Friday, April 21, 2006

When leaving medicine is the best medicine

Why does a doctor hang up her stethoscope and quit?

I don’t mean a doctor who reaches their 60s or 70s and wants to retire. I mean a doctor in her 30s, who not long ago spent countless hours and uncountable sums of money learning her craft. One with a long and potentially bright career ahead.

This question is on my mind because my hem/onc has decided to quit her practice as of the end of May. She doesn’t exactly say why in her letter to her patients, but her office staff provides a little more information: She wants to “go in a new direction in her life.” She “may do some traveling.”

“Doing some traveling” is sometimes a catchphrase for “finding yourself.” I never got the impression that my doctor -- we'll call her Dr. Chopin -- was particularly unhappy with her work. Not that we discussed her situation too much when I visited. She was usually focused on palpating my lymph nodes, knocking on my rib cage to check the liver, and having me breathe deeply so she could go in search of my spleen.

“I can feel a spleen tip,” she would say more often than not. Sometimes we would discuss treatment options, and we once had a long discussion of what we CLL patients talk about all the time: If I use therapy X, am I burning bridges, so how do I control the disease incrementally, as it were. At the end she termed this an “esoteric” discussion, which surprised me, because it was composed of the down-to-earth considerations that patients deal with.

But I liked her general manner, which was businesslike in an easygoing, friendly sort of way. She hid nothing from us (for Marilyn was always there with me) and we felt comfortable being honest with her. If we disagreed about a treatment, we agreed to disagree. I have a feeling that, had she been our neighbor and not our doctor, we might have been gotten along pretty well.

She did let slip an occasional frustration. Once she complained about a health insurance company reviewing her and finding that she had “prescribed too much.” As I recall, she said, “Either the patient needs the drug or they don’t.” Another time she spent much of our appointment talking about the frustrations of dealing with some patients, probably the ones we had seen as we passed by the open door of the examination room next to us. They looked frozen, blank, in shock. There was only so much a doctor can do, Dr. Chopin told us. A doctor cannot make happen what nature has decided cannot happen. Another time, perhaps a year ago, when she may have started entertaining thoughts of leaving her profession, she mentioned that she had seen a movie she liked called “What the BLEEP Do We Know?” It’s a New Agey picture about the meaning of life, and Dr. Chopin declaimed briefly about life's mysteries. Most recently, our always-busy doctor pointed out that she had done the unheard of on a Saturday -- slept in until 11 a.m.

In her bedside manner, Dr. Chopin was not the touchy-feely type. But perhaps she was, inside, and just wasn’t able to let it out -- until now. There must be great frustrations as well as great rewards in hematology/oncology. One saves lives, and one also sees them lost. Dr. Chopin had a lot of breast cancer patients, women her own age, some of whom met their ends well before their time.

Perhaps this left an impression of life’s shortness, and perhaps being in the trenches for six years or so left my doctor with the feeling that there was something else she could be doing, something less consuming and more personally fulfilling. (I do know she is not married and does not have family obligations, which can sometimes lead to career changes and reassessments.)

I cannot really complain -- well, yes I can, because I know it won’t be easy to find a doctor with whom I will get along as well -- but I once did something similar. I gave up a promising journalism career in my 30s when it became apparent that I was going to end up as an editor for the rest of my life. Reporters are a dime a dozen but editors are hard to come by. Still, I knew I had the soul of a writer. Writers act and editors largely react (and being city editor of a newspaper is like herding cats of varying levels of competence.) I remember looking down the long road one day, wondering how it would end. It would have ended in a position of some importance at a newspaper we’ve all heard of, and this would have impressed my family and friends. But my heart sank whenever I thought of it.

Dr. Chopin was just named a “Top Doctor” by Phoenix magazine, an annual event in which doctors vote for their best colleagues. So I suppose it can be argued that she is quitting at the top of her game. I hope we are losing her because her heart brightens at the thought of doing something else, and not because the grind of her work is making her want to scream and run away.

I will miss the sound of her clompy black shoes as she approaches the examination room and pulls my file from the plastic holder on the outside of the door. That task will fall to someone else now. I wish Dr. Chopin luck, and I wish it for myself, too.


There was a hilarious abstract on PubMed from Harvard Medical School called "Leaving medicine: the consequences of physician dissatisfaction." The conclusion? "Our findings demonstrate that dissatisfied physicians were 2 to 3 times more likely to leave medicine than satisfied physicians." I wonder how much money it took to figure that one out.


