Editor’s Note: A long-time supporter of The Atlas Society, Dr. Kyle Ver Steeg shared with Senior Editor Marilyn Moore how Objectivist ethics helped him during medical school and throughout his successful career as a surgeon in private practice. He received his B.S. in Pharmacy at the University of Iowa and his Doctor of Medicine degree at Northwestern University Medical School in Chicago, Illinois. His internship and residency in general surgery were done at the University of Iowa in Iowa City and Scott and White Hospital in Temple, Texas. Recently retired from 40 years as a general and bariatric surgeon in private practice, he lives with his wife and family on a 40-acre tree farm outside a small community in north central Iowa. Except for his educational requirements, he has been an Iowan all of his life.
MM: After you retired, you wrote a book about maintaining your independence as a surgeon in private practice. You give a lot of credit to Ayn Rand. In the book, The Making of a Cowboy Doctor, you mention reading Atlas Shrugged for the first time during your junior year in college. Can you tell me how it happened? What or who triggered your interest in the novel?
KVS: My first wife. I wasn't much of a reader then, but she recommended Atlas Shrugged. She never recommended a book before, but she thought I'd like it. I thought, well that's curious. So I went ahead and started reading it. And the more I read it, the more my attitude changed.
I always considered myself self-interested, and people were always telling me I was, although they didn’t mean it in a good way.
As a kid I was “guilty” of spending too much time on my own projects and goals. I didn’t really concern myself with serving others. Reading Atlas Shrugged freed me to focus on myself and develop my talents without the guilt.
The book gave me a sense of peace, and it motivated me to work even harder on the things that I wanted to do. And that doing so was good, not bad.
I didn’t want to join the Peace Corps. I didn’t want to fight in Vietnam. I wanted to pursue my studies. And I did.
MM: You were already influenced by Ayn Rand when you applied to medical school. In your book, you mention a couple of candidate interviews with medical school faculty in which you received backlash for your philosophy, particularly in response to your reasons for wanting to be a doctor. What did you say in the interview, and why do you think it was so objectionable?
KVS: I would have easily gotten by if I had stuck to the standard answers for why I wanted to be a doctor. I could have said that I wanted to sacrifice my life to serve others. But having read Atlas Shrugged and by now a lot of other books by Ayn Rand, I couldn’t say that.
Instead, I said that I love science, that I'm good at it, and that I want to have my own practice some day. I said that I wanted to provide a valuable service, but as a personal achievement, not as a sacrifice. I said that rational self-interest was proper to humans.
Back then, people were steeped in altruism. And so I think probably half the interviewers thought I was going to be a selfish money grubber, and the other half thought, Bravo!
The dean of one medical school told me that I shouldn't enroll there because I’d have too much trouble with many of the professors. So I went to medical school at Northwestern.
MM: You studied to be a surgeon, during which you derived several interesting principles for practicing surgery, principles based in your understanding of Ayn Rand. One is that a surgeon must be honest. “Evasion from factual input is an enemy of success,” is your quote. Another is the danger of arrogance, which you define as “having an unrealistic assessment of one’s own effectiveness.” Will you talk about these principles? Were they effective guides for you?
KVS: My observations as a student and especially as an intern resident in surgery led me to conclude that you have to be honest to be a doctor. You can't evade. Evasion of facts, especially the unpleasant ones, can be deadly for a patient.
As a resident, I watched a surgeon deny a postoperative complication, which happened to be a leak in one case that caused peritonitis. The peritonitis was obvious, but the surgeon for some reason waited overnight. He certainly had more experience than I did, but waiting caused a great problem.
Another time a surgeon chose to send a patient with a ruptured aneurysm to a doctor 110 miles away rather than refer the patient to me, because I was in private practice at the time and a competitor. The patient died in transit. I was in the emergency department of the first hospital and could have done something right away if the surgeon had made the referral.
To be a first-rate surgeon, you have to treat facts as your ally. Good or bad facts, you have to face them. If you don’t, there will be hell to pay.
The other thing that is dangerous for a surgeon is arrogance, having an unrealistic assessment of your effectiveness. That will tend to lead to evasion, because you won't believe that you could have a complication after an operation. Instead you ignore less-than-perfect results, to the detriment of the patient.
MM: You write at length about the importance to a surgeon of a good scrub nurse and of a good team in general. While this aspect of work, building and relying on a team in a hierarchy of ability, is present in Ayn Rand’s fiction, it is largely ignored. Tell me about your understanding of teams and how they fit into Rand’s philosophy.
KVS: In my field, I need a team. There's no way I can get by without one. I have to have good helpers if I'm going to be an effective, efficient surgeon. In order to have an effective team, I found that they have to be happy to work for me, which comes about through benevolence. They need to be impressed with my ability as a surgeon, and I need to respect their skills, and see that they get credit for them, because those skills enhance mine.
MM: How did you get involved with The Atlas Society?
KVS: I got interested in The Atlas Society after reading David Kelley’s book Unrugged Individualism, which is a book I think can help Objectivism. Kelley’s thinking is less dogmatic than that at the Ayn Rand Institute, which I’ve long thought just isn’t going to work long term. I will say, on their behalf, that Leonard Peikoff’s "History of Western Philosophy" course is excellent. I learned a great deal from him.
I’m also a big admirer of Professor Stephen Hicks, and I was happy when he joined The Atlas Society as Senior Scholar. His book Explaining Postmodernism helped me understand how postmodernism developed and why postmodernists think the way they do.
Ayn Rand wasn’t exaggerating when she took issue with postmodern philosophers and with identity politics. Those points of view explain at least some of the cultural problems we are now seeing.
MM: Several times in your book you are critical of entrepreneurs in medicine. As Rand’s philosophy is fundamentally entrepreneurial, why the criticism? Is there something specific going on in the medical professions? If so, is entrepreneurism really the problem?
KVS: Ayn Rand championed entrepreneurs, of course, but entrepreneurs like Hank Reardon and Howard Roark. Capitalists. She was not impressed by the Wesley Mouches of the world, or the James Taggarts. If they were entrepreneurs, they were awful ones. They harnessed the force of government to hurt competitors.
That is the kind of entrepreneur that I criticized in my book. That kind of business person is a crony, not a capitalist.
Most health care involves nonprofit hospitals, but even for-profit hospitals are highly regulated and controlled by government. Hospitals are really quasi-governmental institutions. When I talk about the business of medicine, I guess I’m really talking about cronyism.
Health care is a separate issue, and health care providers are not the ones getting rich off the current system. The cronies limit competition by creating certificate of need boards, and they restrict competition by claiming that any new health care provider in the area is merely duplicating services, and therefore not necessary. Imagine if that had been the case in the technology sector.
But that's where medicine is now. It's so extremely expensive because there's no competition and the pricing system is gone.
The other thing I want to bring up is the role of money with physicians. Everyone likes to have money, including me. I wanted to make as much as I could. That said, I had what I called the Iron Curtain Principle: Any medical decision or surgical decision that I made, there had to be an iron curtain between my interest in making money and my surgical decisions. Operating on a patient unnecessarily is not an ethical way to make money.
MM: Well, thank you for talking with me.
KVS: Appreciate it.