Home Forums Discussions General Discussion 2 years later

I have been gone from this board about 2 years. At that time, my wife/medical partner and I had made the decision to leave private practice and take positions at the hospital on Saipan, in the Northern Mariana Islands. If you look at my posts, you will see that we had a successful practice in Alaska. While it was a really great, lucrative practice that had made us financially independent with a patient base of people we had come to consider our friends, it had gotten stale. I had been reading all of these posts on the board from doctors who were in despair about the horrors of practice in the lower 48, and when we decided to move posted an offer; we would give away our practice; hardware, software, charts, equipment, delightful patients, great staff eager to keep working, pictures on the wall, pencils in the drawer.. ALL of it?for FREE? no strings attached? to anyone who wanted it. We got no takers. At that point I decided that they would rather suffer and whine than change. I decided they were correct; they COULDN?T move because they were locked in the prison they built for themselves. I posted our experience hoping that some would see that there were other paths possible , but only got some snarky comments like ?Well, we can?t ALL move to a Pacific island.? I felt ?dissed? and just quit.

But, today I got a note from a physician who had read those posts, and is thinking that for him, too, there is another path. So, I will tell of our experience.


We are a ?real? but small (about 80 bed) hospital. We have 2 general surgeons, full time IM hospitalists, an OR with 2 suites, a fully staffed ER, delivery rooms, a 4 bed ICU, respiratory therapy, a decent lab, x-ray with ultrasound and CT (read by radiologists in Guam) a half time gastroenterologist, a full time nephrologist and busy hemodialysis unit. All physicians are US trained almost all board certified, the vast majority born in the USA. If you found yourself in Bisbee, Arizona I bet it would look similar, except for the patient demographics. We have about 40% native Chamorro and Carolinian, the rest Filipino, Chinese, Japanese, Korean, Palauan, Bangladeshi. Our psychiatrist and his family are from Qatar and practicing Muslim, the island is heavily Catholic, I am ?other? and no one gives ia damn. My wife and I are caucasian former Alaskan, and we Anglos make up about 4% of the population. I feel totally accepted and at home. If you wanted your kids to learn about different cultures, this is the place. It is a vacation spot for Japanese, Chinese, and Koreans, with a bunch of resorts, and a million Asian restaurants. You can buy fresh fish along the shore most days from local fishermen. There is a farmer?s market with local produce Saturday mornings. It is about a 3 1/2 hour flight to Japan, China, Korea, Manila. Friends not rarely go to Tokyo for a long weekend. I hear rumors a low cost airline is planning $150 round trip tickets to Inchon. I myself love diving so I am making it a point to dive the islands. So far I have dived Saipan, Tinian, Rota, Palau, Pohnpei, Kosrae, and Pelileu. I have Chuuk and Yap to go. And, I still have nearly 2 months of vacation time saved since I got here 2 years ago, including 2 10 day trips back to Alaska.

So now we are here, taking care of people who have very little and treasure what we can offer. We are in a salaried position working very long hours for the government, making about 1/3rd of what we made in Alaska and giving thanks every day for what we discovered. Not a week goes by that I don?t get a hug from some little old Chamorro lady who thanks me for being here. I just melt. We live in a house on the side of a mountain in the jungle, overlooking the Pacific ocean. We have a garden granting us more tropical fruit than we can possibly eat. Behind us is a cliff riddled with caves and shell holes from WWII. 10 miles away is Tinian, the site of the busiest airport in the world at the end of WWII, and where the Enola Gay took off to drop the atom bomb on Hiroshima. The old airstrips are still there, the pits where the bombs were loaded a monument, bunkers and buildings still standing amidst the jungle And when I have visited it I have been the only person there. It is beyond awe-inspiring.

This isn?t for everyone. One has to be willing to sever a lot of ties, or at least make sustaining them difficult, and be brave enough to take the plunge. Our daughter (who graduated from high school here) is in college in Michigan, 10 time zones and (thanks to the dateline) one day away. When we call it is very early Sunday morning for us and late Saturday for her. It is often a strain, but we have all grown. We lost a lot of conveniences. If you can imagine that people go to Guam and rave about shopping at K-Mart or having lunch at Burger King you may understand. But despite all that it really is the job we have always wanted. Perhaps if you are unhappy there is something out there for you, too.

Thanks for the update, reading your post was able to see many images in my minds eye, thanks again and continue being well.

