What Price, Integrity?

2000 Euro, apparently.

Through a housing allowance loophole, I could have almost certainly been approved for an extra 1000 Euro per month for the next 2 months.  The arrangement would have been a classic “kick-back” scenario between me and the owner of the house we’re buying.

However, in a last-second surge of some strange amalgamated emotion at least distantly related to those of guilt, honesty, obligation and craven fear, I killed the deal.

We are, in fact, buying this house, but will rent it for 2 months until the financing officially comes through.  During this time, my housing allowance will cover the rent – nothing more.

Quite honestly (since we’re on this honest kick), I feel sick about it.  I feel like I walked by $3,000 cash in a bush, and left it there.  I also feel it was the right thing to do.  But believe me, I had all the paperwork set up to take advantage of the oversight up until the final hour.

I should mention that the stakes are high right now.  The move to Europe is turning out to be much more stressful than I imagined.  This place is UNBELIEVABLY expensive.  I don’t understand how anyone can afford to even breathe out here.  I need to get my family out of debt…not go further into it by moving out here.

Let me quickly describe a government “housing allowance” as it pertains to me.  Termed the “LQA” or Living Quarters Allowance, anyone approved to live “off base” (most of us civilians are) is put on a scaled allowance.  You get more money for your status on the hiring scale (I’m waaay up there), and your number of “dependents” (pretty thin air on that one too).

So, when initially told of my housing allowance, I rejoiced!  I’m allowed thousands of dollars a month to spend on housing and utilities.  What a sweet deal!  In deciding if I could afford to take this job, I added my allowance ceiling (close to 50,000 per year!) into my yearly salary.

Keep in mind that my government pay as a doctor is very low in comparison to my private colleagues.  But when I added my LQA – viola! – my salary magically became competitive with the rest of the new-entry family docs in the country.

Then I arrive here to find that, essentially, it’s impossible to spend my LQA.  The arrangement is a “use it or lose it” kind of thing.  If you only spend half of your allowance, you can’t have the rest in cash.

The allowance, really, is a virtual amount that allows me to live pretty much wherever I want during the time that I’m here.  But even the nicest places in the area don’t rent for anywhere near what I’m approved for.  It’s like being told that you just won 1 BILLION DOLLARS!  Buuut, you can only use the money on M&M’s, and they can only be eaten, not sold.  Effectively, I’ve been given a lifetime supply of all-I-can-eat M&M’s.

I can’t have the cash, and, as you might imagine, I also can’t go to a landlord and say, “You’re charging 1100 euros a month for rent.  I’m approved for 3000.  How ’bout you and me split the difference every month?”  A housing office has to approve the rent amount based on an inspection of the house, and it won’t pay above that amount.

This thinking is classic for government, where everything is about sustenance.  Nobody is supposed to capitalize on government money.  You can only be sustained by it.  If you’re important, you can be sustained in really nice conditions.  If you’re not important – crappy conditions.  But either way, you aren’t to actually make money.  It’s unapologetic communism.

Getting kickbacks from your landlord is considered unethical.  And, effectively, this is what I had the ability to do for the two months until we buy our house.  As mentioned, I didn’t go that route.  I feel sick about it.  Not noble.  Not honest.  Not righteous.  NOT cool.  And pretty dumb.

Here’s a few reasons I pondered to justify the choice:

-The unethical thing is that doctors are paid so little in government work. They should have a program that either pays salaries commensurate with the private sector, or add an actual and functional loan repayment component to the salary (most current guv repayment programs are worthless – at best – and complete deception at their worst).  I really, truly, don’t care about money.  But the debt I carry sickens me.  I’m left to fend for myself on their paltry salary and a lifetime supply of M&M’s.

-I was deceived about the LQA.  Sure, it wasn’t deliberate…probably.  All the details and stipulations were simply left out.  But I came out here thinking my salary was 50k better than reality, when it’s really only about 15k.  Yeah, it’s cool to pick virtually any place I want to live.  But not really.  I’m chained to my debt.  And those chains are pretty heavy…too heavy to allow for much swimming in my rented pool in my rented German villa.  I need to make financial choices that will free me and my wide-eyed children from this financial prison.  The system should allow for that and it doesn’t.  I need to exploit loopholes wherever I find them.

-Also as a wealth-building strategy that I would HAPPILY forgo were I debt-free, we are choosing to buy this house. This puts added pressure on me to be happy in my job, and to stay in Europe for 5-10 years, rather than my stipulated 3.  If I want to leave, owning a house highly complicates my exit strategy.

-My mortgage is nearly $600/month more than the housing office has approved for the house in its current condition. So, if I want to rent the house to someone, I can only charge the max amount approved by the Housing Office.

