THE BROOKLYN MEDICAL JOURNAL.
EDITORIAL.
THE FINANCIAL RESULTS OF MEDICAL PRACTICE.
The medical men of the Bay State have been treated several times during the past decade to the mournful story of the meagre financial results from a life-long practice of medicine in that commonwealth. The detailed cases, narrated by Dr. Cotting, were pitiful enough, for they were proof that a faithful, conscientious and skillful medical career could find little laid aside for the “rainy day” of personal illness or the vacation for the tired brain and body, or the reposeful life of a physician’s family when death had closed in on his labors. In the same strain Dr. Jeffries, in his late annual address before the Massachusetts Medical Society, proclaims that “no man has made a fortune as a physician, I mean no one ever paid his expenses and laid by at interest enough to live on through the practice of medicine.”
This breathes in the atmosphere of complaint as if the profession of medicine were exceptional in life’s vocations; as if it, alone of all the lines of work, did not lead to financial results where “enough to live on was laid by at interest.” It is very pertinent to ask, in what pursuit in life inheres that tendency to make the laborers therein independent of labor? It is equally pertinent to ask, where is there an instance, in the history of labor, where a man, following the duty common to his fellow workers and relying on his own unaided hands and brain, ever acquired the competency to live, in his accustomed sphere, independent of labor? Dr. Cotting’s instances of the poverty of medical men are pitiful, but they are duplicated in the ranks of the promoters of literature, art, science and philanthropic work through historic time and will be multiplied to the end. Great wealth is the possession of but very few and, on the lines of legitimate industry, is always the result of combination and the use made of the labor of others. In the early part of the century, Mr. Astor founded a fortune by buying up pelts from the trappers of the Northwest. Had he depended on what his own hands could have done, his old age would have found him drying his skins and frying his bacon with his own hands in his forest cabin. Mr. Carnegie to-day, utilizing the labor of miners in iron and coal and giving direction to the skill and toil of a multitude of mechanics, is still adding to his fifty millions. Had he depended on the limitations of his own brawn, he might still each evening be washing the grime from his horny hands under the faucet in the hallway of his tenement house lodgings. These great possibilities of combination are in the genius of commercial enterprise, though they are realized by few. They are foreign to the genius of labor where combination is impossible, and where the labor is of such a character that there is no monopoly of skill and many can accomplish it equally well. A medical man’s labor is limited by what he can himself do, personally and unaided. He can neither delegate nor superintend. His income is limited by these personal conditions, modified only by the possession of some exceptional skill and the accidents of popularity or environment. The engrossing character of his occupation hinders him from the experience that justifies outside speculation with acquired capital and restrains him from participation in outside ventures which require freedom both of time and thought. He cannot well add another string to his bow.
The results of combination in trade and the income from professional labor are issues from distinct and opposite sources and have no right to be compared or made the subject of invidious reflection. A number of lawyers, each an expert in a special department, may form a partnership, occupy a common office, each helping the other, the emoluments going to the common fund. This is a sort of combine. But the time is not yet ripe, and probably will never come, for the incorporation of a great Medical Trust, with the names of a specialist in eye, ear, throat, nose, lungs, liver, sphincter ani, corns and fallopian tubes, and so on to the minutest subdivision, with the addition of some general practitioners and apothecaries, displayed around the casings of some common front door, to scoop in the community and pool the receipts on a graded tariff. Trade is essentially selfish and works for the individual. “If you don’t work for number one, number two will be working for you.” The accumulation of money is neither end nor contingent in professional life. The pursuit and application of medical science are on the higher level with the learning of jurists, scientists, educators and literateurs, whose mission is the unselfish search for knowledge for the immediate benefit of mankind and the advance of civilization.
