The Privilege of Being a Doctor
The pressures of medicine, sliding into middle age leading to a traditional midlife crisis, and also a flat-out existential burnout have caused me to do something I did not particularly want to do, but I found myself needing to do.
I had to shrink down.
My practice had gotten very large and I was essentially unable to hire significant staff members to keep it sustainable. I looked at probably two dozen viable options, including quitting, retiring, Locum Tenems, selling, direct primary care, and a variation of concierge care. I have chosen a membership style of concierge care that allows me to dramatically shrink the patient population down to a manageable size. As part of that process recruiting into my patients I have had multiple meetings to present the new variation of healthcare that I’m going to go forward with. The response has been good. There were two different meetings at my office with about 25 people attending and then those were in preparation for a very large event where up to 80 people would be gathered for the meeting and that would have two different speeches in the same evening. Meetings were at 4 o’clock and 6 o’clock. I thought those meetings were about recruiting members to this form of practice. I thought I was essentially giving the details of a fee-based membership into a practice so I could better take care of people.
I thought it was about me telling people how I could care for them.
I was wrong. The second meeting at 6 o’clock had 80 people showing up but the first one had over 100. Beyond capacity, I stood in a fairly large conference area and looked around. As the room was somewhat crowded, I was essentially surrounded by people, but not strangers. These were people I knew. These were people for the most part that I had known for years, some of them for decades. I loved these people. I could look around and see people that had a bypass under my care, a stent, a breast cancer, a colon cancer. I knew their stories, I knew their lives. Through divorces and marriages and illnesses and deaths, I love these people. More than that, these people were trying to figure out how they could stay with me despite a fairly sizable cost. They loved me. I could feel a physical palpable love from these people. It took me a while to figure out what it was I was feeling because I had never felt that specific type of feeling before. Not in any family gathering, not in any church I’d been a part of. This is what community was supposed to feel like. As I reflect back on that time, I am struck with the reality that the next time I have that many patients around me will be my funeral. I am not trying to be macabre, but in reality, I see patients a few at a time at best, maybe four or five if I happen to walk into the waiting room during the day. But this many people whom I have had this privilege of being their doctor, I will not get this opportunity again. I am literally saddened by the fact that every doctor in America does not get to feel this feeling. it is overwhelmingly beautiful. I, on this blog, tend to focus on negative issues of healthcare. But the truth is it is an enormous privilege. This was a very unique opportunity to feel this. This entry into the blog world will not have any profound statements or calls for change, and nothing actionable. I will just assure you that the ability and work for all those hours that we have spent becoming physicians and then being physicians – is in fact work. But it is also a privilege. They have allowed me into their lives. I am humbled by their trust.
Retire out of primary care ASAP. Unless of course it’s an office only practice. I did office, hospital and took call. Was physically draining and when my lovely wife died unexpectedly 4.5 years ago and I have guardianship of a mentally handicapped adult son, it was time to go. I made it to 64 years of age to retire though I planned for 65. Not too bad if you ask me.
Was part of a group practice and older patients liked me. I could have been “grandfathered” in to being an “official board certified geriatrician” but I didn’t have time to study for the test so stayed a run-of-the-mill FP who saw mainly older patients.
Circumstances made it easier for me to retire earlier (like Doug) as we never took vacations due to my son’s handicap. Was able to save up resources to be able to get out when I did. I “DO NOT” miss it one bit but I did have some patients I enjoyed seeing and chit-chatting with I do miss. Sometimes have long conversations at Wal-Mart if I run into them while shopping. Kurt
I was also a run of the mill FP who saw old patients but I preferred to say “a shade tree geriatrician.” I miss the patients but nothing else, and like you I still get to see them around town which is wonderful
I have worked in a Family Practice office in a rural area of Oklahoma with the same doctor for over 30 years. When we started, I was an LPN and he had one year of residency left. I’m now a nurse practitioner (not the kind that thinks they are equal to or better than doctors) and he is well past residency. Reading your words brought tears to my eyes. The trust that the patients place in us is overwhelming and I have always felt that it is a great privilege. That being said, there are many days that the doctor and I both feel very tired, defeated and questioning why we continue. The changes in healthcare suck…along with some of the patients. But there are tons of patients that make this last 30 years very much worth the time and energy we have used and exerted. I always enjoy your posts because I read your words and think “this guy is like us and we are not the only ones doing this thing”. Thanks!!!
Only doctors that love their patients are loved in return. We are fairly reciprocal creatures, we humans!