Happy Holidays from the Retiring Geezer

I noticed a JAMA Network title today, “Is It Time to Retire?” I say title because I couldn’t access the piece itself, probably because I’m not registered with JAMA Network. However, the title fits with my current situation because I’m in phased retirement. I found a podcast based on the article, which was published in the April 18, 2017 issue of JAMA. It was about how difficult it is for physicians to make the decision to retire and the role of sometimes unrecognized decline in cognitive and technical skills with advancing age. I was mildly annoyed with the implied reference to Maintenance of Certification (MOC) credit. One of the persons interviewed was a representative from the American Board of Psychiatry and Neurology (ABPN). She dropped a line about the American Board of Anesthesiology MOCA Minute.

By the way, a colleague asked me what I thought about the new ABPN alternative to the high stakes 10 year recertification examination. The MOC pilot  allows diplomates to complete repeated self-assessment activities based upon specific literature references selected by a committee of peer diplomates. I asked what the ABPN would charge for it. It would be the same. It is still all about the money. I told her that I’m retiring and that I do not plan to participate in MOC anymore. I have one more recertification exam and I’m close enough to full retirement that I don’t think it’s worth the money or the time to sit for a test full of items not relevant to my practice.

Here’s an irony; go to the ABPN website and try to find the one MOC module that would be appropriate for Consultation-Liaison (C-L) Psychiatry. You’ll probably be frustrated so just look here to find the delirium learning activity. It was an attempt by Dr. Emily Morse and I to finally make the ABPN MOC mean something practical for general hospital psychiatrists–and it just happens to be relevant to the practice of internal medicine and surgery as well.

Then I read Dr. Meg Edison’s post, “My MOC Failure.” My first feeling was fear, then disgust that I should have to feel afraid of certifying board organizations which have no accountability to dedicated, hard-working physicians for promoting an unproven method for fulfilling the practice-based learning and improvement competency.

I also noticed Dr. Westby Fisher’s recent post,  saying that MOC is officially “dead.” However, it’ll probably just evolve into something less obviously sinister but just as expensive and will still waste physicians’ time.  This reminds me of a quote attributed to Dogen: “A flower falls even though we love it; and a weed grows, even though we do not love it.”

But this is turning into my usual rant against MOC. Hey, it’s Christmas and let’s return to the original topic of retirement. Everyone asks me “What are you going to do?” as though retirement is about not doing anything. It’s a fair question, to which I don’t have an answer yet. I used to do bird-watching.

As I usually do, I searched the medical literature. It turns out there is not a lot written about physician retirement. You almost have to google the question, which is often a crap shoot in terms of actually finding any useful information. The bottom line seems to be it is just damn hard to quit being a doctor. We spend the greater part of our youth and young adulthood scrambling to get into medical school, find out about the corrosive effect on empathy and other abuses of the hidden curriculum but soldier on because of the accumulated student loan debt, ignore the one or  two lecture format classes about the importance of saving for retirement in a career that is shorter by about a decade on average than other professions, drive ourselves through the brutal call schedules of residency, choose between private practice or academic careers where the drum beat of competition and the increasing complexity of regulatory, payor, and political pressures keep us postponing whatever else non-medical could be happening in our lives until the best theme song for us would be “Cats in the Cradle.”

Sadly, a few doctors do quit in the ultimate way, by suicide. My work is not my life. I am opposed to anything giving the message that your work is your life to any trainee, colleague, and friend.

What is the answer to the question “Is It Time to Retire?” I catch myself getting garrulous, repeating the same cobwebbed anecdotes about what a C-L psychiatrist does when I’m doing formal and informal teaching. That turns up as feedback from trainees–“too anecdotal” I mean. My content knowledge about things I never see is low–although my experience and communication skills about the many moving parts of our health care system has steadily grown over the years. Since I’m basically the only C-L psychiatrist here, I catch myself wondering about the meaning of institutional memory and how that might apply to a person who is as vulnerable as the mountain is to erosion.

There are clues letting me know that it’s high time to go. I just renewed for the umpteenth and probably the penultimate time my Basic CPR competency. My teacher was very kind and so was my partner as I struggled with getting an adequate seal of the respirator mask on the dummy’s face. I confess, I’m better at giving rescue breaths without the masks. But the masks are mandatory equipment now. I asked for more opportunities to practice during the class and could just barely get it. Imagine how hard that is on a physician’s ego. I was very pleased to learn the new emphasis on teamwork in giving CPR, which is a welcome change. I can do another task other than rescue breathing with the mask. I don’t have to be the leader–something most doctors feel entitled to because that has been the expectation. And I didn’t know that we’re now getting electronic cards from the American Heart Association. I’ve been used to the paper pocket card. It took me a little while to figure that one out.

I’m moving slowly away from memberships in professional organizations, department meetings, taking on new projects. It’s a long goodbye. Most of the memories are good and I’m grateful. I’m just a little stuck on what I’ll be moving toward.

My wife, Sena, says that I’ll do more of the cooking. I’m collecting recipes–and staying out of the kitchen for now, which I know is not the way to learn. Corn flakes are my specialty.

I’ll be on duty at the hospital over the holiday weekend. That means I’ll get a break from wondering about the recipe for a good life after retirement. Happy holidays!

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