While it is true that very few in any calling “lay by at interest enough to live on,” a very small number of that few do actually retire from active work and live on that interest, and this for two reasons: First, a man in successful professional life is in receipt of an income which enables him to live in luxurious surroundings, gratify tastes and enjoy recreation, which income, considered as interest, would represent a capital sum exceptional even among the results of successful trade, stock gambling or railroad wrecking. Such a man, and he is one of many, could live on what he “has laid by at interest,” if he saw fit to live in less luxury and sacrifice the gratification of tastes which have been cultivated and become necessary to his comfort. He could live on his interest, but he does not care to live in idleness. On the other hand, the conditions of a cultured life are of an ever widening horizon, and it is characteristic of medical men that their intellectual sense is inquisitive, keen, appreciative and alert in their own sphere of action, less satisfied with what is and more anxious for better results, beyond the genius of any other professional life, and this for the distinctive reason that every new discovery in medical science promotes accuracy in the application of medical art. Working becomes a passion with medical men; the more they know the more eager they are to work. This passion is not to “lay by at interest enough to live on.”
It is quite in the sentiment of medical addresses to bewail the profession as ill-paid, and that, for a learned and self-sacrificing body of men, its labor and accomplishments are very inadequately rewarded. The exact contrary is, probably, very much nearer the truth. There are many learned men in the profession and there is a wide range of special learning which is the common property of the profession, and all are more or less adept in the use of agencies of the art. There is, likewise, a vast amount of patient and uncompensated care given in the routine of practice, which is a natural outcome of the practice of the medical art. It would be absurd to claim the diploma as representing a liberal education or even high special attainments, as it would be ridiculous to assert that a dispensary patient regularly received the attention given to the German Kaiser or General Sheridan. There are instances of failure and poverty among medical men, but when the doctors in the country stand to the population in the proportion of 1 to 580, the assumption is that they have become needful, each to his 580. Doctors have many book charges that are not collected. Laborers are swindled by their bosses, and every business man meets his unlucky customers; the parish gets behind with its rector. The doctor is no worse off than the rest, and besides he has no salary list, and no accommodation at the bank to make good.
Most men are discontented, and the want of contentment is just as querulous with the cosmopolitan reputation that unblushingly pockets a double eagle for a few raps on the thorax as with its suburban and obscure double that explores a whole chest half an hour for a dollar. The latter pays a shilling to the village blacksmith to reset a shoe, and the former hands over eight dollars every time the farrier looks at his team. Discontent goes with a misfit, and Depew told the Syracuse students that “misfits were everywhere and were always cheap.” It is doubtful if, upon the whole, there are in any walk in life such an unbroken line of splendid fits, the man to his duty and his clientage, as in the medical profession. It is not to be doubted that medical men, each to his location, his culture, his taste and his instincts, are better housed and clothed, more liberally supplied with the machinery of their technique, have greater demands on their purse in the interests of charity and reform which are duly met, have better educated families, have longer and more frequent opportunities for enjoyment which are not wasted, than can be counted item for item on the balance sheet of the average worker in any other profession or occupation. And these are the proofs of financial success, and they put aside the plaint that because the doctors do not “lay by at interest enough to live on” they are an ill-used class of men. The community pays liberally for being taken care of, and it ought to. The medical man’s entire time is taken up in acquiring the experience to exercise prompt judgment in emergencies, and this is precisely what the community pays for and is far from niggardly in the payment. Experience, needful to prompt judgment, is worth more than day’s wages or marginal profits, and this the community recognizes, and its estimate on the value of this experience is generally just. It may not be invariably accurate, but a doctor’s annual cash total is a very liberal estimate of what his individual experience is worth to the community. If the doctor does not “lay by at interest,” it is not because he does not receive enough, but because his relations to life make a free expenditure of money a necessity. He is at a certain disadvantage with a fair share of the people in being compelled to pay his debts. An excellent physician who is also a bohemian or with loose ideas as to honorable obligation, would be a nondescript. He is a fixture in the community with an open reputation, and it is proof of his liberal income that he is able to make and sustain that reputation.