OB GYN, Physician Training, retirement

Is it Ethical to Retire Early from a Career in Medicine?

Eight weeks after I delivered my 3rd child, I was diagnosed with a 4 cm lung mass.  Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer.  Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis, and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician.

Luckily, I soon found out my situation was not as grave as first expected.  A PET scan leaned toward benign diagnosis (or at least consolidated disease).  I could temporarily push aside the paralyzing fear of leaving my 3 young children with no mother and focus on getting rid of this mass that was causing pneumonia, difficulty breathing, coughing for 2+ years, and go ahead with scheduling the thoracotomy.  After resection of the mass which was densely adherent to my pericardial sac and phrenic nerve, I lost about a 1/3 of my left lung.  To my amazement, after my ICU stay I left breathing better than I had been in years.  Benign diagnosis was confirmed.

This experience made me reevaluate my life and it stopped my “hamster wheel” of life I had been running on at a dizzying speed.  I viewed this health scare as a second chance at life.  I didn’t take this lightly as it almost seemed unfair that I got this chance to live while others who have a lung mass often have it turn out to be one of the most fatal of cancers.  Having to face the prospect of this potentially devastating diagnosis changed the course of my life. I was able to view my career for what it was and had become.

 

I had planned to work in my medical career as a physician indefinitely, or at least well into my 60’s.  It had always been my passion to work in obstetrics and I love my patients and the bonds I build with their families. It was never my intention to leave early, and it didn’t factor into choices along the way for my career.  But here I was, ready to retire in my late 30’s after several years of increasing disillusionment with the health care environment.  Apparently, I just needed this wake-up call for a chance to realign my priorities.

Loss of physician autonomy, pressure to increase productivity as opposed to quality care, and placing cost effectiveness ahead of best medical practice were weighing heavy on me.  In addition, the litigious environment in the US has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.

I could no longer honestly tell myself that I was working so hard for the good of my patients, and I became cynical that my efforts were to the benefit of the financial bottom line of a health care system with its priorities out of sync with my own.  This is not specific to any health care employer, physician group, or hospital.  It is emblematic of the US healthcare system in general.  It is the reason I left medicine entirely and did not merely seek to work elsewhere. The problem is pervasive.

The decision to leave became a question of “why am I doing this, and for whom”?  I decided to retire early.

I have since learned that many feel this is not an appropriate thing to do in your late 30’s.  There is the argument that I owe a debt to society now that I have the skills acquired from all of those years of training. Or that the government paid for my residency salary and that I am indebted due to that.  Or that it is selfish to stop working to spend more time with my family.  There is the argument that it is not fair to leave my patients that I have been caring for over the years.
My response to the ethics of my decision to retire early: If you pay for the privilege of a medical degree and work hard to pay off this debt, should it be your decision if you want to continue to practice?  The government did pay my salary as a resident, which amounted to a little more than minimum wage for 4 years of 80 hour work weeks.  Do I owe something because of this?

As for leaving my patients, I actually do feel a little guilty about his one.  I love my patients.  I also struggle with no longer using my degree for clinical practice, something I worked so hard for.  We are already feeling the strain of physician shortages and this another thing that gives me pause.

In the end, the burden of practicing medicine in today’s environment no longer outweighed the positives for me.

Ironically, it’s my patients who hugged me and told me how happy they were for me to live the life I felt I needed to.  It’s my patients that spoke up (without me saying a word) about how the medical field has changed and that we are losing good doctors as the control of medicine is being handed to hospital administrators and politicians who are making choices about health care without a medical degree. It’s my patients that brought presents on my last days and thanked me for the care I did provide throughout my career instead of lament about what I “could” have done if I stayed longer.

It was a very personal and difficult decision for me to leave medicine and luckily, my colleagues who know me have been incredibly supportive.  On the other hand, one thing that has surprised me is the number of physicians contacting me who want out of healthcare but don’t know how, or can’t, get out.

How do we retain physicians? It is not by increasing salaries. Doctors aren’t in it for the money, we chose this profession to help people and save lives.  We do it by reforming the current health care environment and making this a profession that is sustainable.

Give medical decision making back to physicians.  Decrease the cost of health care by cutting out costly administrators and through tort reform.  This is the way to keep our best physicians and improve health care in our country for our patients.

