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.