Report of aerie physician? What’s that?

You’ll see it in the FOE Ritual book, the eighth item on the Order of Business for general meetings: “Report of aerie physician”. No President in Ontario reads that item, and I’m not aware of any aerie anywhere that does. But there was a time when it was a very big deal indeed.

You’ll see it in the Statutes FOE as well. Section 80.1 lists Local Aerie Officers, including an aerie physician “when so provided by an Aerie in its By-Laws”. Section 90.1 goes on to say those By-Laws should have provisions “regulating his or their duties and compensation, the manner of selection by election or appointment, and the term of office, which shall not exceed three (3) years.”

At the dawn of the 20th century some fraternal organizations contracted with physicians to provide medical care for their members in return for an annual fee paid by the fraternal from dues revenue. It was called the Lodge Doctor system, a wonderful free-market system that provided house calls, treatment, and even minor surgery for an annual cost to the lodge brother or sister for a dollar or two per year, about the cost of a single doctor’s visit on a fee-for-service basis. The big exception usually was denial of treatment for conditions caused by alcohol or whatever the lodge defined as “immoral behavior”.

The best and best-known account of the system is in  David Beito’s book From Mutual Aid to the Welfare State: Fraternal Societies and Social Services, 1890-1967. You can also read about it in Puck Smith’s blog Things I’ve Found.

Beito in particular tells the story to make his case that a completely free market medical system would work best because the Lodge Doctor system was the free market: easy access, low cost and voluntary participation.

The Lodge Doctor patient had a good deal of power in the doctor-patient relationship: if they weren’t treated well and respectfully, they would be reported to the lodge, where there could be sanctions against the physician, who might even lose his contract.

It was first popular among small urban lodges, especially among eastern European Jews in New York’s Lower East Side and black women’s’ lodges in New Orleans – groups with low incomes and a tough time getting respect from society doctors.

Some 500 physicians catered to these New York Jewish societies by 1915 and among blacks in New Orleans there were more than 600 fraternal societies with Lodge Doctors in the 1920s.

And while the system was small-time, local and mainly for the poor who wouldn’t pay regular doctors’ fees anyway, it worked very well indeed. The low cost and guaranteed service encouraged early treatment (preventive medicine), less reliance on cure-worse-than-the-disease folk remedies and the patent medicines readily available, like morphine, laudanum, heroin and cocaine (if there was anything useful in them at all). A young doctor new in town could pick up an entire practice immediately with this bulk contracting of his services. There was nothing then (nor is there today) to match it for people of modest means needing regular care for their families.

Then it went big time. The Lodge Doctor system was adopted by the two fastest-growing fraternal organizations ever, the Fraternal Order of Eagles and the Independent Order of Foresters (where I worked before I retired). Many thousands of people opted for a Lodge Doctor instead of paying fees per visit. In Beito’s book he says that by 1906 in Seattle (where the Eagles was founded) some 20 per cent of adult males were covered by a Lodge Doctor.

Two things happened.

First, some doctors got greedy, contracting with as many as 10 different lodges to be their doctor and seeing as many as 100 patients per day. Then all doctors, through their powerful new closed-shop union, the American Medical Association, launched an all-out assault on this growing threat to their fee-based incomes. As early as 1913 the AMA founded a “Propaganda Department” to spread information about health fraud including the evils of the Lodge Doctor. They also campaigned stridently that there were too many physicians in the marketplace because there were too many medical schools.

Its Code of Ethics  prohibited the solicitation of patients by physicians in 1922, and by 1934  made it unethical for any physician to dispose of his or her services to any lay body, organization, group, or individual under the conditions that would permit any of them to receive a profit on the doctor's services.

Throughout this campaign, those Lodge Doctors were sometimes expelled from the AMA or denied hospital facilities. In some cases individuals who used a doctor who had worked even in the past for a lodge would be denied medical treatment, even sometimes emergency hospital treatment.

The campaign worked wonderfully for the AMA in protecting doctors’ fees. From 1916 to 1919 alone it is estimated that physician income soared by 41 per cent. As the AMA tightened the noose, the number of medical schools also plummeted, from 166 in 1904 to 81 in 1922.

By the late 1930s the Lodge Doctor system all but disappeared – except, apparently, in the Eagles’ ritual.