'Why I'm Leaving Private Practice'

Along with the decision to go into medicine, the next most important professional decision a physician makes is when to leave it. As I rapidly approach the Medicare age, there is much to consider. Although my contract with the cardiology group I started in 1982 ends in June 2014, I could always renegotiate it, or seek an alternate practice opportunity. The question for me then, and many other docs my age, is can I retire? And, if so, when is the best time?

My financial planner tells me I can afford to retire in another year and half, so it would appear that money is not a deterrent or excuse. In order to achieve clarity on this, I have asked myself: "Do I really want to retire, and if so, what will I do after medicine?"

For many doctors, like my father, medicine was all they knew, and they practiced pretty much up until the time of their death. I love medicine, but not that much. A now-retired surgeon once said, "Medicine is a very jealous mistress." In other words, the practice of medicine can be so consuming that it leaves a doctor with little time or energy for other interests.

Growing up in a family where the patriarch had only two interests - medicine and investing - I am keenly aware of this conundrum. Therefore, I have made a conscious effort to develop other pastimes. To name a few: writing, reading, fishing, cooking, gardening, and travel. I have learned much by observing other retired doctors and seeing how they fared.

Some do not do well. A cardiac surgeon friend of mine came out of retirement after only a year, because he was "bored." Another former partner has spent the last six months traveling after retirement, and so the jury is still out for him. A former adviser of mine summed up the post-retirement question well by asking, "So, what are you going to do on Monday?"

In the end, job satisfaction is the key. I had no illusions that the practice of medicine wouldn't change significantly over the length of my career. However, accepting this in theory and living through it are two distinctly different things. It is easy to wax nostalgic about the pre-DRG and pre-HMO days. I can even remember when a nurse would stand up, without me asking, to give me her chair, or when there were actually medical secretaries who stuffed charts full of fresh progress notes and order sheets. Now, with a plethora of insurance people, home healthcare aides, case managers, medical students, interns, and residents, I am lucky if I can find a seat in the nursing station, let alone a computer to use for charting.

Then there is the omnipresent assault on Medicare reimbursements that has lead to yearly declines in physician incomes, without the SGR formula even being implemented. To work harder is one thing. However, to be paid progressively less for that work is downright discouraging. Physicians in private practice have always been fiercely independent, and to a large degree this has lead to our undoing. Unable to amass the coherent solidarity and funds needed to advocate our case against hospitals, insurance, and legal lobbyists, we are now viewed by the healthcare industry as replaceable workers. The regulatory environment has added so much to private practice overhead and damaged office morale, that it is no surprise when every year more physicians and groups sellout to hospitals, or just quit.

Some pioneers, like Dr. Keith Smith of the Surgery Center of Oklahoma, have championed consumer-driven healthcare by posting prices for operations. Others have given up accepting insurance entirely, or started concierge medical practices.

It would likely take a unique opportunity for me to stay in medicine –– something that could excite and challenge me again. I will miss the rewards of healing patients. What I won't miss is the constant overseeing of my day-to-day work by faceless bureaucrats, politicians, and third-party payers.

For me, the time to hang up the stethoscope has not arrived, but that moment is not far off.

David Mokotoff is a private practicing cardiologist in St. Petersburg, Fla., and a contributor to Practice Notes, Physicians Practice's online blog. Are you in a similar situation or feel that this is the wrong approach to changes in healthcare? Tell us at editor@physicianspractice.com. Unless you say otherwise, we'll assume that we're free to publish your comments in upcoming issues of Physicians Practice, in print and online. Have a "Bigger Picture" opinion of your own? Send it along via e-mail and we'll consider it for a future issue.

This article originally appeared in the February 2013 issue of Physicians Practice.