The C-L Psychiatry Service: Don’t Let It Burn Up

I just read an article about volunteer firefighters with which I identify. Being a one-man hit-and-run psychiatric consultant in the general hospital is similar to being an aging volunteer firefighter. The analogy is not perfect. That means the title of the article doesn’t fit exactly, “Fighting Fires For Free, Aging Volunteers Struggle To Recruit The Next Generation.”

Although the kind of work I do is analogous to putting out fires because that’s what I’m doing metaphorically all over the hospital in my role as a Consultation-Liaison (C-L) Psychiatrist, my story could be titled “Fighting Fires For The Juice, Aging C-L Psychiatrists Struggle To Recruit The Next Generation.” And even that title may not be accurate because there are actually some trainees interested in pursuing my line of work.

However, as I enter my first year of phased retirement, I’m aware that they could change their minds. But I think they like to do this for the juice just as I do, for the excitement and satisfaction of running all over the hospital, up and down the stairs, dousing the flames of the many crises blazing in every corner. There’s a lot of traveling involved. Recently I put 4 miles and 37 floors on my smartphone pedometer over the course of a day. That’s pretty good for a Geezer.

Here’s another quote from the article, “They cover vast sections of the country, making up an aging network that is increasingly understaffed and overworked.” I’m not sure how accurate that analogy is either because I have no idea how many aging C-L psychiatrists are out there, running smokejumper operations like mine. I don’t really network with anyone because I don’t know anyone else who does this, and I don’t have a lot of time to get to many professional meetings.

That’s because my hospital needs me and another quote might work, “If somebody wasn’t here to do it, this could get out of hand real quick…” That one fits. In fact, I take the first call pager from the resident rotating on the service when there are departmental meetings for everyone including trainees. Somebody has to be at the station to respond to the bell.

Another quote, “It’s not uncommon these days to find rural firefighters in their 60s or 70s.” In my neck of the woods, that might be true–but I can’t verify it because, like I say, I don’t get out much.

“And while volunteer firefighters are trending older, they are answering many more calls.” That feels true. My RVU’s probably don’t reflect enough volume to impress anyone, but the level of complexity makes up for it, at least in my opinion. The average number of consultation requests has crept up over the years. I hope I’m getting wiser, not just older.

I have to paraphrase the next quote, “I’m a firefighter. I drive trucks, fight fires”… “I’m kind of the Papa of the fire barn.” We have a new fire barn. We also have a mascot, although he runs out of gas every week.

“Time and again you hear stories of departments that, you know, are using old gear, that’s not necessarily the safest, or old firetrucks and old equipment, or not able to afford the resources that they really need…” I’m in that legacy crisis, in which I feel an urgency to try make one last effort to evolve the service into something bigger, better, a shiny new engine with a deafening siren.

“There’s no easy solution.” You can say that again–but don’t.

I have to paraphrase again, “Like many volunteer firefighters, I’m deeply committed to what I’m doing. Because without volunteers and departments like mine, huge swaths of America would just burn up.”

Don’t let it burn up.



Morris, F. (2017) Fighting Fires For Free, Aging Volunteers Struggle To Recruit The Next Generation. NPR Around The Nation