What more could America be were retired doctors free?

Meet Dr. Metz

A profile of retired surgeon Dr. Phil Metz ran in Sunday’s local paper, the Wilmington StarNews. I wrote it. The doctor and I talked for two hours one afternoon in April. Most of that conversation didn’t find its way into the story. Though unavoidable, it still felt like a shame. When one transcribes 7,000 words’ worth of interview, some of it’s going to be left out. Most of the time that’s probably a good thing. Most of the time many people say lots of things because they really enjoy hearing themselves talk.

Dr. Metz, however, is not one of those people. In fact, he’s someone I wish people would listen to a little more. Only he’s not tried to make anyone hear him. He’s wise like that.

I know this is just my tiny corner of the Internet—actually, it might not even be accurate to call this blog a corner. It’s more like one of those tiny tables in a Starbucks. Or maybe just one seat at the bar. But whatever this is, I’d be honored if you’d pull up a chair and listen to Dr. Metz for a few minutes.

I wish not to convince anyone of anything, because I’m still learning of what to be convinced myself. However, I find wisdom in others’ stories and what they have to say, particularly those older and/or with more experience, whether in life or love or a profession, than myself.

Before we begin, here’s the doctor’s story in a nutshell: he retired early because he tired of the long hours, but wanted to keep working. He couldn’t afford to do so in the States because malpractice insurance was too expensive. This apparently has become a problem for many retired physicians. So instead, Metz went to Mbale, a city in Uganda, and Kabul, Afghanistan, with some nonprofit organizations that help doctors do such things.

Why? From the StarNews story: "When I was in my practice doing cleft lips, I came to the conclusion that fixing cleft lips is probably the most fun thing you can do," Metz said. "Because you put a smile not only on the face of that child, but on his mother, his father, on all the people in that family – a smile that did not exist before. ... It's just pure pleasure on my part. I'll keep doing them as long as I can fix them well."

What Doctors Want To Do and Why They Can’t Do It

When I say I’d like more people to listen to Dr. Metz, by “people” I think I mean our government. Now, I know that I don’t know all that goes on politically. I’m sure they’re doing the best they can. At least, I want to believe that. (Of course, there are the times when I wonder what’s really going on up in there. Especially after talking to men like Metz. And reading books like Where Men Win Glory. I don’t enjoy imagining the worst, but sometimes I wish I wasn’t so informed.)

Anyway, the reason I say that is because it’s a pity – and practically criminal – that Dr. Metz can’t work part-time, doing what he’s doing overseas. Did you read that quote? You put a smile not only on the face of that child, but on his mother, is father, on all the people in that family – a smile that did not exist before.

That’s all he wants to do.

Naturally, the fickle monster that is money puts its stranglehold on the good doctor. Here in America, the land of the free and home of the brazenly willing to sue over anything, torts – a non-criminal, non-contractual wrongdoing such as, say, misdiagnosing a patient or making a devastating surgical error – have driven the cost of malpractice insurance to the heights of Everest.

Congress, Metz said, has “bravely” denied tort problems. (For more about what “torts” are, check here.) “We talked to [Congress] and tried to deal with it,” Metz said of the medical community. “ ‘ Oh, no, torts aren’t the problem,’ they said. But torts are a huge problem in the United States. They’re a huge problem in medicine. It basically makes it impossible for a physician to work part-time as he slows down and retires.”

In order to practice, doctors must first pay their insurance in full before seeing any patients.

“So if you’re only going to see five patients,” Dr. Metz explained, “you have to pay the same amount as a guy who sees 1,000 patients. You can’t afford to do that.”

Medicine is the only profession in which that’s the case. Metz drew a parallel with lawyers, saying, “Go to every law firm and look at their letterhead and they’ll always have off to the side someone ‘of counsel.’ That’s somebody who’s retired who comes in and does a little bit. But you can’t do that as a doctor. It’s 100 percent or nothing. That’s just the reality of it.”

Also a reality: our finest doctors, upon retirement, leave America in pursuit of their passion. While surely doing tremendous good elsewhere, what good have we missed out on as a result?

The reason I’d like to see our government listen to Dr. Metz is because he’s seen more than he’d like to remember. He operated on AK-47 bullet wounds during the Tet Offensive in Vietnam before he came home and opened his plastic surgery practice. He’s operated on five continents. He’s seen what works, what works better, and what doesn’t work at all. And he’s far from the only one.

What do our politicians know? I mean, really know. You can “know” something, like that Albert Pujols is batting .300 right now. You can “know” that’s the lowest batting average of his career. But “knowing” that isn’t quite like knowing how to hit .300 as a major league ballplayer. Sure, you might “know” to swing at good pitches and not swing at bad ones. You might even know the right way to swing, the proper bat path one must follow, and all that jazz. But if you can’t step into the box and actually hit .300 yourself, you don’t really know hitting how Albert knows hitting.

I can’t hit .300 in the majors. I couldn’t hit .300 in Division II baseball. But I “know” hitting.

Politicians “know” medicine. Metz knows medicine.

Who would you rather give you advice on hitting: Brandon Sneed or Albert Pujols? Don’t worry, I know your answer, and it doesn’t hurt my feelings. Much.

