When It's Time to Retire: Notes From the Afterlife

David Loxterkamp, MD


Ann Fam Med. 2018;16(2):171-174. 

In This Article

The Doctor

Since my partners and I sold the business, we are no longer bound by fiscal obligation or administrative duty. We are now employees of a large federally qualified health center, and answer to policies and workflows that are drafted at a distance and tailored to payor incentives. I scrutinize their rules, bristle at them, and bend them according to the needs of my patients. These small acts of defiance might have told me that I was sitting in the exit aisle.

It is true that I have less energy at the end of the day, even as the workload became less taxing. Whereas previously I could scour a stack of articles at my bedside, now I fall asleep before my head hits the pillow. Proper names play hide and seek. I struggle to provide patients with the air of certainty that they or their condition demands. I fret each decision as if each could be the final nail in the coffin of an honorable career.

There comes a time when doctors stop investing in their future. Every new teachable moment begs the question: Do I need to know this? Will I ever use it again? Should I keep my options open or let the board certificate expire? "Keeping up" is yielding diminishing returns. When does a doctor know that his heart is no longer in it? Ambition and energy are closely entwined, and both are essential for maintaining a honed edge. How far can one whittle away the hours and scope of practice until he no longer recognizes the doctor he has now become?

I acknowledge that I may be depressed, or at least depleted. The weight of responsibility has taken its toll. I examine faces in the grocery store, the post office, the YMCA. Have I missed or delayed a diagnosis? Have I offended someone or minimized their needs? I mumble mea culpas. At the end of a career, such thoughts can taint a lifetime of accomplishment with the sting of regret.