However, the house has an extra bedroom that was not counted during the last inspection because it needs renovation.  We could pour 2000 extra Euro into renovating that bedroom and adding a bathroom next to it.  This would increase the allowed amount I can charge to a renter. I’ll bet the house would get approved to an amount very close to my mortgage with some good renovation.  Then, I can go to work every day in the freedom that if I get fired, or if funding for my slot dries up, or if I hate the job and want to go home…I can rent the house out without going broke (houses don’t sell well in Germany…sometimes sitting on the market for years, but the rental market is hot because of the military activity).

-I won’t get caught. People do this kind of thing all the time.

-I’m only using what I’m approved for. Not more.

-The Realtor did it. I didn’t think this up.

-Maybe it’s ok in my case, since the loophole doesn’t exist for most others (my rental contract doesn’t need approval from the housing office).

Reasons Against:

My Dad’s face in my mind: The guy works every day.  Supported me every day since he adopted me.  And pays taxes, every day.  He got behind on taxes once, and getting square with the IRS nearly killed him.  But he did it.  Little by little, he gave them every dime they demanded of him.  My housing allowance is paid for by guys like him.  I’m not ripping off millionaire Senators with health care for life…I’m ripping off honest, real Americans who believe that their taxes are being used appropriately.

-Professionalism: Frankly, many of my generation’s colleagues, myself included, hate this word.  What once was a sterling understanding between every member of my profession has become an strategically ill-defined mechanism for manipulation, money-making and power-plays by Boomer Gen on Gen X/Y.  Happens all the time in residency, but banks play the game, insurance companies, lawyers too.

Still, a fundamental element of professionalism is a high standard of honesty.  We say what we mean, we mean what we say, we stand by our word and play it straight.  Doctors regard trust as immutable currency in the most sacred component of our profession, the doctor-patient relationship.  This is the very fabric of our livelihood, and it all is built on trust.

-My training: Let me be discreet here in saying that during residency, I had a few moments where I was *ahem* mildly cavalier regarding my whereabouts on certain mornings.  This lackadaisical approach to the exact truth led to some harsh responses from those who oversaw me.  I got my ducks in a row pretty quickly.  Now, the stringently honest approach is the only one that feels right.

-Sleeping well: Also a lesson learned in residency: if you didn’t do anything wrong, you don’t have to worry about getting caught.  In the movie, “The Hunt for Red October”, a submarine captain prepares to fire torpedoes at an enemy ship…but first he puts a safety on them so that they can’t explode until they have been swimming around for awhile.  “I don’t want those fish comin’ back on us!”  He says.

For me, the same thing is true.  I don’t know – really – how closely they’re watching what I do.  Maybe this is a big problem right now.  Maybe they’re working on closing the loophole and will be auditing everything once they get the new policy in place.  Maybe, maybe, maybe.  I can go to sleep tonight not worrying about the maybes.  I played by the rules.  If something is messed up, I know it’s an honest mistake – that I’m not “busted”.  Makes for an easier thought life (allows me to wring my hands about foreclosure without any messy distractions).

So there you have it, folks.  The emotional undulations I’ve endured over this weekend, mulling the ethical conundrum over and over in my mind.  I feel sick about it.  Improving the house doesn’t just help our investment.  It gives me freedom in my job, freedom to enjoy Europe, freedom from worry.  The pill has been a bitter one.

My brother told me recently that now, as a doctor, I’m not really going to care about a few thousand bucks here and there.  Sure, I’ll be careful with my money, but a few grand won’t be something I’ll break my back for like I would have in the past.

I hope he’s right.  Because that 3000 bucks sure feels like a lot of money at the moment.  I’d work pretty hard for those extra thousands right now because of how much they could help us.  But apparently, I won’t lie for them.  One day, finally out of debt, I suppose I’ll look on this choice as a good one.

For now, I regret it….although I am looking forward to a good night’s sleep.

Reply To ‘Dentist’ Comment

I recently wrote a blog (Sales In Dentistry) decrying a dentist’s attempt to sell me an expensive toothbrush while I sat helpless and captivated in his chair.  The blog generated quite a backlash from some dentist’s groups.

One of the comments on the blog, however, was so thoughtful and challenging, I decided I would turn it into a second blog.  Below, I’ve pasted parts of the comment and replied to them (in red).

Dear SecretWave 101

I read your blog with great interest.  It is an unfortunate commentary.  In my office we are constantly trying to help our patients get what they need, but it is always a challenge to not appear to be selling when one makes the diagnosis and has the solution for the problem at hand. That’s just it…THE solution is not a branded toothbrush, there are others on the market…my dentist should have pointed out pros and cons to each of them.

