Retired One Year

One full year has elapsed since turning in my pager and employee ID tag en route to retirement.  I've not been able to identify anything substantial about traits or activities that might make endocrinology specialists unique in retirement other than a paragraph from a 2008 review of the strained endocrinology work force:  https://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/%7B511d7427-678b-42e0-9b7b-4e374fabc62a%7D/us-endocrinologist-shortage-affects-access-to-care-physician-satisfaction  It estimated that about 10% of endocrinologists at the time identified themselves as retired but did not elaborate beyond that.

I know a few others who have taken this gamble, though never exchanged updates.  At the Endocrine Society Annual Meetings, there are certainly people senior to me in attendance, largely men with successful research careers suggesting that the glory of science may be more alluring than contemporary exam room EHR medicine which requires a more defined end point.  While the daily pageant of the hospital and multispecialty Physicians Network goes on without me, though I still get an occasional phone request for some guidance, the interests pursued and the experiences acquired over most of my adult lifetime continue to express its imprints, sometimes in unanticipated ways.

My journals still fill my mailbox, one paid subscription, one as part of a professional membership, and a few others unsolicited.  I actually read more New England Journal of Medicine articles now than when I was working, not having the distractions of office appointments, lab reviews, phone calls, commuting, et al.  I especially enjoy the many endocrinology studies and reviews along with the opinion perspectives and Case of the Week.  The Cleveland Clinic Journal and the Mayo Clinic Proceedings get some attention most issues.  The authors are more my colleagues in absentia perhaps.

Grand Rounds, which was too inconvenient for me most weeks while juggling patient responsibilities, has become a destination.  I am on the notification list of the center from which I retired and a closer one nearer to my home.  Having attended those that interest me, more about the practice of medicine than endocrinology or any other clinical subject, the audience has changed.  People at mid-career seem woefully under-represented at both institutions, likely for the same reason that I rarely went.  In its place I see residents in a swarm of white coats who would get a demerit if they read charts or examined patients in this alloted time and physicians of late career or post-career.  To restrain my often wandering mind, I jot down some questions as the presentations proceed and usually ask one after the lecture.  The answer from the speaker may be all the professional verbal interaction I get for quite some time.

Professional society memberships pose a dilemma, since they cost money that exceeds tangible benefits.  I was going to let the Endocrine Society Membership lapse.  They do not publicize their post-retirement discount which I learned about only after sending a note to their membership VP that I could no longer afford renewal.  Their retirement age exceeds both Medicare's and mine, so they will likely be forced in the near future to adapt to physicians who call it quits prematurely as burnout creeps into Endocrinology as it has with ER or primary care.  We came to an agreement, pony up full dues one more time and then half-dues.  I receive their Journal, not read much beyond titles,  and some on-line updates that are especially well done.  Philadelphia also has the first regional Endocrine Society in the USA.  That one I maintain.  Nominal membership, great presentations each month, OK buffet dinner with a glass of wine, and most importantly colleagues to entertain me with the travails of being a doctor, for which I can now be fully sympathetic.

And when I take a class at the Osher Lifelong Learning Institute, I find myself frequently the useful doctor in the room, that person who understands the difference between vaporized nicotine and combustible tobacco, how AIDS in Africa affects the population differently than AIDS in America, and why their prescriptions have become prohibitive in price.

Among my most valued possessions as a functioning physician, not adequately appreciated at the time, was my privacy in the form of a big desk in an office with a closable door and mezzuzah on the doorpost, that personal Holy of Holies.  It took six months of decluttering and rearranging furniture but My Space has become a reality at home too.

While it can be difficult for physicians who were challenged by the demands of their careers to escape its imprints, a certain amount of cerebral decluttering needs to occur.  This begins as retirement is being prepared.  Marie Kondo of popular streamlining culture asks, "does it spark joy?"  ABIM modules and the fear of a high stakes exam did not.  Phone requests for peer to peer reviews when the right thing to do was rejected by somebody less capable than me never sparked joy.  It's hard to think of anything less a source of spiritual ecstasy than our office Electronic Record.  All delegated to the professional shredder.

Even after exiting the medical workplace, the clock and customary waking times remain the same.  Some physicians developed passions rationed by their clinical responsibilities.  Fishing or the motorcycle could easily expand.  I suspect, though, that most people are like me, the medical identity remains paramount, though not exclusive.  There are limits to how much I want to visit my kids who have first entered the medical orb.  If  I wanted to see Australia,  my job provided me vacation time and ample funds.  Not going there had nothing to do with my work schedule.  As consuming as professional obligations were, I never felt that other interests were seriously neglected as a result.  I have maintained my two blogs, each started years ago: http://consultmaven.blogspot.com for the medical thoughts and http://furrydoc.blogspot.com for the non-medical, neither expanded in a meaningful way.   This makes replacement of the daily schedule, once largely specified, now not so much, all the more challenging.  When I would head home on the interstate each evening, I knew I accomplished some very worthwhile things through my diligence.  That forced accomplishment transitioning to voluntary achievements may be the most difficult element of retirement for me this first year, and likely for many other physicians.

