I have five years left to live

One man's story about the need to take a step back.

Don’t get lost in the details of this article. Instead, focus on enjoying medicine – and your life – more. You have enough money to retire or change your 24/7 lifestyle today. Don’t wait. Stop trying to be everything to everyone, and focus on helping fewer people more. You will be happier. I am not talking about concierge medicine; I am talking about concierge lifestyle.

The practice of medicine has become the business of medicine, and nearly all of us have been more consumed with the bottom line than the patient. Our ‘job’ satisfaction, predictably, has declined.

As administrator, my annual report card became your W-2. I squeezed on both sides and lost focus, as did you.

If someone asks you to tell them about you, what do you say? Let me guess what you’ll say: I’m a doctor who works in a practice. I specialize in blank blank blank. If pressed, you will say you work far too many hours for too little pay and for too little appreciation. Patients just don’t respect doctors like they used to ‘back in the day’. You may be right.

Here's the thing, though. You make far more than the average person relative to your peers from ‘back in the day’. Your health insurance is paid by the practice, you have a better retirement plan contribution than them, and you – and I know from experience, as a doctor’s son – likely work less. You could work less, make less, spend more time with each patient, and be happier if you choose. But you have to choose to get off the hamster wheel.

Concierge medicine is a step in the right direction.It’s a cognizant acknowledgement that you cannot be all things to all patients and be happy. Concierge doctors have established a boundary by capping the number of patients they see. There are other ways to skin that cat.

First, you must accept that you cannot and should not be all things to all people. You must recognize that 5-10 minutes appointments are not good healthcare and certainly not why you got into medicine.

Second, you must accept that you can make a bigger difference by taking better care of fewer patients. Some of you will take issue with this point, but I beg to differ. Patients deserve more than a pat on the head and triaged care, yet that’s what happens most of the time. It isn’t satisfying for patients, and it shouldn’t be fulfilling for you. If it is, stop reading this article; we’ll never agree.

Third, you must embrace that you are in charge of your own destiny. Change may be uncomfortable or expensive in the short-term, but you are the only one who can change your current trajectory. You don’t have to keep up with the Drs. Jones to be happy unless your W-2 is your metric.

I learned the hard way. For years, my annual report card was the W-2s of my doctors, yet many variables were out of my control. I was over-lauded during good years, over-beat up during average years, and completely lost focus of the real bottom line: making a difference in patients’ lives. I think the same was true with my doctors. Had the practice seen fewer patients and spend just a few more minutes with each patient, I think the patients would have been happier.I also think my doctors would have been happier. And I know I would have been happier if my superlative metric had been satisfied patients.

Long COVID took me off the 24/7/365 hamster wheel of running a large medical practice. Despite my lingering symptoms, I am indebted to Long COVID.I never ever imagined I would be happier at 60 than 50 or 40 or 30, but I am.I am so proud of what my team and I accomplished on the hamster wheel, but we did it at a cost. We gave up nights, weekends, and vacation days, we missed soccer games and PTA meetings, and though we said we were doing so for the patient, it never really was for the patient. It was for the bottom line.

I may come across as a hypocrite. My previous article was about the impact of Medicare cuts on your bottom line, yet here I am telling you to focus less on the bottom line. Here’s the thing: the bottom-line matters, but it doesn’t have to be your bottom line. A better work-life balance and more enjoyment in practicing medicine are missing from the bottom line of most physicians I know; I hope you find the proper balance.

Lucien W. Roberts, III, MHA, FACMPE, is a retired physician practice administrator. He is based in Glen Allen, VA, and may be reached at lroberts@theinfusionsolution.com