Ultimately, is it ethical to retire early from a career in medicine? Or is it a bigger picture issue of how do physicians take back control of medicine so that we aren’t leaving at a time of shortage? This is a major concern for our country moving forward.

 

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29 thoughts on “Is it Ethical to Retire Early from a Career in Medicine?”

  1. I am sincerely sorry to read of any trouble that an OB has. OB’s are treasures as they “are there” even in the middle of the night, and even on the weekends. Nobody works harder and has such a great personality even when so sleep deprived.

    My wife had problems, and her OB “was there” every time, every day. I can not thank OBs enough.

    And when the “human” OB has her own children and wants to be a MommyDoc for years, how does she return to the clinic and OR? The Center for Peer Review Justice has worked for 17 years on that question. The AMA and others have their own “guidelines”, but they insist on draining your family’s checkbook, and that is unnecessary, and frankly, does not respect the fact that OBs, like all specialist physicians, are so overtrained.

    Great blog.

    Richard B. Willner

  2. As always, your words are so inspiring and full of wisdom. My heart breaks at what you have gone through and I am glad you have found peace and happiness among such a difficult time and decision. It’s scary going into this world of Medicine and knowing how things are. I also know that I will struggle for being a visionary and wanting to do things differently but I can only hope to give the best possible care to my patients and to always try to find a balance to be happy. Thank you for sharing your story and continuing to inspire so many of us.

    Best,

    Jani

    1. “Jani” It makes me so happy to know we still have a great new generation of OB/GYN’s on their way. We will continue to work towards improvement in health care for patients (and physicians too!). Excited to see the changes your crop of physicians will bring

  3. I’ve lurked in the shadows reading your entries, but this one was too spot on too pass up the opportunity to comment.

    First, thank you for sharing a frightening experience in a manner that helps us go through those highs and lows alongside you. You are a gifted writer, and I’m grateful your newfound “free” time away from medicine has permitted you to explore and develop this talent.

    Second, as someone transitioning to a lighter clinical load (with the eventual goal of no clinical load), I am completely in favor of fulfilling your individual needs as a human before feeling beholden to meeting society’s needs for physicians.

    The most redeeming part of your story is that your patients were able to see you as a complete human being with needs beyond the clinic. It restores my faith in others.

    Keep up the meaningful work!

    1. “Crispy Doc” thank you for comments. I truly appreciate your thoughtful reply. There seem to be many physicians out there with similar experiences and sentiments and hopefully we are starting to make our voices heard with our stories.

  4. Dear OBDoctorMom,
    Thank you for sharing your story! I too have struggled with the same issues and to some degree continue to wrestle with these ethical / moral dilemmas.
    You are absolutely correct about the “wake up call” and kuddos to you for listening and waking UP! Unfortunately, most would have taken a deep breath, paused for a few seconds, and then returned to the hamster wheel and kept the current medical climate of this country going.
    The only thing that will change the current “failing” medical environment is if the physicians and the patients demand it to change. Physicians need to stand up and leave the current medical system and start offering an alternative model (medical system) to the patients.
    I left the current medical system (general ob/gyn) one year ago and am studying “Functional Medicine” now, in addition to having started my own practice “Integrative Gynecology” – a holistic gynecologic office practice. I would have continued with doing surgeries, procedures, and obstetrics; if the malpractice insurance cost was not outrageously high. Also, in the current medical system, where the insurance and pharmaceutical companies dictate and direct the “dis-ease” care; patients are to be seen, diagnosed, and treated within minutes (average physician-patient interaction is 5-10 minutes to be financially productive for this system).
    I feel healthcare needs to be practiced as personalized / individualized care where the physician spends time with the patient and really gets to know them and their needs; before diagnosing and treating. The medical care must be tailored to each individual being. The goal is to improve the quality of their overall health and well being, not just absence or presence of disease.
    Grateful for your inspiring story,
    Suman Tewari, MD
    Ann Arbor, MI

    1. Suman Tewari, MD: Your comments are spot on. I love that you are practicing medicine the way you feel is in the best interest of your patients and did not stand for the “status quo”. I do believe more physicians are reaching the limit of what they will tolerate for patients and themselves and hopefully we are on a changing tide for the better. Still a long way to go, but I love to hear about stories such as yours.

