Five years ago, I left hospital wards and emergency rooms behind and entered a new & improved medical practice model, at least for me. Since then, I only see patients for office consultations and procedures. Office medicine is a very different trade than hospital practice each having very distinct skill sets. If I were to return to the hospital now to see patients, it would be uncomfortable for me (and them) having not used these skills for years. Similarly, hospital-based doctors might find transitioning to an office practice to be clumsy and uncomfortable.
While it might seem that a gastroenterologist or any medical
specialist should be able to see patients in any location, this is not the case
for most of us. Hospital medical issues
are quite different from office medical complaints. Physicians, as in so many other occupations,
need repetition in order to maintain high competency levels. There’s a reason, for example, that airline
pilots need to maintain specified flying hours.
Athletes, musicians, heart surgeons, comedians, police officers,
paramedics or therapists all need a certain volume of clients and customers to
maintain their professional edges. Consider
an example to illustrate this point. If
you needed to have a cardiac catheterization, would you favor a cardiologist
who performs the procedure several times each week or three times yearly? (Hint: this is an easy question.)
If I were thrown back into the hospital now to see gastro
patients, I would be confronting issues that I have not seen for years. There are likely new diagnostic and
therapeutic strategies in place. Medications have changed. I
might very well be both out of practice and out of date. While I could probably muddle through, I
think that patients are entitled to a higher medical standard than muddling.
I recall years ago, I gave up performing an advanced
endoscopic procedure. I recognized that
my low volume of cases was not sufficient to maintain a high-quality
level. So, I eliminated the procedure from
my clinical repertoire and have since referred these patients to more expert
practitioners. All professionals and
tradesmen should know their limitations and disclose them freely to their
customers. I have yet to hear a patient
complain when I remark that I am referring the patient to a more capable or
experienced physician.
My current office medical skills are sharp and current. The outpatient arena has become my lane of
comfort and competence. At the end of
this road will be my retirement. I hope that
I will have the necessary skills for that occupation.
As a family physician practicing for 39 years and having been relegated to outpatient practice since 2007 and retiring on 8/1/24, at age 72, I will say this has been the hardest transition/phase of my life. I deeply miss the relationships that I have had with many patients for over 30 years, having practiced in the same practice for 35 years . Also there is the loss of purpose and identity which I need to work through.
ReplyDeleteWhy retire or is this a forced retirement?
Deleteexactly in the same position for the past 12 years. I felt temporary loss of purpose and certainly some loss of revenue, but feel that the outpatient medicine model, when well-organized, should be the main avenue for gastroenterologists and GI patients. Never heard a patient complain when i tell them someone else more equipped will see them if they get admitted to the hospital
ReplyDeleteMy father was a GP and saw patients in the hospital in the morning and had office hours in the afternoon; that's what medical practice is, or should be. If you can't do both then you're not much of a physician.
ReplyDeleteDon't really agree. There is a different skillset for hospital and outpatient medicine, and sometimes different meds, lab tests, etc. It was easier in the past to do both. I always maintained my skills for both settings and felt comfortable in both settings, but not everyone does.
Deletehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484472/
DeleteI disagree. The studies show improvement in patient care with hospitalists.
I did both for 40 years and only office for the last 5 years. Hospital practice is better for our established patient's care, but is 90% of stress and inefficiency for us. The best part of hospital practice was dealing with physician colleagues on a personal level.
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