The decision to leave clinical practice usually doesn’t occur overnight. My own decision required a gradual progression over several years and resulted from numerous factors. Overall, clinical practice was simply not what I imagined when I made my career choice as a high school junior. Medicine changed, and I have to admit that I even changed. Fourteen years will do that.
I originally went into medicine to become a cardiac transplant surgeon. It is difficult to determine exactly when I decided to go into hand surgery instead, and it is impossible to decide when the option of leaving clinical practice came into play. These were the two major steps in my decision process and were driven by different goals.
I decided not to become a cardiac transplant surgeon mainly because of quality of life issues. During my final year in medical school at Columbia, I did a month-long emergency room elective down at Vanderbilt University. I was considering Vanderbilt for my future training and met with some of the general and cardiac surgeons during my time there. The most memorable of these was Dr. William Frist, a successful cardiac surgeon who would later leave practice for the US Senate. I was impressed by Dr. Frist, partly from a surgeon’s perspective but, more importantly, from a personal standpoint. I met with him twice while I was there, and then interviewed with him for a surgical residency a few months later. Dr. Frist gave me a copy of his book, Transplant: A Heart Surgeon’s Account of the Life-And-Death Dramas of the New Medicine, which was an autobiographical account of his life as a transplant surgeon. I read the book on the flight home. I still remember the chapter in which he describes coming home in the middle of the night, holding his child, and noticing how much weight the child had gained since the last time he was home. The book was written by a cardiac surgeon who seemed enthusiastic about his profession, but it later came as no surprise when I heard that the author was running for Congress.
The book didn’t have a profound effect on me at the time. In fact, I was still so filled with naivete and enthusiasm that I partly dismissed the chapter and similar passages as an overly sentimental exaggeration of life as a surgeon – the type of stuff that sells books. It wasn’t until the next year, during my internship, that I remembered the book and began to relate to Dr. Frist’s descriptions. I had gotten married between medical school and internship. My wife and I were considering having children, so I was viewing my career choice from a completely different perspective.
Internship exposed me to the realities of clinical practice – I was no longer just jumping in and doing the exciting parts as I did in medical school. I was starting to see the paperwork, the hand-cuffing limitations of managed care, and the threat of ambulance chasing lawyers. The novelty of being in the operating room was also wearing off; the technical challenge was interesting and rewarding, but the mystique was fading. The hours were oppressive and no longer affected just me.
Toward the end of my internship I decided not to become a cardiac transplant surgeon. Doing cardiac bypass surgeries seemed less appealing, fairly repetitive, and even more limiting to one’s lifestyle, so I began rethinking my options. I was mainly driven by the technical challenges of my surgical options, and decided to go into hand surgery. I did my next five years of training with that goal in mind. During that time, I was never really certain that I was headed toward the right career. The first shift from my original cardiac surgery plans – plans that I had always taken as a given – placed doubt on the entire field of medicine for me.
As a hand surgeon, my patient population was made up of a lot of Workers Compensation and managed care patients. I found myself working all night fixing complex hand injuries, only to later find out that the patient’s insurance company did not allow hand therapy or only allowed a few therapy visits, making a poor result all but a certainty. I even had a few patients who were not allowed to return to see me postoperatively due to managed care restrictions. I constantly found myself operating on people, only to find out that I could not continue providing proper care and was stuck dealing with a frustrated patient unlikely to improve adequately. I battled this with angry phone calls and hate letters to insurance companies, activities that now occupied most of my time. I also had little control over my “spare time” and was often called into the hospital during dinners or social outings, even when I wasn’t on call. Pressure from the legal system manifested itself in endless hours of paperwork for documentation and protection in the event of a lawsuit. I was the victim of a few bogus lawsuits that were eventually dropped, but the constant threat of lawsuits caused excess stress.
After two years of clinical practice, I felt as though I had experienced what my life would have been for the rest of my career, and I decided to make a change. Then it was just a matter of what to do with myself.
