'Why I'm Leaving Private Practice'
'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.
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We need our docs and we can help!!
Your premise of physician's having superior intelligence is wrong. Well educated maybe. But to be good at what they do they also need to have their hearts in the right place and not all do. Every profession is victum of that but it shows more glaring in a profession that holds human life in its hands.
First, I want to thank Dr. Mokotoff for his brief view behind the white coat.
I have been in the medical sales world for over 20 years (Cardiology). Sadly, I have heard this story many times. This past year has been a real wake up call for me (Obamacare), when doctors have money problems so do I (and so-on).
I am a glass half full type of guy and my prayers are with Dr. Mokotoff's practice and the Cardiology industry.
Thanks again and good luck,
Joseph Yanes
David, I talk with doctors everyday who have a story similar to yours. That's why Physicians Helping Physicians (promotional content deleted) exists and offers some free resources for other doctors. I hope you find what you are looking for!
Dr. Mokotoff, I feel the same way you do and I totally agree with you. For this reason, i am in the process of starting a new Physician's organizaion called Physicians-unite.Org. We are in the processing of filing for our non-profit status. I hope that you and your colleagues will join in the near future. Why should payments to Physicians be a fixed pool of funds, yet every other area of the government and heathcare are getting increases? Physicians need to take a stand and take one soon!
M. Latina, M.D.
Above is a well-thought out and also real presentation of practice of medicine as it is today;all the bureaucracy etc.,is very discouraging to say the list;I just retired myself and I miss practicing medicing after about 28 years of medicine;wish you well.Dr.J.I.Raj,Family Physician.
Dear Dr David Mokotoff,
One solution would be to become a patient advocate; and offer your expertise to patients who need help. Since you are surgeon and know the ropes, patients would be happy to pay you for your hard-earned expertise !
Dr Aniruddha Malpani, MD
Medical Director
HELP - Health Education Library for People
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I am a Board Certified Internal Medicine Physician with 20 plus years of experience and decided about 5 years ago to leave Primary Care for good. I had already seen the writing on the wall with regards to the degradation of the Healthcare System in this Country (which really started about 30 years ago) even prior to that. I decided to even write a book about what I feel is the "only way back", and the only true way to healthcare reform. My next step is also to leave Medicine for good.
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I can empathize with Dr. Mokotoff moving toward the end of my career as a pediatrician. I have always loved the art and science of medicine and caring for my patients. I have seen practice become more more impersonal as I click away at my computer, with my back to my patients, ensuring I meet all the criteria for the proper coding. We spend extra hours documenting every comment and call to and from patients to protect ourselves from lawyers and achieve our goal as a medical home, ideally to improve patient care. In actuality it is 90% extra work for possibly 10% benefits. We have been dealt an uneven playing field where big insurance companies can determine our fees and we cannot join together to fight them as that is price fixing. We spend most of our time now on the business of medicine rather than the practice of medicine.
Good luck.
Similar story for everyone in practice. Deal with the alphabet soup of regulations (OSHA, HIPAA, DEA, CMS, ACA, HITECH), fight employees who use lawyers to game the system against you, fight insurance companies who consistently cut your reimbursement, accept Medicare at the same rate as 10 years ago, struggle with EMR implementation and PQRS requirements or just QUIT. The rosey view of life as a doctor most Americans have is based upon a myth and memory of possibly how things were twenty or thirty years ago. Now it is PAINFUL to provide reasonable care. Lawyers, bureaucrats, hospital administrators, and hospital owned physicians are aligned against private practice physicians trying to provide reasonable cost-effective life-sustaining care both in the hospital and in ones office.
Dear Dr. Mokotoff,
I wish you all the best with your plan for retiring. However, it does not mean that you have to stay away from the healthcare industry. You can keep yourself active throughout your life by being involved by contributing a small percentage of your time if not all. There are plenty of activities to choose from. To name a few, you can teach part-time at a medical school or community college, mentor younger doctors, work part-time (one or two days per week) for a practice, perform one surgery per month, be a visiting physician, be a consulting physican for boarding homes or assisted living communities, promote a cause that you have always believed in, etc.
I am seeing many doctors in your situation. We have been helping medical practices with IT services, EMR implementation, practice management and billing.
Regards,
Siva.
Hi Doctor Mokotoff,
It's Dr Kathleen Cullen Internal Medicine from your neck of the woods. I just closed my practice, and although I am going through a grieving process, I know there are new and challenging opportunities out there just waiting for me to discover. Like yourself and other docs nationwide, you've spent a great deal of your youth pursuing your dream of becoming a doctor. Then somehow, someway, you wake up 20 plus years later wondering what happened? I thought I was a doctor, actually a good doctor, maybe even a great one, well educated, with years of clinical experience, and with some degree of authority.... so why do I feel so empty? What happened to my dream? How did I become a data entry chump at the mercy of insurance companies making the decision of whether or not to accept my treatment plan, let alone pay me for seeing my patient? Trust me, I loved my practice and I tried everything I could think of to keep the doors open from offering cash based services to selling supplements. Well, I finally got to the point of putting on my big girl underpants and stopped being a victim of the system and am now on the road of becoming a victor! There is life outside of traditional clinical medicine. With the current healthcare and economic situation, the world of telemedicine has opened up. The technology is there. Imagine being able to communicate with patients via phone, video, and email, review labs, share your expertise, write medical reviews....tasks you have already been doing all these years....
Now imagine getting paid for it....
Please email me....
kcullen14@gmail.com
We need to chat
Kathleen
David
I agree whole-heartedly that life after a career in medicine is a challenge. After 36 years of cardiovascular surgery, I had to retire due to health reasons that prevented me from operating. It took me two years to get past a major depression, two mental health hospitalizations, and a cornucopia of medication adjustments. I finally found energy in starting a consulting practice and pursuing a Masters of Health Administration. I write a monthly blog on health care issues. Since I have limiting my work time to 10 - 20 hrs a week, I've found a balance between work and leisure that seems to be working for me. Our plan is two buy a condo in Sarasota and keep one in the suburban Chicago area and sell our home in Bloomington, IL. With the freedom to pursue my consulting work from any location, I feel liberated from all that frustrated me in medicine over the past two decades.
Good luck in finding something to keep you enthusiastic about living. Otherwise, retirement will be a living hell.
David, you make it seem like the only alternative to practicing medicine is retiring. I suggest you read Marc Freedman's book "Encore:" Finding Work That Matters in the Second Half of Life." Baby boomers all over the world are finding renewed vigor and passion for life by working in careers far distanced -- and more exciting -- than thier primary career.
Much understood. The only satisfying and rewarding time each day is the face to face time with the patients. That used to be 95% of my day. Now thanks to insurance companies, Medicare, politicians, EMR, etc. it is less than 50% of my time, yet working longer hours and getting paid less. I'm retiring from private practice next month and won't miss the constant oversight of all my day to day patient care decision by the bureaucrats. I will very much miss the patients.
I would love to know what you find that excites and challenges you again. My heart goes out to physicians that are no longer respected for their superior intelligence in a very specific area. I, as a patient, am very afraid of what hospitals and government are doing to our medical advances. What can we do to stop the runaway costs of healthcare??