June 30, 2014. I don’t need to have this date circled on my calendar, or on my phone calendar reminder app. It is now etched in my brain. That is the date of my anticipated retirement from private practice. It is hard enough for me to grasp that next summer I can enroll in Medicare, let alone quit working––something I have done with only one brief 3 month break, since I was 16. Yet this is a self-imposed deadline. The contract with my medical practice ends then and I have stated my intention to retire on that date. I probably could renegotiate a contract with them; however, in less than a year, they will likely start searching for my replacement. So the question is, “Do I really want to retire?”
Friends and patients ask me continually, “What will you do if you retire?” And my answer is always the same, “Fish, read, write, cook, garden, visit the grandkids, and travel.” My financial advisor says I should be able to afford it. Yet, the work ethic is so deeply engrained within me, that the mere thought of not drawing a regular paycheck gives me pause to reflect. It is in these moments that I recall a line from Viktor E. Frankl’s book, Man’s Search for Meaning, “Your work is not your worth.” Or another famous quote, whose author escapes me, “ No man dies wishing he had spent more time at work rather than with his family.”
Devoted and long-term patients grow increasingly anxious and ask me about the date. I half-jokingly tell them, “It depends upon who wins the election.” But this too is a dodge. No matter who wins, Medicine will never be the same. Change of course in life and nature is inevitable. But all change is not necessarily better. Some changes in the practice of medicine seem to be an improvement, such as electronic records, and point of contact lab testing. Others seem worse for doctor and patients, like pre-authorizations, guidelines, effective comparisons, bundled payments, and HMO’s, to mention only a few.
The reality is that in order to gain satisfaction from practicing medicine today, doctors must come to grips with the cold reality of diminishing autonomy over decision-making roles. As a breed of fiercely independent individuals, we are loath to do this. At least for me, this sense of powerlessness, or someone always looking over my shoulder, is in essence the biggest hindrance to job satisfaction. Mitigating that is the occasional complement by a patient or family for a job well done.
I may keep a foot, or toe, in medicine after June 30, 2014. However, as that date creeps ever closer, it is a good time to reflect on a life of service, and how it has affected the lives of others, and not just me.
David Mokotoff is a cardiologist who blogs at Cardio Author Doc. He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.