Terry Hamblin said...

There was a time when doctors would not dream of leaving the profession. We used to talk about a vocation (not a vacation). The time taken training, the self denial involved, the long hours of reading, the desperate tiredness of being an intern and resident, the emotional growth that comes with managing bereavement; this was all too much of an investment to abandon.

In today's throw-away society medicine has become just a job. I have seen many young doctors leave the profession when a little more gumption would have seen them through their difficulties.

Investment for the future has become a worn-out concept; the NOW generation won't wait. I guess it has something to do with a loss of faith. You only have one life, they say. Those of us who think we are laying up treasure are bemused.

Vance Esler said...

As you know, I have alluded to these pressures in several posts on my blog. One of my partners, age 44, decided to take a sabbatical after ten years of practicing oncology. There is strong doubt that he will return to medicine.

I have also mentioned that the net number of cancer doctors entering the field each year is MINUS 125! So even though we are turning out about 400 a year from fellowships, we are losing more than 500 a year from practice.

There are many reasons why this is happening, and it isn't just the young ones who are becoming disillusioned.

At the risk of sounding sexist, a great number of those leaving medicine are women. Years ago we thought it was great that women were entering a field that had been dominated by men. Now, however, many of these women are choosing lifestyle over career. Medicine has its non-monetary rewards, but so does being a wife and a mother.

I'm sorry you got caught up in the scramble. It is tough starting over again...

Anonymous said...

Women are much more likely to leave a profession than are men. They just don't have the dedication nor the feeling of responsibility that men do. My family physician (female) did the same thing. She said she wanted to spend time 'finding herself'. Her hubby was a doc also, and they were getting along quite nicely on his $250,000 salary.

Stick with the male docs and you will do better. I won't go to a female doctor, dentist, lawyer, etc. They have no problem leaving you in the lurch.

Ice Scribe said...

"If you saw Atlas, the giant who holds the world on his shoulders, if you saw that he stood, blood running down his chest, his knees buckling, his arms trembling but still trying to hold the world aloft with the last of his strength, and the greater the effort the heavier the world bore down upon his shoulders--what would you tell him to do?"

"I . . . don't know. What . . . could he do? What would you tell him?"

"To shrug."

(Excerpted from Ayn Rand's Atlas Shrugged)

Anonymous said...

In reading the post by anonymous.."they (women) don't have the dedication nor the feeling of responsibility that men do".....I had to force myself to not respond immediately, but rather give myself time to "cool down". As a woman who spent almost 30 years in education, very committed and proud of the contribution I made, as well as a mother to 3 grown, responsible adults, I take great exception to your statement.

There were many times when I felt overwhelmed, overworked, and underappreciated. I vowed at the beginning of my career, though, that if I reached a point where I felt I was not doing my students justice, then it would be time for me to leave.I retired early to be able to teach overseas, only to be dx with CLL.

Having a family and trying to maintain a career is a challenge; unfortunately many women still bear more of the child-rearing responsbility than men; yet, I feel it would be unfair to have to make a choice - either/or.

My other point...would you really want a doctor, dentist, teacher, etc., who was not completely dedicated to doing the best job they could/should do?!Perhaps it took more courage to recognize they were not in a position to do just that, thus, the decision to leave.

Terry Hamblin said...

It is more difficult for women. Not only has the 'housewifely' role for women persisted despite feminism, only women can have children (still) and many women psychologically are more closely wedded to building a family than men. Although women are better at passing exams and more concientious students, they sometimes lack the single mindedness that spells success in a career. Stlll, while naked ambition is admired in a man it makes a woman a selfish b**** in the eyes of society.

But leaving medicine is not a gender issue primarily, it is more a generational thing. Chekhov, Keats and Conan Doyle were all men who left medicine.

Abeyance said...

I was interested i your blog, I am a woman that has for the most part left medicine. I found trying to raise two small children in a city where we have no family was impossible. My husband also is a physician and he was not willing to share child and home responsibilities. One day under all the stress it hit me, go home... (home meaning be a home maker, not back to Detroit!) I had a undeniable feeling of relief and peace. I was incredibly dedicated to me career. But I could not let my children suffer. I closed my practice mid- November and plan this month start working one half day a week, just to keep my feet wet. This is the best thing I have ever done for me and my family. I blog about my experience on:

I wish you the best in your journey!