.

My specialty changed, as others did, from offering a lifetime certification to one that was time-limited, requiring retesting every ten years, further picking our pockets to reassure the public of our “quality.”  My first round was a written day-long exam at a testing center fifty miles away, followed months later by an oral exam administered by eight examiners in a remote city.  What it would be like ten years in the future was a guess.  Unforeseen time and monetary considerations were now part of the “career” equation.

I was offered an attending position at my residency program, but there was no way I would consider that.  It was a toxic environment.  Meanwhile, Hillarycare was in full swing, and the reaction of medical practices was not to expand locations or add additional personnel.  Instead, I found temporary work.

After several years, I landed a job in a rural community.  Things were good for a while.  I grew the practice and, with that, my income.  But in less than five years, a physician group in a different specialty with the assistance of a local hospital decided to encroach on mine and compete against me.

As my practice spiraled downward, I became aware that the competing physician group was committing Medicare fraud.  It was significant enough that the Department of Justice agreed to move forward.  All looked favorable until my state decided not to proceed, which was a condition for litigation.  My attorney would not disclose to me the why, but reason dictated that my competition was somehow “protected.”  With an unrestrained “competitor,” the practice I ran dried up over time, and in several years, it was forced to close.

At the peak of that practice, and with grand ideas, I decided to open another practice two counties away, this one from the ground up.  It meant engaging architects and a builder and attending township meetings.  Unfortunately, my attorney had to explain state regulations to township officials, leading to time delays and cost overruns.  Six months behind schedule, I opened.

Over time, the growth of that practice stalled.  The main medical center in the area began a merger campaign, folding smaller surrounding community hospitals into the mother ship.  The first one went without a peep, with the state attorney general rubber-stamping the deal.

Smelling a skunk, I contacted the state’s A.G. staff.  An issue I brought to the table was that physicians on staff at the smaller hospital had now lost their privileges and therefore could not provide care to their patients at that hospital.  The A.G. staff claimed to have been unaware that this would occur.  But their approval was final, and with that, I lost a portion of my physician referral base.

The medical center’s second hospital merger was not as easy to “slip” by the A.G. office, but nonetheless, it was approved.  I even appealed to the Federal Trade Commission’s Bureau of Competition based on the medical center’s creation of a medical monopoly in my area.  Getting nowhere fast with the director, I asked, “How is a monopoly defined?,” to which was responded, “That’s a good question,” followed by silence.  Shouldn’t the director be knowledgeable about existing case law?  For this medical practice, just as the last, there would be no help from D.C.

My building was landlocked, and access was sporadically problematic.  The owners of the property through which I had a deeded easement put up gates to prevent my entry.  The township attorney had to discuss with them the illegality of their action.  On the other side of my property were doctors who owned their building and had access to the main road.  They produced a solution.  I could break the curb separating our properties and take out two of their never used parking spots for the bargain price of $100,000.  I passed on their generous offer.

The writing was on the wall.  The base of referring physicians being too slim now to support my practice forced me to close.  The real estate market likewise was not so kind.  The building sat empty for five years.  I eventually sold it to the police, in part to be a crime lab.  And that property access issue?  The township invoked eminent domain, cutting a path much wider than two parking spots.  And it did not cost them $100,000.

During the run-down to closing that practice, I was approached to work in a corporate-run facility, only a three-hour round-trip drive from home.  I spent nine years there.  In one respect, not being their employee gave me a degree of freedom employees did not have.  The nine years, however, was no joyride, since it fell during The Time of COVID.

The two years of pandemic hysteria and rollout of the “vaccine” allowed me to go farther along a path I had started down well over a decade earlier, once medical training had ended, debt cleared, and financial stability was in sight.

As an undergraduate, I was a history major.  By the early 2000s, I became more skeptical about mainstream historical narratives.  When the COVID deluge began, I delved into aspects of medicine not discussed in medical training or journals.  Why question historical narratives only when medical “science” also offered much that appeared sketchy?

It became glaringly obvious that most physicians toed the party line in what to accept or question.  Prior to DIE, and as I mentioned earlier, medical school entrants reflected in large part their ability to memorize an enormous volume of technical information dressed up in a foreign language.  As all things COVID demonstrated, critical thinking was not a forte for many.  For those, this quote by Pat Shannon would not resonate: “Who is more dangerous: the liar or the people who believe the lies?”

Questioning the only accepted mechanisms of infection and contagion, formulation of medical definitions, laboratory testing methods, the basis of virology, electron microscopy, and vaccine development and effectiveness and side effects was a heresy to many.  Ignoring the role of Big Pharma in funding medical science research or the whispers of scientific fraud, as noted by publication retractions, was common.  Too many physicians did not consider alternative explanations or, worse, nefarious intent.  There would be little consideration for ideas such as expressed by John “Birdman” Bryant: “There is no reason to suppress a viewpoint unless it is true.”

To be fair, few in any endeavor will stick their neck out when threatened, especially physicians, pinned under large educational debt, years spent in specialized training, potential loss of licensure, and for most no other way to make a living commensurate with that obtained through the practice of medicine.  Physicians, with few exceptions, became masked in silence, got jabbed, and continued as instructed.

As with my other jobs, this one was to end as well.  The corporation leased the property from the local hospital, which became part of a different medical center’s merger-acquisition process of folding in smaller hospitals.  Eventually, I was offered a position within the hospital to continue as the town’s physician in my specialty.

It is here that I now sit.  My office resembles a supply closet, or, as I refer to it, a room on Cell Block A.  However, I am lucky.  The specialists on the other side of the wall are four “providers” housed in a larger cell.  Yes, once you finish schooling/training, become instructed on the Big Pharma narrative, and follow the rules as directed by men in suits or part-time white coats, your reward is the title “provider.”

There is no longer an “art” to practicing medicine.  I have seen it morph from independent judgment to insurance guidelines to hospital protocols.  As the larger entity takes over the smaller, the protocols change, seemingly by whim.  “It’s how we do it at [fill in the blank].”  That is, unless a patient’s medical insurer requires “precertification” of my proposed treatment.  Interestingly, no other entity or individual is listed on my malpractice policy.

Our “unique fund of knowledge,” laughable on its face since every trade, profession, and activity possesses such, turned into “consensus,” a squishy word not necessarily meaning complete agreement.  Bertrand Russell summed it up: “The fact that an opinion has been widely held is no evidence whatsoever that it is not utterly absurd.”

Had I known that I was embarking on a “career” whose only permanence was uncertainty, I may have chosen otherwise.  They do not teach you in doctor school the skills you really need to survive in the medical field.  Unfortunately, it is by necessity that you acquire those skills, after you have taught yourself how to be a doctor.  

<p><em>Image: Pkd2016 via <a href=Wikimedia Commons, CC BY-SA 2.0.

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Image: Pkd2016 via Wikimedia Commons, CC BY-SA 2.0.