Late Life Change

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Late Life Change

There’s an adage in surgery that change is bad; the only thing worse than change is change you don’t control. As with most such aphorisms, there is a hard core of truth about how surgeons view the world contained within it. We must deal with risk, both predictable and unpredictable, every working day. The tendency is to spend a lifetime doing things the same way because it is safe, it works for you and it reduces the unpredictable risks to a minimum.
Sometimes change is forced upon you, whether you planned for it or not. This is nothing remarkable. Everyone experiences unpredictable shocks, large and small, throughout their lives. Some of the biggest changes are sometimes the least predictable – the unexpected death of a loved one, the unanticipated loss of a job, the unwanted pregnancy, the discovery of a personal betrayal – are among the biggest life stresses that anyone will experience. And there is nothing unique about any of these things. We’ve all been there. And yet the personal experience of such a stress is unique, at least to the one experiencing it. It doesn’t lessen the emotional turmoil to reflect on the fact that many others have gone through the same sort of thing, or even worse things, and survived them.
Recently, the trauma center where I have worked for 23 years informed me that my services on the inpatient trauma team were no longer required. My contract to round on the trauma inpatients and provide ICU and ward care was canceled with a letter informing me that the hospital was invoking the 30 day notice off non-renewal built into the contract. Privately, the trauma director was quick to point out that this had nothing to do with my performance, but was a business decision. The hospital system that owns the trauma center is moving to an all-employee physician model and all of the independent contractors like me are being let go. I will still be doing three or four 24-hr trauma shifts in the ER each month ( that’s a different contract) but will no longer be involved in the inpatient care of the patients I admit to the trauma service.
I’ve tried to be objective about this and see it in a businesslike fashion, but it is still a personal blow. It’s like a veteran starting infielder being suddenly relegated to the role of pinch-hitter. I realize now that I have defined myself professionally for so long as a trauma surgeon that I am not sure what my identity will be going forward. My reaction isn’t unique. Millions of workers have had to deal with the loss of a job, often the loss of an entire career, because some manager decides they don’t fit the new business model being rolled out. In that, I am no different than many other middle level executives that have had to find new directions at a time in their lives when they expected to be coasting.
And, although I am not so naïve as to expect loyalty from an institution (that’s a rare enough quality to find in an individual), I realize that I expected something more than a form letter telling me of my demotion to second string. To be fair, the trauma director did make a very welcome personal effort to explain the move and reassure me that he still held me in high regard, but he doesn’t make the decisions about how the contracts are handled.
I still have my separate private surgical practice and can still be involved in the emergency care of trauma patients. The financial consequences of losing the contract will be significant but not crippling (I hope), and there are opportunities to expand my surgical practice now that a significant chunk of time is no longer committed to inpatient care. I hope to be able to take up the slack, but have no guarantee that increased availability will mean increased work. I won’t hurt for basic income even if it doesn’t.
Some other things will need to scale back, mainly commitments to free care. I will continue to set aside about a fifth of my volume as unpaid care and remain committed to the charities I already support, but medical mission work will not be practical for the time being. A planned West Africa trip was already canceled by the sponsoring organization due to the Ebola epidemic, but I’ve had to turn down a request from Canvasback Charities to accompany a surgical team to Majuro in March because I can’t afford four weeks off right now. And I’m debating whether to start looking for exit strategies a few years earlier than I had anticipated. I had always anticipated slowing down as I neared 65, but had figured it would be on my own schedule and not someone else’s.
Of course, I can always find another trauma center to take me on – they seem to be sprouting like weeds in the Phoenix metro area these days. Actually, that is pretty unlikely. Most of those centers are also looking for employees, not troublesome independent surgeons. And many are too far from my home to be practical in terms of response time (less than 30 minutes for back-up call). I could relocate, but don’t really want to start over again this late in my career. There are many options and I am ruling some out just because I don’t like them, not because they aren’t workable.
For now, I am doing nothing. I tell myself it’s because I’m waiting to see how the practice works out without the regular trauma work, that I’m ‘keeping my options open’. But I suspect there’s a big element of inertia and fear behind it. It’s not a feeling I am accustomed to. As they say, ‘A surgeon doesn’t have to be right, but he does have to be certain’. Right now, certainty isn’t in my repertoire.

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