Would I have it any other way, though?  Not a chance.

License Renewal

Every two years, the state has an obligation to its inhabitants, or not even inhabitants but also those who traverse borders to get their care, that the people offering that care in exchange for their livelihood have a threshold of training and character that justifies this.  It's a little harder to certify skill, but education makes a reasonable surrogate, or at least one that is easy to document, not very different than quality measures imposed on us in practice that give the illusion of quality in lieu of the real thing.

My three licenses have come from my state of residency training, lapsed many years ago as the maintenance requirements became increasingly onerous and expensive, justifiable only for those still hostage to that Board for their livelihood.  I have maintained one in my state of residence, where I also maintained a solo practice for 20 years and in the state where I practiced for my final eight years, retiring a few months ago.  On the off chance that I might want to do some locums tenens in one of those states, and the fee not being too exorbitant, I opted to maintain them one more time.  One comes due in a few weeks, renewal submitted electronically with MasterCard authorization, with a prompt email notice of approval.  Pennsylvania has a retired physician option which waives the educational requirements but not the fee so it pays to just do the Continuing Medical Education for now.

Unless one has been accused of activity unbecoming of a physician, which is not a lot of people other than maybe malpractice accusations which need to be acknowledged but do not disqualify, the barrier to renewal rests with the CME needs.  Like my other states, and a fair number of my insurance credentialing criteria, Pennsylvania requires 100 hours of CME spread over two years.  Category 1, the type that gets certificates of completion is usually the most difficult to obtain and sometimes requires a fee, only has to be 40 of those hours.  Much more, and the Commonwealth might have to deal with de-licensing their rural physicians who either do not have access readily or would need too much time away from  the practice to accumulate that much, which would run counter to the mission of making competent medical care available.  City slickers, which is me, just pick from the Grand Rounds or online options.  And since Category 2 can be interpreted loosely, medical writing in my case, consultation, lectures, mentoring medical students, it is readily available to rural physicians and accumulates in the course of ordinary physician activities. 

But there is always fine print.  Twelve of those hours need to be in risk management education, which can be interpreted rather broadly.  Medpage Today used to have an agreement with the University of Pennsylvania to certify what qualifies as risk management and offer a UPenn certificate of completion.  The University dropped their participation but Medscape Today kept the same classification, so when in doubt it is safe to assume that qualifies.  It comes in quarter hour increments so you could be doing dozens of those articles and questions to come to 12 hours.  Grand Rounds with appropriate titles do not require a learning exam, so that's probably the fastest way to accumulate these over two years.  I got six that way, the rest online.

My home state of Delaware found itself in a pickle a decade or so back when a pediatrician turned out to be a sexual abuse predator.  As unusual as this is, Delaware followed by many other states including Pennsylvania, enacted a series of child protective laws and require all licensees who might have occupational contact with children to take a course in what those laws are and answer some questions to make sure they are understood.  It's fairly easy, but takes a full three hours, for physicians who are highly literate and used to taking reading comprehension tests to do this.  The requirement may be more difficult for some of the holders of other occupational licenses or others without a state license but occupational contact with children who have little formal education or familiarity negotiating a computer course.  Printed certificate in CME folder.

Finally Pennsylvania officials are still uncertain whether their docs are the cause of a dangerous expansion of opiate use among the state's citizens, or maybe the best resource for its resolution.  A two hour CME module on opiate prescribing was added to module, probably irking the pathologists and radiologists whose patients are beyond pain. 

Done.  $360 added to my next credit card bill.  Maybe an audit somewhere in the next year or two to see if I am more truthful than our current President, which I perceive myself to be.

Those fees are a big windfall for  the Commonwealth of Pennsylvania, which has a lot of doctors.  There are disciplinary proceedings that the Board reports from time to time but I do not think I have ever personally known a doctor cited.  Level of skill varies, but I think everyone exceeds its threshold.  While I am technically permitted to do brain surgery but don't know how, some self-screening occurs and for those who really want to practice above their level of skill, there are other credentialing mechanisms of hospital staff membership that keep the medical Walter Mitty's in check.  And when all is said and done, those 140 hours of CME category 1 that finally accrued probably added less to my skill than the board might have hoped, except for the 22 obtained at my national specialty meeting.  But pursuing medical knowledge for the sake of mastering it has its psychic dollars, so I really didn't mind the effort.  And it's likely the last time except for a minor provision I will need to satisfy for Delaware in the coming months.