I’m getting old, and as I age, my desire to do inpatient work seems to diminish each year.
When I started out 20 years ago, I thrived on it. There was excitement in an urgent ED call: the chance to go in and give tissue plasminogen activator, do an emergent lumbar puncture, or break status epilepticus.
Back when I was fresh out of training, I hustled. I walked through the ED to make sure they knew I was around. I hung out in the doctors’ lounge, shaking hands and introducing myself. I was trying to build my practice and get my name out. Other neurologists, closer to retirement than I, were more than happy to let me move in and take the hospital’s late-night and weekend calls.
But years and a family take a lot of that away, and the situation has reversed. If someone else wants to cover the hospital, I’m willing to let them. I used to be offended when they’d give the consult to someone else. Now I’m thrilled. One fewer consult to see, note to dictate, paperwork to do. The odd hours and unpredictable nature of hospital work saps your drive over time. Now, I’d rather get a decent night’s sleep than race in to the ED. The desire to help is still there, but my energy level drops with each birthday. Intellectually, I still enjoy the challenges of the job, but I’m perfectly happy to sort them out at my desk instead of the nurses’ station.
With time, hospital medicine becomes more of a young person’s game. As I move from being a newly minted attending to an old fogy, I’m happy to leave the work to the next generation.
My hospital work is now down to one-in-3 weekends and no weekdays. I’m not quite ready to give it up entirely and don’t want to turn my back on my call partners of 15 years. I still enjoy the challenge of the cases, the joking around with the nurses, and the family meetings to bring comfort and explain things as best I can.
But I can live without the late night runs, the driving back and forth, and the unpredictable hours. These days, my time at home is more valuable than it was when I started, and I envy those who keep banker’s hours.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
