Not Missing It
Not Missing It
It took years to decide that I was going to opt for a half retirement. While my current role is fulfilling, it is completely free of direct patient care. I don’t physically examine patients anymore, nor do I make diagnoses. I am completely in an advisory role for nurses, chaplains, and social workers. Because of this, I have no real need for malpractice insurance. The only reason I haven’t cancelled mine already is the knowledge that after going insurance less for two years, it is almost impossible to qualify again. Thus, a two year gap means the end of practice as a physician. Although most would feel it important to keep one’s options open, I am not so sure. After five months of leaving clinical medicine behind, I have come to one conclusion. I’m not missing it at all.
Not one bit.
Stress
I’m not missing it. Not missing the stress of being in charge of other’s lives. I no longer wake up in the middle of the night in a cold sweat worrying if I did something wrong. Worrying that I missed something.
I used to walk around in haze, ambushed by negative feelings on a regular basis. I often didn’t recognize why I was feeling so badly. Only later would I realize that I was having negative feelings about some patient encounter or another. Fearful that I had missed a diagnosis, or kicking myself in the butt for choosing the wrong treatment course.
The negative feelings far outstripped the positive. The weight on my shoulders was relentless and heavy. I rarely slept soundly, nor was able to completely relax. There was always something pulling me back.
Fear
I’m not missing it. Not missing the fear that was part of every waking moment. The fear that one of my decisions would cause a patient harm. The pain of dealing with the consequences of my decisions regardless of how hard I was trying to do my best.
The fear pervaded every aspect of the job. Not only that I would would make a mistake, but that even if I did everything right I would be blamed anyway. The worry of being accused of malpractice was a constant companion. It never went away, and colored every patient encounter. Taking the difficult and complex and making it terrifying.
And if that wasn’t enough, Medicare was constantly breathing down my neck. Compliance was fraught with difficulty. Doctors are threatened with punishment, and fear pervades the relationship. Audits are used as weapons to bully providers into underbilling and make us cower.
Anger
I’m not missing it. not missing the anger. I feel like I was the target of so much anger as a practicing physician. Patients and families were angry because death is inevitable. Suffering happens. And we can’t cure even the simple cold.
Hospitals, nurses, and administrators are angry because they are put in the most difficult of situations. Instead of helping people, they are being pulled in a thousand directions by the government, insurers, and business people. Caught between doing what’s right and what’s expedient, the anger spewed out in all directions.
As a doctor, I was often right in the line of fire. I was the one to get yelled at and threatened.
Taking care of people should be hard because life is fraught with the ambiguities of illness, disease, and bad luck. Not because someone isn’t getting the money they think they deserve.
Final Thoughts
I’m not missing it. Not missing clinical medicine. For the first time in the last few decades, I am feeling no stress about work. There is no fear. And no one is mad or threatening me.
I had forgotten what it feels like to be normal.
I doubt I will return to seeiing patients ever again.
Somehow it seems that your practice managed to serve up all the negatives that today’s medicine has to offer without balancing it with any positives. That’s really sad.
Your hospice job is very unique. If you ever tire of it, or if it ever dissolves, you may have a lot of trouble finding similar employment. Then you will be retired from medicine, whether you like it or not.
My personal advice would be to work locum tenens for a couple of weeks a year to keep your license active and your employability as a physician.
You may also discover that many practices offer far more positives than negatives, even in today’s corporate culture that you so accurately describe. The role of a locums is usually very appreciated. My locums experiences really breathed life back into my own practice of medicine. (Of course, many stories in my book, “The Locum Life: A Physician’s Guide to Locum Tenens.”)
In my teaching, county, hospital, for example, we suffer all those things you describe, but to a much lesser degree. Overall, our patients are very appreciative and we don’t tremble in fear every time we write a note because we might get sued. (Maybe we should, but we don’t!). For the most part, we are not on production, work very collegially, and are supported by caring staff and administrators. There are many limitations and inefficiencies that persist, needless to say.
I’m a big one for keeping your options open, particularly this early in your career. If we have learned anything from the last 10 years, medicine will change, and tomorrow’s practice of medicine will be different from today’s.
While there are “side gigs,” a recent NYTimes article pointed out their limitations. https://www.nytimes.com/2019/04/06/opinion/sunday/tax-day-side-hustle.html
It’s pretty tough to find a “side gig” that pays better than a physician’s salary in today’s economy. Some have succeeded, but they are like the basketball players that make the NBA–a select, lucky, hardworking few that hardly represent all those trying to succeed as professional B-ball players.
There were some positives. I made a great salary and I had control over my work place because I worked for myself. Instead of locums I have become a contractor for a hospice company. That fulfills my needs.
I know exactly how you felt and look forward to my freedom from the spectrum of the anxiety>fear>anger continuum that is directed squarely at physicians.
It feels good to be away from it!