I very seriously doubt doctors know everything, even about medicine, even as experts in their fields. Nobody knows everything about anything, no matter what they say. But I think lots of doctors know a lot about a lot, and I think our government would be wise to, at the very least, listen.

About British Doctors, Who Apparently Are Lazy....and Why We’re Going to Be Like Them Soon

Health care needs reform. There’s no doubt about that. But the reform taking shape is not the reform we need. It leaves out important things while portions of it only further poison the current system. 

Early in our interview, Dr. Metz wryly stated, “The beautiful reform of the healthcare system that just got ran through fails to deal with the real problems that we have in this country. And one of the problems is that we have no method of retired physicians working part-time.”

Dr. Metz’s first trip overseas was three years ago to Uganda. He spent two weeks in Mbale, wherein he handled 25 cleft lip cases. Solid work. Had he been in the States, however, Dr. Metz could have done way more. Long ago, Uganda was imperialized by the British; therefore, their medical systems now operate like the British. The British, though they have riveting dialect complemented by fantastic accents, don’t make for the most diligent of doctors. In general, British physicians don’t start working until 8:30 a.m. and finish around 4:30 p.m., and that includes breaks for lunch and, of course, tea.

“Americans work harder,” Metz said. “You’ll find our ORs (operation rooms) working well into the night, through the middle of the night (in America). You hardly ever find that in England…The only thing they do in the middle of the night is true emergencies, with people who have had something awful happen to them.”

Elderly women have been carried into British emergency rooms only to be put up for a week before anyone treats them. Metz witnessed it himself. “In the states, it’s an emergency if some old lady breaks a hip,” Metz said. “They add her on the schedule, and she gets done at 6 or 7 o’clock at night. That would never happen in England. That’s a semi-elective procedure. She might spend four or five days in the hospital before she gets done. It’s not an efficient use of the hospital, but it’s the way the British hospitals are.”

He paused, then added, “And that’s where we’re headed.”

The “beautiful” new health care reform only further removes incentives from physicians, which were heading toward a shortage already. “There is a looming shortage of physicians,” he said. “Guys like myself who retired early or will retire early, because they’re tired of working so hard. (Metz regularly worked 60 to 80 hour weeks.) Once they take the incentive out of the system, there would be no reason to do that…In very few countries do they operate like we do in this country. So that’s just going to back everything up, because there’s not going to be any reason to do it.”

About Kabul

Kabul lies in the heart of America’s conflict with Afghanistan. Metz has been there twice. Once he felt the impact of an IED – improvised explosive device, a favorite homemade bomb of the Taliban – from 100 yards away. Felt like a baseball bat to the chest, he said. Every war has its signature injury, and this one will be brain trauma, Metz hypothesized.

Lazy British system of operation aside, Dr. Metz thoroughly enjoyed his time in Mbale. The people had little, but they had joy.

In Kabul, however, Dr. Metz saw the underbelly of humanity, and by that I don’t mean just the “bad guys.” There, he witnessed things he feared sharing with me. Not because it was too hard for him to talk about. No, because he feared the American government finding out he’d talked, and he didn’t want to deal with that. Wise man, the doctor. All he would share is that he’d like to return to Kabul, because there are good people there, but won’t yet, because “things just aren’t right there.”

“The average Afghan I met, the ones at the hospital,” he recalled, “even though they’re Islamic, they’re decent people trying to live. The Taliban is so dysfunctional. The government is so dysfunctional, they’re caught in a vice. They don’t know which way to go…They don’t know what to do. They just want to exist. They just want to live.”

So backwards are the Taliban that they destroyed Kabul’s entire medical library. The reason: they believed that pictures of the human body, any part of it, are evil.

I closed my profile with this:

"Things need to change there," he said. "They're horrible people, the Taliban. And that's the conundrum of Afghanistan. We walk away, they're back in, killing the women. … You can't just walk away from that. They don't care for the kids. It's just hard to believe this mindset that they have. You can't understand it. It's nonsensical. So I don't know what to do there."

So he does what he can. He fixes people in broken countries. He gives smiles to people with little reason to smile, except that now they can. He gives people in borderline hopeless situations joy, and maybe a little hope.

For most of them, that didn't exist before, either.

Wishes

I wish something could be done to give men like Dr. Metz the chance to do what he does here in the States, so he didn’t have to go somewhere else where his life is at stake. I wish he could give our people in our country those smiles.

What if men like Dr. Metz could afford to work in our doctors’ offices? What if we had honest men who are so passionate about helping people that they’ll risk their lives but so upstanding they’ll not risk their families’ livelihoods by chancing a malpractice suit?

Not to say there are no good, upstanding doctors. No, not to say that at all. There are plenty of them. But why should some of them be forced to practice elsewhere when they just want to spend some time, but not all of their time, helping people by doing what they do best and love most?

What could America be with their help? How could the face of America’s medical landscape look were doctors less fearful of lawsuits so they could be more free to do what they love? Some are surely in it for money. Such it is in any lucrative profession. But I believe that others, many others, are like Dr. Metz. They are doctors because they’ve come to the conclusion that what they do is the most fun thing they could do.

If only when they needed to be free from the shackles of 80-hour workweeks, they could still have that fun here at home rather than halfway around the world.