Musings on 46 years a physician

Leaving clinical medicine is going to be bittersweet, but I feel the time has come.

“Parting is Such Sweet Sorrow”

Juliet in Romeo and Juliet

Tomorrow I will wake up on a Tuesday and, for the first time in my adult life, except vacations, have no place I have to be nor anything scheduled for me to do. So, this is retirement…………………

Years ago, I read a book by Bob Buford. Second Half: Moving from Success to Significance, that moved me to consider the second half of my own life.

I graduated from the University of Miami School of Medicine in 1978 so I have been a medical doctor for 46 years as of this past July. As I contemplate my upcoming retirement beginning on October 1, and what to do with my ‘second half,’ I cannot help but reflect on over four decades of clinical practice as a general surgeon first and then a plastic surgeon.

I love surgery. I have loved my profession since my epiphany as a third-year medical student that this was what I wanted to spend my life doing. Little did I anticipate that it would include seven years of the hardest, most demanding training I have ever undertaken to finally be able to practice my craft as a board-certified plastic surgeon. I have been immensely blessed to do what I do. I would not have wanted to do anything else. I only hope I have given back enough to justify the investment that my professors and surgical mentors made in me. God knows, I tried.

I will turn 72 this October. While I feel I am in excellent health and more physically fit than most of my peers, I cannot deny the ravages of time. I have arthritis in my left index finger and doubtless will develop this in others with time. My back, neck, and shoulders have taken the brunt of the physical stress of surgery, and it was only thanks to a weekly therapeutic massage and strict adherence to a twice weekly gym regimen to strength those areas that I have lasted as long as I have. I have always tried to provide excellent care and those times where I have fallen short in some manner weigh increasingly heavily on me. With the passage of the years, the joy and pleasure of surgery- doing challenging operations on complicated patients- has gradually been supplanted by the stress of surgery.

I feel that I am still in my prime with respect to my surgical abilities, but I don’t want to wait until my decline is so obvious that others will drag me away from the operating table.  

I have often said that retirement is overrated. I could not imagine going from a productive career in any field, not just medicine, and then retiring to a life of unrelenting leisure and self-indulgence. I do not judge anyone for whom this might seem appealing, but I knew it was not for me. I knew that to walk away without regret, I would have to replace clinical practice with something of substance for which I would have equivalent passion.

I have found that passion in writing and in advocating for traditional, Hippocratic medicine.

I would like to leave medicine knowing that the profession is in good hands and better than when I entered it. Alas, I cannot. Despite incredible technological advances in medicine, I feel we have somehow left behind the essence of medicine- its humanity. The corporate takeover of medicine means that over 80% of physicians are employees subject to a relentless push to see more patients in less time. Their pay is dictated by RVU’s* and metrics, such as Press Ganey scores of patient satisfaction. While lip service is paid to patient care, the primary goal is profit. There is more. Much more that I will be commenting on in the days to come in hopes of sounding a warning that medicine in this country is in serious trouble and we must turn this around else we risk irretrievably losing the legacy of excellent medical care left to us by those who came before. It may already be too late for this generation.  

My trust in organized medicine and venerated institutions, e.g. American Medical Association, American College of Surgeons, Centers for Disease Control, National Institutes of Health, Food and Drug Administration, and others has been irrevocably shattered with revelations of ideologic capture, malfeasance on a scale heretofore unimaginable, and selling out by physicians to government and pharma.

If you had told me a few years back, before Covid, that I would spend my retirement in activism and advocacy, I would have thought you were crazy. Now, my transition to physician activist and advocate seems inevitable.

I will be forever grateful for the confidence of my colleagues and my patients and hope that I have always practiced in a manner that justified that confidence.  

Now, on to the second half!

Richard T. Bosshardt, MD, FACS Senior Fellow, Do No Harm Founding Fellow, FAIR in Medicine

*RVU- Relative Value Unit, a number that dictates insurance reimbursement for every visit or procedure performed.

My book, The Making of a Plastic Surgeon: Two Years in the Crucible Learning the Art and Science, is available in eBook and paperback on Amazon. I hear it is a good read. You will get a unique glimpse into my world.