Today is the last day I will be a licensed physician. Tomorrow I will be a civilian. Today is the first day of my 69th year as well. I’ve been “retired” since 2017 so my ability to obtain malpractice has already expired (except by locums route) so today is a formality anyway. None the less I do about 50 CME a year because, just because, and I will continue in that. It’s so damn easy to obtain CME these days and I can focus on my interest instead of my specialty. Medicine is at once incredibly full of shit and incredibly interesting.
I came to Medicine in an unlikely fashion. My training had been in Neuroscience, Chemistry, Engineering, and Biophysics. After grad school I settled on Engineering, working as a communications engineering consultant and as a educator at a community college. I had zero interest in Medicine and considered the pre-meds assholes, Part of the way I put myself through school was tutoring inorganic and organic, math and physics to pretentious pre-meds who couldn’t be bothered to learn the subjects, “just tell me what’s going to be on the test man”, so I did. I was poor, had 2 other jobs and it helped pay the rent plus I learned the subject matter REALLY well. See one, do one, teach 100.
My Biophysics interest was on stroke evolution. We discovered a previously undiscovered wave form in the injured brain that was ipsilateral hemisphere specific but also had a contralateral component. This allowed us to map the progression if a stroke. It turns out the injury is not all at once but stepwise additive, so stroke outcomes are the integral of a bunch of discrete mini-injuries that typically occur over 24 to 48 hours. My hope was to develop a tool where pharmacologic intervention could arrest stroke evolution, but to do that kind of research requires access to a rat colony and access costs money and no one is breaking the iron grip grant reviewers have on each others money. You pay the guy this year who will be reviewing your research funding next year. The CT scan was just being developed in those days and you could charge a lot for a 5 minute CT, so though promising my research would never breach the energy barrier necessary to be born into clinical use. One feature was I leaned neuro-anatomy cold.
I hooked up with a woman who needed more money that an engineer, college teacher could make, so I sat down 5 years out of University and spent 9 months studying for the MCAT. I scored in the top 1% nationally. All of that tutoring I did virtually guaranteed me a seat. I got accepted and the woman split for Cali anyway, so I was single, debt free, had enough money in the bank to pay for my medical education (until the inflation of the early 80’s hit) so I moved to Chicago and acquired the distinctive odor of the anatomy lab. I was older than my “fellows” and very aggressive in learning Medicine and being properly aggressive in a seasoned way gets you opportunities. I had a good time in Medical school. Such opportunity. The information was voluminous but so what? I had plenty of time to master stuff. I let the faculty mold me as they would without resistance. It was their goal to make me a physician. It was my goal to become a physician.
In 1986 after my internship year, I became a licensed physician. I was a real Denison of the ICU, any ICU. Burns, medical, surgical, neuro, CCU, pediatrics, neonatal. Our hospital did 16 open hearts a day and I spent a lot of time in post-op hearts. It was my first rotation internship year, and running the post op vents in all of the surgical sub-specialty ICU’s with 30 hours on, 18 off every 2 days was my first 3 months of residency. It was intense but the guys who ran that aspect of the Anesthesia service liked my work and they were critical to the Anesthesia “machine” that served the hospital, so I was able to do stuff pretty quickly. The chief of ICU team was boarded in Medicine Cardiology Anesthesiology and Critical Care. so access to him was very useful. Together we tried to develop a new kind of balloon pump that worked on the principals of a machine gun trying to develop resonance in the aorta. What I wound up proving was the circuit could not be resonated, and I proved why it can’t be resonated and I learned a ton about the biophysics of cardiovascular physiology in the process.
The great inflation of 1980’s hit me in Med school, so my 4 years expected savings were wiped out in 2 years. I’ve actually experienced inflation and it’s consequence. I decided I wouldn’t go 400K in debt in 1983 dollars on 21% interest loans, so I joined the Navy and got the sweetest of deals. They paid for my final 2 years and I owed them 2 years. I made about $700/mo as an Ensign beside tuition books and all that. Since Anesthesia was a prized specialty I was allowed to float till I competed residency and then it was anchors aweigh for 2 years as a Lt in USN MC. My duty station choices were Guantanamo, Memphis or Orlando so I wound up in FL, got a FL license and did some moonlighting. Somehow the Navy decided I knew something about pain medicine and ORL is a world class airport so I started getting pain consults from all 5 branches sending patients TDY to me from all over the SE US. YIKES! Pain medicine in the service is tricky because there are certain things that absolutely can’t be prescribed or the service member looses their rating and therefore their career. Pain was a fledgling sub-specialty in those days. Implantable devices were still a few years away. I am so grateful I was able to boot strap myself into pain, it became a large part of my subsequent career.
I was called up for Desert Storm but never made it to the transport because the war lasted 100 hours. It was nearly time for me to go anyway. After I got out I became a locums doc, and my wife and I traveled around to various beach communities for a couple years so I could learn the business ropes of Anesthesia. Nothing like going to a distressed group to learn the cracks, failures and egomania. I moved to my present town as a fee for service solo practitioner on a tip from a locums job. We were forced to become a group by the hospital so I became a group owner. I also started a pain practice on the side, became director of the same day center, and after 18 years left the hospital for a free standing SDSC 2 miles down the road and ran that practice and did pain. I quit at age 65 to get my long term tax picture in order, plus it was no longer fun. It’s time to go when you’ve had your fill. Gruber, Emmanuel, Obamacare and the bean counters broke Medicine. Grueling comes from the word Gruel, a thin porridge often fed to slaves. Medicine is now a “grueling”. When I was doing 30/18 in residency it was intense, but you could see the progress of your work. Some people died, most lived to tell the tale. Today the medicine is the same but the work is double which means the relative rate of return is less than half. Still it’s bittersweet to let it all go. I get 10 locum offers a week, but it’s not worth it.