I will never be the physician that my father was

Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked seven days a week for much of my childhood, and seemed to be on call all of the time. I can remember multiple Thanksgivings that were cut short or scrapped because someone needed him.

I’m the oldest of three children, and we were all born during his residency and fellowship. He spent pretty much every other night in the hospital. My memories of my father when I was little are of a man who came home every once in a while, sometimes yelled, and then fell asleep.

This is when you should remember how I began this post.

But my father was a phenomenal physician. He was immensely dedicated to his patients, who knew that he had – literally – saved their lives. He always seemed available, regardless of their ability to pay, regardless of how frustrated he might become. I worshiped him. He was awe inspiring, the reason I became a doctor was likely because at some level I wanted to be like him. But he was also demanding, sometimes short-tempered, and not always present. His career consumed so much of his life. He always so very tired.

In the mid 90′s, my father had a terrible ski accident. He needed to have complicated surgery, with bone grafts to repair his leg. He was off his feet for six months, and still can’t stand to do long procedures. He was forced to quit surgery, and to give up the career that he loved.

Personally, I think it’s the best thing that ever happened to him. For the first time in his adult life, he slept. And I mean slept. He also slowly became a different person. He became more interested in his hobbies, and became a pretty impressive woodworker. He read, not just journals, but fiction and non-medical non-fiction. He played golf. He made friends.

He became a better human being.

My wife only knows my father since his accident. She only knows this man who rolls around on the floor with my children, who has been known to cry easily, and who always seems to want to give you a hug. I have to explain to her often that this is not the man I grew up with. He celebrated his sixty-fifth birthday last year, and when I gave a toast at his party, I said that he was a man who was getting better with age. I meant every word.

When I entered medical school, I knew only what I didn’t want to do with my life. I knew I didn’t want to be a surgeon.

I love my father, but I want different things than he did when he was starting his career. I want to be present for my children when they are young. I want to make it to every Daddy’s Day at Sydney’s preschool. I want to be available to take Noah to football practice. I want to spend hours playing video games with Jacob. I want to be able to meet my wife for lunch every so often.

I know that this means I will never be the physician that my father was. I will never be as close to my patients, nor will I garner the respect for my clinical skills that he did. I can live with that. I absolutely love my job, but I want to have protected time to be with people I love. I want to read, and to write, and to grow. I want to try new things. I want to spend time working on being a better father, a better husband, and a better friend. I want to do that now, not just when I retire.

I was thinking about this just yesterday morning, as I was visiting someone I’m close to who was in the hospital. I was there not as a physician, but as a friend. I was grateful that I have a career, as a physician, which allows me the flexibility to be there for people I care about when they might need me. I think that makes me a better human being. I think that makes me a better doctor.

There are those who disagree with me:

It is one Sellers, a doctor for 37 years, hardly recognizes from the days not that long ago when physicians worked 20, 30, 40 hours in one place, on call at all hours, their social lives often non-existence. That isn’t the way of most of today’s young docs. Not when you get into the whole new issue of changes in physician productivity that are really generational, Sellers explained…

“The priorities in the profession have changed in the last 30 years dramatically from (days when) always before the profession came first. I’ve got to work 90 hours a week. I know that going into the profession, it’s a 24/7 profession. I’ll make arrangements for coverage if I need time off. But yeah, that’s what I do. the marriage relationship and so on suffers,” Sellers said. “But the priorities for younger physicians, generally speaking, place the profession below quality of life, below family, below concerns about lifestyle. So productivity-wise, the current estimate is that the new generation of physicians, in general, will be 50 percent as productive as the retiring generation.”

“They won’t be putting in the time.”

I’m sorry, but I have a really hard time identifying with this kind of thinking. It’s not uncommon these days, though, especially among older physicians. Me? I don’t know why doctors think it’s a good idea for them to martyr themselves on the altar of professional sacfirice.

When I was a medical student and resident, I worked with an untold number of attending physicians who were absolutely miserable. I don’t believe that made them better at dealing with patients. I knew many who left the house before their children got up and got home after they went to bed. I don’t think this made them better pediatricians. Did you know that physicians have the highest suicide rate of any profession?

I remember one of my medical school friends who interviewed at a top-tier surgical program where they bragged that over the seven year training  period the divorce rate of residents was more than 100%, because some of them divorced twice. They were bragging; I was horrified.

I think there’s room in medicine for all types of people. Some obviously enjoy working 90 hours a week. I do not. It turns out that most people don’t:

After Sellers joined a practice of seven internal medicine specialists in Sioux City, he gradually saw the practice depleted by retirement, departure and death, and the survivors quickly learned that they were not able to recruit internal medicine doctors willing to share equitably in on-call coverage for the group, which included covering the two hospital emergency rooms for unsassigned patients that might need their specialty. Even reducing the on-call coverage obligation from 90 to 60 hours a week failed to draw any new recruits.

Maybe I won’t be as famous as I would otherwise be if I worked that hard. Maybe I won’t be as rich. Maybe I won’t touch as many lives or be as beloved as those who came before me. But I believe I’m replacing a lot of that quantity with quality, and I’m investing in my family, my friends, and my community.

Someday my children will have to make similar choices. Maybe they’ll choose to be like me; maybe they’ll choose to be like my father. I’ll love them either way, just like I love my Dad. But this is my life, and it’s my decision, and I really wish doctors could stop judging each other for making different choices than they themselves made.

Aaron E. Carroll is an associate professor of Pediatrics at Indiana University School of Medicine who blogs at The Incidental Economist.

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