At first sight you may think that this is a nonsensical topic. Is anyone really going to care about your professional credentials post-collapse? Unfortunately the answer may be “yes.” In order to illustrate the problems you may face, I am going to present you with a hypothetical scenario of a physician providing general medical services in an ongoing-collapse or post-collapse environment. The general principles are also applicable to other professions such as nursing, dentistry and pharmacy, civil engineering, etc.
Imagine that you are the sole physician in a large village or small town providing medical services to a few hundred people. You are going through a “slow collapse” scenario where there is no dramatic crash, but services are slowly deteriorating. The electricity supply is intermittent and the telephones, television, internet and banking ceased to function a while ago. The postal service is slow and unreliable but you can still tune in some radio stations. These tell you that there is fighting and civil disorder in some parts of the country, but your area has been relatively spared and remains peaceful.
You provide basic medical services to the community, doing the best you can with what you have. These include minor surgery, suturing wounds, setting broken bones, delivering babies, using herbal medicine and comforting the dying. You also provide the community with public health advice on clean water, sewage disposal and limiting the spread of infectious diseases. There is little paper money in circulation and you are mostly paid in kind with food, favors and maybe a little gold and silver. There are few supplies coming in from outside the area, and consequently consumable/disposable items like latex gloves, paper towels, plastic syringes and plastic speculum tips are in short supply. Because of the lack of writing paper, you make brief, if any, medical notes, and store most of the information in your head. You sterilize and re-use most of your surgical equipment. You haven’t been approached for annual subscriptions by your medical licensing board or malpractice insurers for a couple of years, so you have let those lapse, considering them no longer important. Nobody has the time, the money or the inclination to hire lawyers any more anyway. The community understands the limitations on what is available and is grateful for your services.
One day you receive an unexpected visit from representatives of the state medical licensing board. The board’s head office is in the state capital some 200 miles away. The representatives are touring the outlying areas ensuring that standards of medical services are being maintained even in these difficult times. They ask to inspect your premises and your charts, and you comply. At the end of their inspection they state that they are dissatisfied with many aspects of your care. You have not paid your malpractice or licensing board subscriptions. You are not using sterile disposable items. You are not keeping adequate records. You are setting fractures without taking x-rays. You are growing opium poppies and preparing opium for medical purposes but you do not have a license to do this.
The representatives of the board inform you that you have 14 days in which to remedy all of these deficiencies, failing which your medical license will be revoked and you will be required to close your practice.
What should you do? Here is a suggested 9-point plan.
1. DON’T PANIC. Similar scenarios have probably been played out many thousands of times during this and other collapses. There are multiple ways out of this dilemma. What you are observing here is the struggle between the dying old order and the emerging new order. Slow collapses are messy and confusing because people are unsure of who is in charge, what rules apply and what their roles should be. The old order is like a fatally wounded dinosaur: doomed, increasingly irrelevant, but still dangerous until it is completely dead.
2. Maintain the four C’s: stay cool, calm, collected and courteous. There is nothing to be gained by appearing angry, rude or flustered. Be cooperative. These people are here to do business with you and, like it or not, you will have to do business with them. Tell the board representatives that of course you understand their concerns, and any misunderstandings or defects in performance will soon be rectified. Offer them your hospitality. Smile a lot. (People rarely hit a man who is smiling: they might cut their knuckles on his teeth.) Tell them you need a little time to sort things out and to wait while you go and speak to some people.
3. Comply with their requests if it is possible to do so. In normal times the medical licensing boards do a reasonably good job of maintaining medical standards and protecting the public, and they deserve the cooperation of practitioners. However, these are not normal times, and in the scenario I have outlined, it is not possible to comply with the requests because there is neither the money nor the materials to do so.
4. Try to establish the facts. In times of slow collapse and increasing lawlessness, things (and people) may not always be what they seem. Your visitors may indeed be representatives of the medical licensing board, as they claim, and the board may just be out of touch with reality. Or they may be former employees of the board who have discovered a lucrative sideline in extracting money from physicians. Or they may be con artists with no connection to the board at all. Your response may have to be tailored depending on the reality of the situation. But you can’t rely on the facts being what your visitors say they are: try to verify them from third party sources (see Step 5, below).
5. Recognize that this is a situation you cannot handle on your own. You need the support of the community, both for information about the situation and, if necessary, for bodies on the ground. It helps if you already have the support of the community before trouble occurs; in other words, if you have been providing a good service to the community, and they are grateful for it and don’t want to see you go. If this is the case, then go and see whoever is in charge (village elders, mayor, chief of police, sheriff, chair of town council), explain the situation and see if they have any information which could shed light on it (see Step 4, above). Does anyone know these people? Are they who they say they are? Have they visited other physicians or communities in the area and what was the result?
6. If the visitors are genuinely from the medical licensing board, try to make a realistic assessment of what powers of enforcement they have. In normal times, if a physician continues to practice after his license is revoked, this becomes a criminal offence and enforcement is handed over to the police and the criminal justice system. However, if the police and the justice system are locally based and not willing to carry out enforcement, or absent altogether, the board has no power to enforce its orders. Explain the situation to the local sheriff or police chief if you haven’t already done so, and see what his view is. He may be quite happy to throw the visitors in the local jail, under a charge such as the all-purpose “Vagrancy with intent to commit a felony,” and release them once they come up with the requisite paperwork to certify your practice as fully compliant with their demands.
7. If collapse is quite far advanced in your area, the ultimate person in charge may be local representative of an organized crime syndicate, who has extensive (although informal) powers of persuasion, enforcement and protection. Let’s call him Mr. Big for short. His people may already have approached you and persuaded you to purchase an insurance policy of sorts; if not, it may be time to inquire about their services, because it may soon be the time to make a claim on that policy. If you feel squeamish about this, you need to overcome that squeamishness; these are different times and you need to adapt to the new ways of doing business, or perish. Go and see Mr. Big and explain the situation. He will probably be eager to help because, as a matter of principle, he can't allow outsiders coming onto his turf to interfere with his clients. Also, he won’t want to lose a paying customer, and he won’t want to lose a physician who is a useful resource to him and his men. Lastly, his men need something to do, to keep them in practice. However, having informed him of the situation, do not make any specific suggestions or requests. Instead, tell him that you still hope that the matter can be settled amicably. If he laughs in your face, don't argue.
8. Now report back to your visitors. The exact conversation you have with them will depend on the information you have been able to gather and the resources available to you, but it will probably be something like this. Tell them that although you would like very much to comply with their requests, unfortunately the lack of money and materials makes it very difficult to do so, and request their patience and understanding. Tell them that, even more unfortunately, their visit has come to the attention of some very influential locals, who are not happy about the situation. Tell them that you will do everything you can to ensure their safety, provided they leave, but if they choose to return, then all bets are off. Say that you would be very grateful if they would give you a good inspection report and recommend to the board that your license be renewed. Make it look like a win-win situation all round. Keep smiling (see Step 2, above).
9. Ideally, this business should be concluded with Step 8. There should be no need for any physical unpleasantness, which should be kept as an absolute last resort. However, if all else fails you may have to return to Mr. Big, explain that despite your best efforts, the business could not be concluded peaceably, and call in your insurance policy. It is then up to Mr. Big, as a matter of principle, to find and negotiate an equitable settlement with your visitors' “insurer,” provided they happen to have one. And, in case they do not, be sure say a prayer for them.
Although the discussion above used a medical practice as an example, the exact same principles apply in most other professional activities that currently require licenses, certificates, liability insurance and memberships in professional associations.