  5. oh man- your story is my story only i practice (for about 11 more days) internal medicine and i am 50 and (hopefully) healthy. i am done for now with the primary care wheel. all i do is computer work and check boxes and follow up on this form and that and fight with insurance companies who don’t want to help sick patients and i am done. i can no longer do this. after 18 years now it is not worth the money or my time. i have an 11 year old daughter, a wonderful husband and an awesome dog that i miss! not to mention aging parents that need me. so i have left my practice (much to the dismay of my employer who wanted me to take over) but i am not looking back. only forward. i will do medicine somehow in the future but on my terms. i am not sure how, but it will figure it out.
    good luck to you and yours!

    1. “someone” I love your comment. You have made your decision and are moving forward! Only a few days left! Sounds like it was the right decision at this point in your life. Like you said, you may be drawn back into medicine in some capacity in the future, but let it be on “your terms”. Congrats.

  6. Congratulations on having the courage to retire and follow your heart to grow with your family. I also retired, and although I truly loved and enjoyed my medical career, I now love my new career as a full time mother and wife; even more. This career change has definitely been one of the best decisions I have ever made. No regrets. Enjoy!!!

    1. “Dr. Wimbley”- great to hear that your path has been a successful one, and has been filled with no regrets! Always love to hear from others who have ventured to make a drastic change to pursue the life they feel compelled to lead.

  7. I also retired around 36 for many complicated reasons. The breaking point for me was my kids. My son was born and had kidney failure and ongoing developmental and psychiatric issues. My husband (pediatrics) enjoyed his job much more than me (ER), he was treated better and reimbursed MUCH better. So I decided to stay home. My “obligations” to society were not utmost on my mind- I put in a lot of work and paid all my debt. I don’t think other professions would tell their members that they have a duty to stay, despite being repeatedly abused by their system. Why do doctors have to sacrifice their health and happiness and families for a system that treats them horribly? (See physician suicide rate.) I am now looking for ways to use my medical knowledge in a lucrative way, although the best way I’ve used it is for my kids!

    1. “Dr W”, I agree that few professions tell their members they have a duty to stay despite personal challenges and in some cases an abusive system. In the end, it seems you have done what was right for you and your family at the time. Your kids have no doubt benefitted from your medical knowledge. There are certainly other opportunities for you to use your medical expertise. I’m hoping to highlight some examples in future blogs.

  8. You don’t need to justify your decision to anyone. You paid in time and $$ for your education and you don’t owe it to anyone to keep working if you neither want nor need to.

    I had my first child in medical school as well as a health scare which made me re-evaluate my priorities. Ultimately it heavily influenced my specialty choice (outpatient with little to no nights/weekends). Though I loved surgery, I couldn’t justify the toll on myself and my family. As I wrap up residency, I do get twinges on what I’m missing but honestly feel like I have enough time for my kids, my husband and myself and am grateful for where I am.

    1. Sophia, Isn’t it ironic that it takes a “health scare” to realize where your priorities lie? I found my own health scare to be something that turned out to be a blessing. Happy to hear that you were able to structure your life in a way that works for you and your family.

      I agree that I don’t really owe anyone anything and that helped me come to the decision to leave. Best to you and your family!

  9. I strongly feel you do not owe anyone an explanation. Any OB/GYN understands the pressures you are under. I t is great if you got away before you got sued too. Medicine is changing rapidly I am essentially practicing concierge gynecology. I see patients 3 days per week. I do not have an EMR. The last straw for me was increasing unattached call. I am financially very secure so I consider my practice to be almost a hobby. I truly look forward to seeing my long term patients. I will fully retire sometime between now (60.5 and 65).

    1. Your patients are lucky to have you. I do miss my long term patients. Our field is quite enjoyable when you are able to practice with some autonomy.

  10. Your comments;
    Loss of physician autonomy, pressure to increase productivity as opposed to quality care, and placing cost effectiveness ahead of best medical practice were weighing heavy on me. In addition, the litigious environment in the US has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.
    were exactly why I also retired early. One can vote with their feet only once. I feel guilt that I am no longer using my skills to help others, but the litigious environment keeps me from returning. I have never been sued, but I don’t want to risk my savings or spend the rest of my years in an unjust court situation. As a primary care physician overhead and non-funded mandates also make it difficult to work other than full time. I reside in a rural area making medical volunteerism difficult. I did work in Bolivia, and Haiti, but didn’t accomplish much for the time and money spend to do so. I’m glad you have other options.

