On Retiring From the Practice of Medicine

Medscape

a day ago

Last week, I retired from practicing medicine. My medical work stopped 3 years ago, but now retirement is official.
To retire, all I had to do was submit a one-page form to my state medical licensing board: name, address, email, and two boxes to check. One said that my patient records would remain accessible. The other affirmed, 'I am not aware of any open or reasonably anticipated complaints to the Board against me.' (Complaints about any physician can be submitted by email, so the most a doctor can promise is that nothing is 'reasonably anticipated.')
I had decided not to renew my license this year, to avoid fees and continuing education requirements.
My first medical license was issued over 50 years ago, when I was an intern. For 42 of those years, I practiced medicine in my own office. The end of my office work was sudden. I had already cut back working hours when COVID struck. On Friday, March 13, 2020, I left my office and never came back.
At first, I stayed in touch with staff by phone and saw patients online a few hours a week. That was frustrating and almost useless. Remote technology back then was poor, and the visits achieved little.
Some professionals who retire wonder whether doing so will cause them to lose their identity. I have found that what identity I had seems to still be there.
Practicing medicine was a great privilege. Being able to help, guide, or reassure people in their times of need struck me then, and strikes me now, as a most worthy way to spend one's working life. I regret none of it. I just don't want to do it anymore.
Consulting with patients, I met many people I would never have otherwise come across. They hailed from towns nearby and from countries around the world. Many shared stories I had never heard, some of which I could not have imagined.
In this way, I got to know my patients, at least a bit. Over time, I grew to know some of their children, even their grandchildren. There were times when getting to know them, what they did, how they thought, had a direct impact on managing their medical condition. Most often it did not. Still, it always seemed to me that caring for people is better done if you know them, at least to some extent. Through the years, nothing changed my mind about this.
Throughout, I remained grateful for the efforts patients had to make to see me. They fought traffic, scrounged parking, struggled with officialdom over referrals, sat in my waiting room, all for the honor of hearing what I had to say. To the end, I never stopped wondering whether what I had to offer was worth their effort. I would like to think that, at least for many, it was.
Looking back, the practice of dermatology, and of medicine in general, has of course changed a great deal.
The big change in dermatology has been the emphasis on cosmetic work, which was not part of what dermatologists did when I started out. Lasers and cosmetics have lent our profession more glamour, and for many who practice it, a different emphasis. Cosmetic clients ask different questions and have different expectations from patients with purely medical concerns. I got involved a bit with cosmetic dermatology before I really understood what it entailed, but my heart was never in it. Cosmetics remained a small part of what I did.
The big change in medical practice in general is the ubiquity of electronic medical records (EMRs). The advantage these offer dermatology is the ease with which photographs and other visual records can be incorporated into visit notes. These offer much-needed precision in identifying and following lesions that was unavailable in the old days of scribbled paper charts.
EMRs have of course also changed the texture of practice life, demanding hours of record-keeping drudgery, much of it in the service of recording data of dubious significance.
The third change worth mentioning is the acceptance, by the medical profession and the public, of mid-level providers, nurse practitioners and physician assistants (PAs). I worked with PAs for 20 years. Their competence, and interest in traditional medical dermatology, was a source of much professional satisfaction for me and of great value to my patients.
Retirees I met, among my friends and patients, sometimes told me they were unhappy, not because they missed their work but because they missed the people they had worked with. In medicine, those are staff and colleagues. They share an intimate knowledge of the small charms and frustrations that fill working days: the cranky gent who sends the staff flowers; the insurer who will not cooperate; the regular patient who cannot manage to show up on time, or at all.
As I mentioned, many of my own colleagues were PAs whom I trained myself and worked alongside for years or decades. All were capable; one was extraordinary. At times, she and I shared a heart-to-heart about the work we did together and how we felt about it, what it was like to live with a sense of unending responsibility, challenged at times by spasms of self-doubt. What if we had not offered advice in a way the patient could accept? What if well-laid plans did not turn out well, or if our suggestions seemed on reflection to be ill-advised or just wrong? Life offers few chances to have fully honest talks like those, with someone who truly understands, on matters that cut to the core of the soul. I will cherish with gratitude the memory of those discussions.
Some people who think about retiring worry about needing to endure going-away parties. Along with food and drink and perhaps a parting gift or memento come speeches and sentiment, which may spill over into sentimentality.
If such are the rites of passage for leaving an office, what must they be like for leaving a profession?
While recall is fresh, I can share my own experience. The acceptance of my application for retirement status came by email: