“Some are born retired, some achieve retirement and some have retirement thrust upon them” (apologies to Shakespeare’s Twelfth Night).
Mark Clemons, a friend in Ottawa, and I were asked by the editor of The Oncologist to update a retirement article we wrote eight years ago. Dr. Chabner wrote: “It would be interesting to hear how you all feel about retirement eight years later, especially in view of the increased regulatory aspects of practice, COVID and the practice change to virtual visits. I think the incentive to retire is greater now than before.”
What has changed? A lot and not so much. There remains the spectrum of retirement pace – from the Macbeth approach (“If it were done when ’tis done, then ’twere well it were done quickly") to the MacArthur approach ("Old soldiers never die; they just fade away") and shades in between.
The changing world
Compared to 2013, we’re experiencing a pandemic-accelerated societal revolution of diversity, inclusion and equality, with a feeling of unease in some quarters, a shrug in others and applause in still others.
Forty-six years ago, when I came to Canada, there wasn’t much extreme polarization of political views, or if there was, social media wasn’t around to amplify it. I sensed no feeling of “them” and “us.” The wealthy had perks like golf club memberships, but there wasn’t a pervasive feeling that if things went wrong it was always someone else’s fault. Maybe it’s the pandemic but, when listening to CBC Radio now, so often someone is complaining that someone else needs to do something about something – usually the government. Politics seems to have become much less of what’s good for the country or province and much more of what’s good to keep me in power at the next election.
Societies are changing faster than ever before in human history – although often “plus ça change, plus c’est la même chose” – the same problems emerge in a different context, like elderly loneliness and adolescent confusion in an artificially connected screen-gazing world. Our multiple cultures, races, regions and tribes with their centuries-old ways of doing things now find themselves (thanks to the internet) mixing, jostling, arguing and antagonizing each other at a faster pace, where before change came slower with give and take.
Social media excess has generated a feeling of chaos. Pre-Facebook or Twitter, an unpleasant loudmouth in a committee or social gathering could be ignored to wallow in his certitude. Now he has a platform with amplification to generate more anger. If there’s a fool born every minute, you can now lasso all of ’em with one click.
But for all the apparent self-flagellation going on, and although we don’t have a perfect society, millions are still doing their best to enter Canada and live here. But some of us have had enough conflict and want to retire to the boat or to keeping honeybees.
The changing medical scene
In Alberta, the last 18 months have seen doctors attacked by fallacious allegations from politicians, assailed by micro-managing armchair experts and assaulted by scoffing releases and tweets from eager press secretaries. Family docs in cities and in rural areas have been insulted and defamed while seeing their practice revenues dropping 20% to 30% – meanwhile politicians have nobly taken a 5% salary reduction. Despite peace talks, for those who can afford it, retirement seems a logical release.
Digitization did not feature in our original article but seems to have more influence now on retirement decisions. The electronic medical record has revolutionized access to patients’ data. Instead of poor Susan running around all day with a pile of charts in her arms delivering them to whomever, now any number of people can access clinical information at the same time. This is fine, but administrators need to make a mark and tech companies need profits. Instead of improving privacy and ease of use, they cannot resist changing the appearance of screen pages and some critical aspects of medical ordering. Learning a new system purported to be “better” means adjustments that some are not willing to make as the realization dawns that the number of days of keeping on the upper side of the grass are falling away like the movie cliché of wind blowing pages from a calendar.
An example of a slick Macbeth retirement comes from my co-authors in Ottawa. A local surgeon at the end of an exasperating session learning the new and not necessarily better computer program Epic threw his hands up at the end of a session and announced: “That’s it. I’m out. Chao.” And he meant it. He left – lists cancelled, hasn’t been seen since.
Secretaries used to keep the regulatory paperwork under control, but now physicians do more themselves. Clinic organization in hospitals? Well, Ottawa Hospital has brought in “process engineers” to “help” docs organize their clinics using mathematical modelling of “target” versus actual numbers. No more last-minute clinic adjustments for urgent cases! Vacation time must be planned a year ahead. Spending the day staring at a screen is not what most went into medicine for. Many docs have had this up to their gills.
COVID-19 has increased time spent doing telephone or virtual visits. This is fine for well follow-up patients with no new symptoms and for some psycho-social interactions, but the importance of a good history and physical examination for a patient’s sense of well-being can be underestimated by busy physicians. The power of touch after a full and confident history and physical is well-documented – hard to do virtually although I’ve tried peering at a screen and asking the patient to move closer to the camera! The gratitude of thankful patients keeps us going.