    1. Yes, I was never sued either. However, I also worry that if I ever returned-even if only part time- I would be risking a lot- (my family’s security/savings/college tuition/etc). Not to mention years in legal quagmire if I were to get sued. I wish it didn’t have to be such a defensive atmosphere to practice. It would be much better for patients and physicians without the litigious environment. While I would love to volunteer services here, I would probably look into options in another country for this reason.

  11. Good article. I am a firm believer that no one has an obligation or moral responsibility to work in any job if they don’t want to. It doesn’t matter if taxes paid for part of school or training. What if we applied this logic to all schools or training that get any government funding or subsidy? Do we hold everyone who goes to public school morally accountable to have a certain job, or use the skills they learned? If society demands physicians work a certain about of time to repay whatever debt they morally owe then then can make a law. Until then, we are free to choose when, where and how much to work.

    The fact of the matter is, physicians on average retire later and work longer careers on average. I think there is this perception that everyone is leaving medicine and retiring early, but the data just doesn’t support this. Everyone complains about how horrible it is to practice, yet everyone keeps working 🙂

    Good for you having the courage to do what is right for you.

  12. Congrats on your retirement.

    Hericlitus was a Greek philosopher who hailed from Ephesus on the west coast of Turkey. He lived around 530 BC. He was pre Socratic and pre Socratics dealt mostly with the physical and metaphysical. His philosophy revolved around the notion of the unity of opposites. One example was fire, a fire could rage a fire could barely be there but it was always fire. Another was the concept you never step into the same river twice, because the river you stepped in before is now down stream yet the river seems to be static and the foot always comes up wet.

    I think as physicians we become too wrapped up in being human doings and to that extent we neglect being human beings. Doings are transitive, beings are intransitive, You are the unity of opposites one time your a physician the next your a mommy in a while you’ll be a grand mommy. One day you’re 30 the next 30 and a day. You never step in the same river twice, so instead savor the river you are stepping in today, and lament not the river from yesterday The unity is you are you intransitive. You are not a modifier. The opposites are one day you are physician, the next you are not physician. You just stepped into a different river, and the stepping was by choice. Tomorrow yet a different river will present. Society can pose no judgement on the river, it’s nature is to change.

  13. With luck, many of us know our birthday, but hardly ever we know our departure date. A “moment of truth” is a reminder that we only live once and that life is not a commodity. The value of our minutes and the importance of those who really matter gets elevated when we realize that our departure date could have been closer than expected. I had my “moment of truth” when my younger brother died unexpectedly three years ago. He did not see it coming. We did not see it coming. He skipped two opportunities for early retirement because he thought he had time. He and I spoke on a Sunday night and he died of a heart attack on Tuesday morning soon after arriving to work. His children, our family and friends were devastated. He was only 49. I promised to myself that I will take action and do whatever was necessary to own more of my time. I learned about FIRE. I took action and my date is just around the corner.

    Bob Dylan once said that — ‘A man is a success if he gets up in the morning and gets to bed at night, and in between he does what he wants to do.’

    We can easily replace man for person. We are all even more successful not only be doing what we want in between waking up and going to bed, but in our ability to spend the time with those we love. I wish you much success in your new stage and happiness along the way!