Some people call this convenience and others, like you with a half empty cup world view your half empty is my half-real, tomato-tomaghto, brother look at this type of presentation method as a “selling for profit” conspiracy.  To address the facts of your case experience:
1.  You were examined by a licensed hygienist that presented her findings to a licensed dentist that made a professional diagnosis of advanced periodontal disease and suggested a plan for treatment for the diagnosed problem. If they’d dropped the toothbrush infomercial, I’d believe that more easily.
2.  You perceived the diagnosis as patronizing because they had a solution to your problem at hand in the office in the form of an expensive tooth brush. As mentioned…A solution, not THE solution.
3.  You lost faith because it was “too” convenient a diagnosis and appeared to be in the best interest of the dental office and team. The problem wasn’t convenience, it was bias.  There are other options that weren’t presented.
4.  You did not accept treatment because of your lack of faith in the diagnosis and the apparent “selling atmosphere”. I might have given that impression in my blog, but in fact I actually did buy an electronic brush (Oral B – 80 bucks at Costco)…and then went shopping for a dentist I better “connect with” (read: trust)
5.  You posted your experience on line for all, including half empty people like yourself, to commiserate with you and to further cast a negative light on dental profession’s ethics.  True.  And your critique here is fair.  I’m willing to consider that my blog entry didn’t promote collegiality among professionals and potentially denigrates your profession to patients, which really wasn’t my intention.  But for the moment I can only meet you half-way on that point because I do believe my main points are fair criticism. Perhaps I chose the wrong venue.

Sounds to me like a lack of faith in yourself self-doubt is my constant companion…and we’ve become, if not friends, at least good neighbors, although I agree that it appears to be a conflict of interest to some people when a solution to a problem is proposed by the same person that found the problem.  My mother always taught me that unless you have at least a proposed solution to a problem, that you should keep your mouth shut.  I thought I outlined my very simple solution…don’t sell crap in a medical office.  Ever.  It’s available in stores everywhere.  There’s NO reason to do it except to make a profit and in the process eliminates competition between brands.  And this isn’t my solution.  It’s ILLEGAL for doctors to have a pharmacy in their offices for the same reason.

By the way, the meat hook “periodontal probe” is really a graphic perception and betrays your world view.  Fair attack on your part.  Graphic.  Unfair and a bit exaggerated, but I just can’t keep my hands out of the hyperbole cookie jar.

My team and I will have a great time discussing how we can deal with people like you “Mr. Half empty”. That’s doctor Half empty, pal There has been quite a bit of discussion about your blog on at least one dental forum *polishes nails on lapel*, and I appreciate all the positive comments.

I suspect that deep in your psyche you have some severe reservations about your own personal honesty see self-doubt comments above.  This is projected to others by you, and you perceive that others are trying to “rip you off”. Actually, I’m fairly gullible…

Trust is essential to any form of long term communication, and because of your deep seated insecurities, you are unable to trust Let’s see, this is deep seated?  Madoff, World Com, Lehman Brothers, Ted Haggard, Enron, Scooter Libby, Barry Bonds, Roger Clemmons, *sigh, inhale* Richard Nixon, ‘Iah did NOT have sex with that woman’, Bill Richardson, Baron Munchausen…who, exactly, should I trust? I suspect you have significant problems with long term relationships you are free to ask my wife of 11 years or 4 kids about that, or maybe my parents with other creatures actually, I”ve only recently managed to form a lasting relationship with a cat…I’ve consistently dropped a number of them off at the pet shelter in years past.

Since you posted this blog and have acknowledged a problem that I also recognize in organized medical and dental services “conflict of interest”, what is your solution?  Don’t sell stuff in your office.  Just don’t. Be a dentist, not a salesman.

As for all your patients that have chronic dental needs without treatment: dentistry and periodontal disease, it is usually a self inflicted disease secondary to poor personal habits and low self worth.   You are espousing classic conservative ideology, which I don’t always disagree with.  But in the realm of basic health services, I think people with a tooth abscess should be able to see a dentist.

How do you propose that medical practitioners help others without helping themselves?  I don’t.  We all have to make money, and health pros should be well-compensated for their expertise, management of responsibility, and years of sacrifice.  The thing is… they are.  Doctors and dentists salaries are in the top 1% of the nation.  Which is why there’s no reason to overdo it with value-added products that unnecessarily extend profit margins.

Good luck in formulating an answer if you dare.  Thanks.  My answers probably sucked.  But this was my best shot.

See?  There’s that self-doubt that once again keeps me from trusting myself.  You could argue that this dubious companion prevents me from getting too arrogant; that it forces me to carefully examine my motives.  But I suppose that perspective on the value of inner consternation would be far too “half-full” for some people to tolerate.

David S. Peterson DDS, FAGD