I dropped the news of my finally getting out of prison (via my retirement after working as a physician there since 2002) in a few other threads, but I promised I’d not hijack those threads in case anyone wanted to ask me now what I really think of the US prison system, modern medicine, and being old and cranky.
I began my medical career in 1979 as a student, graduated with my MD in 1983, and finally hung it up this past July 1, exactly 39 years from my first day as an intern.
I trained in Family Medicine, got board certified, delivered babies, attended to newborns, children and adults. I casted uncomplicated broken bones, assisted in general surgeries like appendectomies, hernia repairs, gall bladder resections on my patients, read my own ekgs, spun my own crits, did my own wet preps looking for yeast, BV and other critters, and did my own micro exams of urine specimens back in the beginning. My practice was heavy on pediatrics, general internal medicine, neurology, nephrology, gerontology, infectious disease, psychiatry and more back in those days. It was fun but tiring.
I also struggled with chemical dependency during this early time frame, and didn’t stop drinking alcohol until 1986, and kept relapsing to drugs until 1990. Lost jobs, had medical board and legal trouble, etc. It all eventually got better when I managed to stay clean and sober. Good thing as I had a family by that time, two girls plus spouse.
Medical practice in recovery was a joy. I worked for a staff model HMO for 15 years, where I got paid a straight salary to manage my patients as I thought best. Perfect for me. If it was out of my expertise, I referred. Or learned about it, and took care of the patient. But that eventually ended, when we got taken over by one of the big medical corporations. There, the emphasis was production, and we primary care docs were “encouraged” to refer the complex stuff to the specialists, even if we knew how to take care of it. Why? Because specialists could bill more.
So soon I was taking care of a whole lot more of the worried well who didn’t really need anything but reassurance. Yet I found myself being urged to order tests when/where insurance would cover it, especially if the patient wanted it. Pleasing the customer was the mantra, patient satisfaction survey scored helped decide one’s salary, and producing revenue was the watchword. I was sad.
Being a recovering alcoholic, I could read the writing on the floor. So I jumped to the public sector, “corrections medicine”! In the past, it was commonly stereotyped as where docs who were less than fully competent were exiled. But the system I joined had a new medical director who was busy working to hire qualified, board certified physicians to try to raise the standards in the prison network in my state. I was his first hire.
It was immediately absolutely fascinating, and there were few constraints to keep me from practicing up to my skill level. I really felt like I’d found my niche. Got more responsibilities, more job titles, actually dragged the system kicking and screaming into something like proactive care instead of reactive care, saved some lives even.
Which was nice while it lasted. Budget constraints, bureaucratic stonewalls, changes in the political appointees who were my ultimate bosses kept us from really making much more progress. Still, I felt I served a very underserved and neglected population. But trying to care for patients plus be a supervisor/medical director/acting head boss 2003-2019 ate my soul away, and I ‘demoted’ back to physician in the prison closest to my home in 2019, where it was much less stressful. For 4 months, until Covid hit.
1200 patients in my institution, 1100 got covid. Only 1 died. Thanks mainly to our superb nursing staff. Unsung heroes for sure. They/we got little credit/recognition save from our own peers.
We’re still dealing with covid in our system but it’s a lesser threat for now. I recognized just how burnt out I was some years ago, and committed to retire as soon as I could transition seamlessly out on full pension and into Medicare, etc. Even though my latest post was low stress and great staff, I am just done.
Looking back, I’ve not taken a break longer than 2 weeks since 1983 that wasn’t health related, save for 3 weeks off between private and public sector gigs back in 2002. I’d amassed over 5 months of vacation time in my sabbatical account that I’d been too busy to take. I should have used more of those hours. Delayed gratification had been my thing, but it had been too costly, now that I reflect on it.
So I retired to a whole bunch of congrats and attaboys, and gee it felt nice to get those, and it felt right to stop when I did. It also feels right to have transitioned into prison medicine back in 2002. I feel I did far more good for people’s health working in a prison than I would have in the private sector. I truly do had some mad med skills and I really did get to use them with my inmate patients.
So now I’ve time on my hands and I am enjoying just sitting around and thinking, or not thinking. Thanks to all SDMB denizens for letting me blather and bloviate here today, and in times past.