  14. You are so brave for doing this – your posts are more widely supportive of true health than any practice could be because it’s ultimately empowering. We never stop being healers – we heal by just being our happy selves, by doing what we love. Taking back our power – our autonomy – of how we heal, is paramount for physicians and for society.
    I find it so sad that most physicians feel they have to justify their reasons for leaving. I too, as an ND, felt guilty about leaving, ethically, until my health took it’s toll with hypertension and facial drooping warning of impending stroke, and simply no longer wanting to get out of bed in the morning. I only worked part-time so I can’t say I was ‘overworked’ either, although I was exhausted after each day all the same. I enjoyed my patients and overall, made decent money and had a great job – on the outside. But I had lost myself. Who I really was and my dreams of being a musician, artist, writer and speaker were all left to the wayside. I was essentially caring for a thousand children, including my own family at home, and had put myself on the back burner. A couple holidays a year was not enough to get away from it all. Doing my passions ‘on the side’ didn’t allow for any real commitment to myself and I could just no longer teach my children that toiling at something that doesn’t fit, is ok. People said to me ‘just leave it all at work’ but if we are empaths and compassionate people, we take these people home with us every day as caregivers, no matter how good our boundaries are.
    It’s no mystery that doctors have a low life expectancy – no one is meant to be in caregiving long. We all need to move on and our society needs to encourage people to look after themselves so much more. I saw so many cases that were just foolish – people could clearly take care of simple issues with a little effort. And far too many cases where people were simply unwilling to change. Where should the burden of responsibility lie?
    I was expected to perform miracles, to never make a mistake and was blamed for others’ lack of responsibility, had to tolerate abuse from patients who didn’t like what I had to say in truth to them and even my own provincial association had no interest in supporting me. In what other job is this acceptable? A person cannot work under the unreasonable distress of unrealistic expectations.
    I had made good investment decisions early on and eliminated my massive debt by keeping my overhead very low (I had a small modest office that I purchased instead of rented, providing me with an investment that I cashed in on after retirement) and by simply going without for many years – I never buy new and I don’t have 7 sports cars. Too many physicians I see, take their pay check and spend unwisely, creating more debt and therefore, getting caught in a vicious cycle – you CAN’T leave work at that point. The truth is, most physicians make a modest living. They may have a ‘millionaire title’ but they cannot afford a millionaire lifestyle. This is not necessarily a doctor problem – many young people have unrealistic expectations when they receive money in hand. What you want and what you need are 2 different things. In no way is my life ‘lacking’. I have everything I desire without the debt. Live simply, buy used and focus on what you already have. Stuff, titles and status do not make us happy. In fact, my title caused me a lot of pain. I was ostracized from others as being an ‘authority’, causing them to change their affect immediately when they found out I was a doctor, often asking me for free advice to boot. I was no longer equal in their eyes and I grew to resent my title as being nothing more than a burden. Although at first, I found it difficult to release (after all, I’d paid heavily for it), I now feel completely free and loved for just who I really am, not for my title.
    Early retirement from medicine can make us feel ostracized and embarrassed, by colleagues, associations and patients alike, akin to a disowned child facing a disapproving parent who does not like your free choices to be independent, wagging it’s authoritative finger at us and scowling at our ‘disobedience’. They make us feel as though we’re a failure – like a deserter who’s just ‘given up’. Like a soldier that cannot leave the battlefield unless he’s injured or dead. As though we are greedy to ask for our needs to be met.
    My early retirement after 15 successful years of practice was mostly met with hostility from my patients who felt they ‘needed’ me – from people I’d known for years that I thought really cared. I was shocked by their lack of support and general selfishness and even their denial. My association admonished me as well for retiring so early, saying I was too young, implying my decision was foolish. Make no mistake – they feel they own you and the price for the maintenance of your title is you must sell your freedom as more and more rules are implemented, as they apply increasing costs and demands for our ‘continuing education’ and as the rising costs of association and malpractice fees are laid upon us, literally consuming your entire life, funds and all your ‘free’ time. As far as they are concerned, your sentence is for life. I had given so much of myself over the years, done so much work for free, doing my very best every single day, only to realize they only wanted more. I realized then, I had made unequivocally, the right decision… getting out was a small price to pay compared to staying.
    Don’t get me wrong – I gained so much from my practice and I don’t have regret or grudge. I’ve realized that a person changes in life – they learn, evolve and move on, and their outer world and career need to reflect this. Perhaps we do this more than ever now in our more modern, free thinking world. I truly loved my job as a kid at a coffee shop too but I don’t have any guilt that I left, nor do I call myself a server anymore. Being a doctor isn’t the end all be all. We need to be honest with ourselves and face the fact that the greatest gift we can give humanity is self love and self healing. I don’t regret my practice because it served to heal me, as I helped heal others. This is not selfish – it’s our birthright. In fact, we can only truly contribute if we are happy. We have to learn to put ourselves first in order to become living examples of truly healthy humans – by doing what makes us truly happy. Physician, heal thyself…

    Tamsyn, (happy and free 🙂

    1. Wow, tamsyn. Thank you for your powerful comments. I love to hear the stories behind other’s decisions regarding their medical careers and different paths ptheir lives may take. Best to you in your kfuture endeavors

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