Thank you so much for checking in with us. It's good to hear about your new life. Practice is still good here in Alaska. We are building a new medical clinic so we don't have to rent for the next couple of decades and would like to expand. Obamacare continues in its death spiral: we have one participating company on the exchange now. One of my patients just announce his premium is changing from $2000 per month to $3000. Another patient has a small construction business. He works about 80 hours a week in the summer. He has cancer, so he is locked into his plan which costs $4000 per month. But hey, we have the Affordable Care Act and we have ""insurance." On the Horizon is Meaningful use "Stage 4 on Steroids" MACRA.

I'm sure you're glad you left all these things behind. Enjoy the diving, the history, and the intense cultural experiences!

Chris --
Did you go there to retire?
Do you plan to stay there permanently?
Is it like working on an Indian reservation? -- Tremendous gap between the Whites and the Natives that leads to a certain level of permanent resentment that eventually becomes too hard to deal with?

I don't believe I could give away my practice in Astoria, either. No one wants to be a "PCP" any more -- its a job for losers.
Except, that after 28 years in one place, I have a lot of patients who beg me not to retire.

I plan to work about another 2 decades before retiring. I plan to stay in AK, at least until someone destroys the healthcare system. All the Natives get free medical care at their own clinics, and I serve mostly the regular working families, most of them are Caucasian. If anything, we envy the free care the Natives get. Maybe you would like to come up and check it out sometime, perhaps semi retire at 3 days per week?

David,

I just read your post, and I am confused. I don't remember those snarky comments. I don't think I would look at it like you got rich so now you can live in some tropical island.

I think your offer was incredible. I thought about. I imagine many thought about it. Especially those who knew you the way a lot of us know you. Sure, I whine all the time. I would have to say that, all in all, I hate my job. I get thanked every day. At least two out of the 25 to 30 I "HAVE" to see every day. I would much rather make more money and have it a lot better in Alaska. It's not like I was in Florida and had to decide between hell in Maine or paradise in Alaska. There is just something called inertia. The rat race. The "hard to change what you are doing." The can't see 30 days down the road, because you are at the office until 11 pm finishing charts.

So, I think MANY thought about it. Just like I think about it when I get an email telling me there is a job in Austin, TX paying $280,000 a year, six weeks vacation, four days a week, no call, full benefits and all loans paid. But, it is hard to leave a practice you have built over ten years. 2,000 patients who consider you "their child's doctor" until they are 18.

I respect the hell out of what you did.

David
that sounds so spectacular! Great to have guts and go for the gusto. So glad you were able to find what you were looking for. I'm not sure I could do it - I could not leave my family ties here.
I am not complaining about the clinical practice of medicine. Working in my micropractice with a stable population of 750 patients over the past 12 years, I too have been the beneficiary ( and on the giving end too ) of deep and lasting appreciation respect and caring from my homogeneous, white, relatively privileged population here. People are people wherever you are, whether rich or poor, white or non white and the ties that bind us appear to be the same. Previously had worked in a Latino - immigrant based FHQC for 15 years and had been hesitant to move to this practice location in bikable/runnable distance from my home due to just the homogeneity of the population and the air of privilege issues, but this turned out to be not the issue. Rich people need doctors too ! The issues here are primary care payment and the sheer volume ( and increasing) of crap 'quality' documentation authorizations etc being in practie requires. But you cant have everything apparently. As long as I have the most important things, then I remain overall satisfied with my choices.
Lynn

Bert.. I just heard ( and still hear) so much despair. I just wanted to reach out to you all, my friends, and say "it doesn't have to be that way. We are so lucky to be allowed to do what we do. If you feel trapped, there are alternatives...". It was so disheartening to feel I was shouting to the void, and for some just being annoying.

Lynn.... you are spot on. Rich people need doctors, too, and caring for them gave us the freedom to do this without worry. We just inverted what you did, and came to feel we needed to pay back some of what we had been given.. I feel my answer to the question of why we are here is "we are people who always wanted to join the Peace Corps but went to medical school instead". There is no part of my former life that I don't still love. We just feel we are getting two lives for the price of one.

That's nicely put David. I'm glad it is working out so well for you. I hope you will keep checking in with us here, people who care about you.

Thanks David. I don't think you were ever thought of as annoying. Trust me. I look for a way out every day.

David: one thing I've been able to do to expand my horizons beyond my office door, is going on medical missions to countries with poor healthcare infrastructure. This has really opened my eyes and improved my diagnostic and treatment skills, not to mention understanding of vaccines and tropical medicine. It's wonderful to practice medicine with no burden of documentation, and this also helps a team of 6 to see 600 patients in a day.