There Are Many Places I’d Rather Be, But This Is Where I’m Needed

crispydocUncategorized

When I started this blog, I was all over the FIRE bandwagon. I felt trapped by medicine, and was looking to load up, cash out and exit as quickly as was financially feasible.

Something happened along the way to the early retirement component. Cutting back on my clinical time transformed medicine from a vindictive and jealous ex-mistress whose only objective was my misery into an old friend with a shared history who offered me a remunerative and interesting hobby with a community service angle.

Perhaps we could extend our friendship, or at a minimum slow its demise.

Buoyed by a record bull market, I hit my number, and then decided to stick around. I liked my colleagues, and I enjoyed our shared sense of mission. My reduced clinical role meant I could now prioritize family and self-care more than I had during the first decade and a half of my practice of medicine, so it was no longer an either / or decision between medicine and happiness.

Financial independence removed the yoke from my neck, and as a result I could practice a different kind of medicine on my own terms. That made all the difference.

What About My Debt To Society?

Let me go on the record as saying that the community's claims to control physician destiny are flimsy to nonexistent. If a physician wants to retire early, so be it.

For the nearly half of physicians who report symptoms of burnout, there is high inter-rater reliability in the assessment that full-time medicine is a crap job.

If society truly values physicians sufficiently to want to keep them from leaving the field, society can make it a career in medicine a better, more sustainable job and let the free market provide the incentives in place of maudlin appeals to a moral code no one else is expected to abide by.

  • Restore physician autonomy in patient care.
  • Enable physicians to own and operate their businesses by favoring physician-owners over physician employees through regulatory incentives and via the tax code.
  • Reward personalized care designed to meet human needs over economies of scale with replaceable, disposable human widgets designed to be burned through and discarded as afterthoughts.
  • Implement flexiblity in scheduling so that "the patient comes first" doesn't always equate to "the patient comes first at my family's expense."

Others, notably Physician on Fire, have addressed in greater depth whether physicians owe a longer period of practice to society.

If It's Not An Obligation, Why Am I Taking The Risk?

Lean in close, big secret here: I like caring for patients. Most docs do.

What I don't like is bureaucracy, hassle and red tape: Computerized Order Entry, the Electronic Health Record, quantification and metrics, onerous documentation. Eliminate these and it's a job I enjoy.

The aggravations deplete me less since I started working fewer shifts.

Sometimes, in advocating for a patient or completing a workup, I end up staying late after a shift. This used to cause tension at home. It matters less now that I have lunch most days with my wife, since I am cashing in chips from a much larger pot of goodwill.

Looking beyond those reasons, life is not a zero risk activity (as Warren Zevon put it, Life'll kill ya).

People are getting sick. I am able and willing to help. I feel lucky to have the skills that allow me to do so. I'm not so burnt out that I can't take it any more.

Most docs feel similarly.

No one on a moral high horse is going to guilt trip someone who is done with the practice of medicine into coming off the bench.

But most docs entered the field because they enjoyed being the kindergarten teacher's helper; because they liked helping a friend work through calculus problem sets during college; they accepted that to learn a certain skill set they would sacrifice income and social opportunities during the prime of their lives.

I like helping people. It's the absolute worst kiss-of-death cliche in any med school applicant's essay. It's also a defining characteristic of most docs I am proud to work alongside.