But unless you are built better than most, by 50, you can’t work as fast and as hard anymore and can’t tolerate the sleep deprivation that you once could. Unlike other occupations where you work less hard but get paid more becuase you are higher up the ladder, you get paid per unit or work. Unlike law where you charge higher hourly rates for being older and wiser and better, in medicine, most of the services are price-fixed–the same fee for everyone: the best, the worst, the most experienced, the least experienced, the virtuoso, and the quack–all get the same fee for the same procedure.

So when you start to back off, take off a long-weekend every now and take care of yourself a little and try to keep it to a reasonable 45 hour week–then your earnings start dropping. You get on antihypertensive, maybe get a bad cath–start to see that you are not immortal.

Another way of looking at it is you sprint at first, and then start to realize you are actually in a marathon and start pacing yourself. You see that you will not be able to afford to retire until 70 or so, and need to pace yourself to make yourself last that long if you can.