Buddy, Can You Spare a Retirement? by Pat Conrad MD

Meet Dr. Myron MacDonald, of Canada, a general practitioner in West Vancouver, British Columbia. Dr. MacDonald also has an interest in osteoporosis, “and is one of the original members of Greenpeace,” who is trying to retire. It’s tough sledding up in Vancouver, where the kindly doctor has run afoul of B.C.’s College of Physicians and Surgeons. His crime? This letter. In short it says, “I was a hippie, got married, sailed around the world where I learned a lot about nutrition, got divorced, was a dedicated doc, loved you all, make sure you take your Vitamin D (!), practice was too expensive, I need to retire but I’m running low, please help fund my retirement.” An actual quote from the 74-year-old: “Any amount will be of help to me. Perhaps $20 to $30 a month on your credit card could work for you.”

The B.C. College of Physicians and Surgeons statement says, ” “Any physicians who request money from patients to support him or her in retirement would be contravening a foundational principle which every physician is required to abide by: do not exploit patients for personal advantage.” A patient dutifully quoted by CTV News said, “I think that was wrong. It’s against medical ethics on that point.” I don’t have a lot of use for the field of medical ethics. Like many of you, I sat through an ethics class in med school, and that class and the couple of books I’ve read on the topic, combined with a keen appraisal of approved public positions over the past two decades have taught me that a great deal of it is more often than not, malleable, expedient crap sold by academia and government to justify their (usually bad) decisions. I could paper my office walls with the 4X6 glossies of physicians who think that health care as a right is an ethical obligation, those same docs being later flabbergasted that they are broke. I’m guessing that Dr. MacDonald is one such dupe, who states that he has a progressive neurodegenerative condition that is ending his productive years.

“MacDonald, 74, billed the medical services plan $163,978.42 last year, but says expenses chipped away much of that money, resulting in a letter to patients asking them to help him.” His reviews vary, but here is one that caught my eye: “The receptionist would not allow me to speak to the doctor. She said ‘he does not speak to patients on the phone.’ I said this is a simple quick question about my medical records, and asked why couldn’t I speak to him: ‘Because he doesn’t get paid’. This is typical of Macdonald’s office and the way he works” (And yes, I’m well aware that many online reviews are bogus, so you can read them for yourself). Does this story not sound a little familiar to you primary care types seeing Medicare patients? How about this: “But he (MacDonald) said his practice became a financial burden, partially because he didn’t bill patients for their annual physical exams, which are an uninsured expense.

‘I didn’t want to burden any of you with this fee but in the end I burdened myself financially.’” Dr. MacDonald was stuck in a lousy system designed to please patients but not their physicians, and then loaded up and shot off another couple of toes (a metaphor, not really sure about Canada’s gun laws) by not charging where it was appropriate and legal. ” He said he sent out a letter to patients several years ago asking for a yearly $200 contribution to cover the cost of other uninsured services like over-the-phone prescription renewals or missed appointments.” And what, apart from criticism, derision, and outright scorn did it get him?

There are so many lessons to this story. It highlights some predictable financial failures inherent in universal health care, including unfunded mandates, increasing regulatory costs with no commensurate revenue to balance, and no guarantees for effort expended.

It also demonstrates the case of a truly dumb doctor, one so busy becoming a martyr that he did not make sufficient provision for himself. Why not charge what your government master allows you, at least to minimize the damage? Harming oneself is NOT compassion, and if his sacrifices truly were, then he should not complain at all.

This showcases yet another toady organized medical society, no doubt fully in favor of the government health service’s edicts, and able to adjust their ethics accordingly and on a dime. How is a private citizen down on his luck exploiting patients by asking for a handout, unless he’s just making it all up? Does the B.C. College of Etc. take no part of their colleague’s plight, noting the result of government policies that they likely supported?

I suspect there is a lot we don’t yet know about this case. And I suspect that this is a do-gooder progressive who got his just deserts by depending on an anaconda that he helped raise. I suspect that a great many of his patients think that they had a right to his care, and do not respect him enough to bail him out they way he claims he once did for them.

Neither medical economics, nor medical ethics will stand the test of time without mutual respect between physician and patient, where neither party is to be exploited. That respect will not be present without some cash on the table, and some skin in the game. This case, if it is to be believed, is the exact opposite of DPC, where the respect is requested after decades of work is already done.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Buddy, Can You Spare a Retirement? by Pat Conrad MD

  1. Bridget Reidy MD
    December 16, 2016 at 12:00 pm

    He’s not dumb. His business practices are pretty standard here in BC, (among honest doctors -many charge the physical fee routinely to the government even though the rules changed to where it’s hardly ever justified while patients and doctors still find it necessary due to tradition.) And as all self-employed docs know annual billing is not annual salary. It’s hard to be a caring doc and bill for services patients expect to be covered when they are not, or need them but can’t afford them, and there’s the usual tons of uncovered unbillable work we do. It shouldn’t have anything to do with medical ethics if he sends the letters out in his last week of practice, and the College should have no control of him if he is no longer licensed (though they probably have some way to enforce their rule about us storing records afterwards).
    Here in Canada we have the same problems with patients assuming we are wealthy, but it seems we have a larger middle to upper middle class retiring very comfortably between their pension and their home equity, who assume we are in the same boat. I applaud him for getting this issue in the news, so my patients who are wealthier than me don’t balk at bills or me expecting them to make two visits to do the work of four.
    I’ll be retiring in poverty. I’m not dumb, just unlucky and more interested in doing what’s best than what’s lucrative. I hope by then the middle class patients I’ve helped a great deal want to take me out for dinner sometimes or enjoy their hospitality in their lovely houses on the coast, or maybe take me to a show, but it won’t happen if the general public just doesn’t get it.

  2. Ben Van Raalte
    December 11, 2016 at 12:46 pm

    Contrast that to the United States where California public employees have $100,000 a year or higher pensions. Or Chicago where teachers retire at 95,000 a year. Professors at the medical school UIC getting over 400,000 a year pensions.

    Our public employees make sure their retirement is generous.

Comments are closed.