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Give up the knife | medpage today


This year, I stopped doing surgery, put down the scalpel, so to speak. It was not an easy decision to make. I have been a surgeon for 32 years since I graduated from medical school. It has been a distinct part of who I am for most of my life.

This does not mean that I have retired. I still practice in a clinical setting and continue to do procedures in the office. I just don’t operate in hospitals or ambulatory surgery centers anymore. And because of this, I no longer take calls from hospitals and their emergency rooms (which is required to have hospital surgical privileges). Anyway, in the past few years, seeing patients in the office took up most of my work week.

And yet, now, the time spent in the office is less stressful and more attractive. I am more in the moment with the person in front of me, without that sense of dread that comes with the unknown: an unexpected complication in a postoperative patient, a call from one of the emergency departments, the hospital, or the transfer center.

Meetings in the office have been more rewarding. In addition to a patient’s medical problems, I am more inclined to see the intangible qualities of him, aspects of his nature that can be intensely interesting or downright comical.

I miss the operating room. I miss the people in the OR. Although we have faced a torrent of terrifying and pee-in-the-pants situations like any surgical team must face, much of the time it was quite enjoyable and fun. Yes, surgery can be a real kick in the pants. That is the reason why I became a surgeon.

I miss some of the most challenging surgeries when actively treating a cancer patient was the best of my surgical profession. But I gradually gave up some of the more complicated and lengthy surgeries a few years ago.

Part of this was that the resistance of my youth had diminished; some of those cases took 6 to 8 or more hours of continuous operation without interruption. More importantly, more fellowship-trained surgeons today are subspecialized with more experience. The best thing for the patient was to be treated by these people, even if it meant traveling 3 hours or more to get there. Every other ear, nose, and throat (ENT) specialist in our area has done the same.

I was the only “veteran” still in private practice. All of the other ENT doctors in our area are employed by a large hospital system with a huge referral base. My surgical volume was much lower than that of my colleagues employed at the hospital, which did not bother me as I was getting older. However, last year, I was the only ENT who took calls for all three hospitals in our area. He could have been employed by a hospital, earn much more, and give up the business of running a practice, but the loss of autonomy wasn’t worth it.

I was not unhappy about earning less than my peers. There was no dire need for more money. What is the end point with money anyway? How much annual income is really enough? My wife and I always budgeted our expenses and were able to save each year while contributing regularly to our children’s college funds, even during the most difficult years. We stuck to a strategic savings and investment plan and almost reached our retirement financial goals before I decided to go out of business. Our quality of life was not negatively affected. The additional money would not have changed our lifestyle.

Stopping the surgery and taking hospital calls was the right thing to do at the right time. Eventually I felt the stress evaporate, replaced by greater peace of mind. I see this not as an end but as another stage in life’s journey. But I’m not ready to retire yet.

After giving a lecture earlier this month, a third-year medical student approached me. He said that he was interested in becoming an otolaryngologist; His reasons are a good mix of clinical and surgery, some of the same reasons I chose this calling. He said that aside from tonsillectomies and ear and nose procedures, he didn’t know we did surgeries like thyroidectomies, parotidectomies, neck dissections and the like, which fascinated him even more.

He asked how you get to that point of doing such a complex surgery. He had that same fascination when he was a lost third-year medical student, not knowing which field of medicine to choose. The epiphany came during a series of lectures by some of the ENT assistants, one of whom was a head and neck surgeon who later became my mentor (bruce campbell, md). Like a drooling dog wagging its tail, I walked up to him and asked more or less the same questions this third-year medical student was asking me.

I chose ENT and never looked back. It has been, and continues to be, a fascinating and rewarding career.

Saying goodbye to surgery is a pivotal and bittersweet milestone, but I look back on my surgical career with fondness and satisfaction. And even though I no longer perform surgery in the OR, I still want to treat patients until I can’t.

Below are some lines from a Address to the graduating class of residents I was asked to give this year, which speaks to this very point:

“At this stage of my career, I still want to move on. I still think of medicine as an adventure. I still find joy in our profession. I still learn, I learn from all of you. my residence, and I reflect with a sense of satisfaction and pride and no regrets. Although I hope to retire one day, I am hesitant to do so as what we do is so meaningful, absorbing and valuable that I don’t want my professional journey to end. That is by choice. Being a doctor is part of who I am, embedded in my DNA. And I hope it is with you.”

Randall S. Fong, MDis an otolaryngologist and can be contacted at his placeas well as his Blog.

This post appeared on Kevin MD.

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