Practicing Urology as a Catholic Physician

In the late 1990s an observer might think that I had it all. I was happily married to a beautiful woman and we had three beautiful children. My urology practice was very busy, our home was comfortable, and overlooked a bay off of Lake Michigan. Long bike rides with friends in the summer and strenuous cross-country ski outings in the winter kept me in great fitness. We attended our Catholic church every Sunday and our children attended the Catholic schools.

But, something was missing.

Back in 1992, while I was serving as a urologist in the Air Force, my wife delivered our third child after a difficult pregnancy. At the time, we thought that a vasectomy was an appropriate thing to do to prevent future difficulties. Little did I know how that error would impact my future.

Once in civilian private practice, I offered the typical spectrum of urologic services to my patients, including vasectomy and fertility evaluations that included my requesting masturbation collected semen samples.

I participated with the usual panel of insurance policies, but over time, it was evident to me that the insurance company presence in my exam rooms was corrupting the sanctity of the patient-physician relationship. The ever-growing bureaucracy that hampered the delivery of good medical care frustrated me. It did not make sense that I would have to spend so much time and overhead expense just satisfying insurance company’s requirements to get paid for services rendered to their policy holders.

During 1998, while my wife and I were escalating our efforts to live good Catholic lives; we decided that my professional life had to reflect the same degree of Christian virtue that we were striving for in our personal lives. I felt that the most ethical way to practice medicine was to return to a direct relationship with my patients. I had to be responsible to my patients by providing the very best urologic care, good and cost-effective service and at a fair price. In exchange, my patients would need to participate in their care and pay me directly at the time of service. I decided to perform the proverbial “medical office administrativectomy.”

Over several years, I gradually cancelled all of my commercial insurance contracts. I de-participated from Medicaid. It actually cost me less to provide care to the poor at no charge than to fight with Medicaid for the ridiculously low reimbursement. I could then give poor patients special discounts or atypical treatment plans to meet their specific needs when that would not be possible within the insurance participation contracts. On October 1, 2001, I opted out of Medicare and had created the first cash-only urology practice in this country. I lowered all of my fees, my overhead expenses decreased by 75% and my hourly income increased. I was no longer subjected to HIPAA and medical coding compliance regulations. My practice volume initially decreased steadily until, in early 2002, I was seeing 10% of the total patient volume from the previous year. Some months, in that first year as a cash practice, I did not take home a paycheck.

Since 1991, I had developed a niche subspecialty of radical perineal prostatectomy for prostate cancer. My publications and international presentations fueled a referral practice for difficult prostate cancer cases. However, in the Spring 2002, the financial condition of my practice was not very impressive. As I looked at my schedule book, there were a handful of appointments scheduled for the next couple weeks. Most of these were for vasectomy consultation or vasectomy procedures. There was no doubt in my mind about what I had to do, but I was not sure that my practice would survive another hit to the bottom line. With some trepidation, I instructed my receptionist to call those patients to cancel their appointments, as I no longer provide that service. It would seem odd to many people that you can’t get a simple vasectomy at your local urologist’s office, but then again, this was not your ordinary urology practice. At this point, I was not sure whether I would have enough business to meet my financial obligations, let alone remain in practice. It was quite clear to me that I could not perform vasectomies and still think that I was living Catholic doctrine – even if that meant going out of business.

Concurrent with the changes in my practice regarding vasectomies, my wife and I came to terms with the mistake that I made in having a vasectomy after my youngest daughter was born. In my mind, there was only one thing that I could do to seek absolution for this sin. After my successful vasectomy reversal, my wife and I gave up any attempt at interfering with God’s will and our fertility. While we still only have three children, there were several times when I was sure there would be more. We strove to incorporate Christ into our marriage and every aspect of our lives, despite how atypical that seemed in the milieu of modern urologic practice.

Today, we have greater peace of mind, heart and soul at home and work since this transition. With a slower urology practice, I have been able to provide better and timelier care to my patients. I have also had the time for important activities such as assistant scoutmaster, assistant golf coach and participate as an active parent for the cross-country ski team. I spend more time with my wife and children and my prayer/devotional activities have reached new levels.

Within a couple days of clearing my schedule of vasectomy patients, the phone began to ring again. My schedule repopulated with prostate cancer patients and my volume gradually increased until I was seeing 40% of my prior volume. My take home income was 60% of my prior income, but my work hours were about half of the crazy hours that I worked in the mid-90s.

As long as I trusted God to take care of me, I had the right amount of work to exceed my financial needs. My practice grew and became the preferred practice for patients in my community. I was not overly busy, but had the optimal clinical load to meet my needs. At times my schedule would get lighter, and some other demand for my time would arise. On one occasion in 2010, my schedule seemed lighter than usual. I did not understand this initially, but within a week or two, a medical emergency at home occurred that necessitated my being available as a primary caregiver for several weeks. As that need abated, my schedule became busier. Over time I have come to understand that I am a passenger, not the driver or navigator, on this journey and the sooner I sit back and enjoy the ride, the better the ride will be. In 2014, my wife and I share our marriage and family with Christ. I pray while scrubbing my hands before surgery for guidance to positively impact my patients and my operating room team. At home, we pray the rosary together daily, pray the Liturgy of the Hours, attend adoration (my wife) and try to escalate our obedience to the Word. We make more regular use of the Sacrament of Confession and spiritual guidance. While we are challenged by the anxieties of life in this world, we are better able to cope with the trials that we face. The peace and calmness that we feel now compared to the rat race that we were living, is remarkable. We thank God for the wisdom, strength and perseverance to embark on this journey.