Giving Up the Knife

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This year, I stopped doing surgery — giving up the knife, so to speak. It wasn’t an easy decision to make. I’ve been a surgeon for 32 years since graduating from medical school. It’s been a distinct part of who I am for most of my life.

This doesn’t mean I’ve retired. I’m still practicing in a clinic-based setting and still do procedures in the office. I just no longer operate in hospitals or ambulatory surgery centers. And because of this, I no longer take call for the hospitals and their emergency rooms (which is required in order to have surgical privileges at a hospital). In the past few years, seeing patients in the office occupied most of my work week anyway.

And yet now, the time spent in the office is less harried and more engaging. I’m more in the moment with the person in front of me, without that overhanging sense of dread that comes with the unknown — an unexpected complication in a post-op patient, a call from one of the emergency departments, the hospital, or the transfer center.

Office encounters have been more rewarding. Besides a patient’s medical problems, I’m more inclined to see their intangible qualities, aspects of their nature that can be intensely interesting or downright humorous.

I do miss the OR. I miss the people in the OR. Though we’ve faced a torrent of scary, pee-in-the-pants situations as any surgical team is bound to face, much of the time was quite pleasant and fun. Yeah, surgery can be a real kick in the pants. That’s the reason I became a surgeon.

I miss some of the more challenging surgeries when actively treating a patient with cancer was the ultimate high of my surgical profession. But I gradually gave up some of the more complicated and lengthy surgeries some years ago.

Part of this was that the stamina of my youth had dwindled — some of those cases took 6 to 8 or more hours of continuous operating with no break. More importantly, more fellowship-trained surgeons nowadays are sub-specialized with more experience. It was best for the patient to be treated by these folks, even if it meant traveling 3 or more hours to get there. All the other ear, nose, and throat specialists (ENTs) in our area have done the same.

I was the sole “old-timer” still in private practice. All the other ENT doctors in our area are employed by a large hospital system with a huge referral base. My surgical volume was far lower than my hospital-employed colleagues, which didn’t bother me since I was getting older. Yet last year, I was the only ENT taking call for all three of our area hospitals. I could’ve been employed by a hospital, earning much more while relinquishing the business of running a practice, but the loss of autonomy wasn’t worth the trade-off.

I wasn’t unhappy about making less than my peers. There was no dire need for more money. What’s the endpoint with money anyway? How much annual income is really enough? My wife and I always budgeted our expenses and were able to save each year while regularly contributing to our kids’ college funds, even during the leanest years. We stuck by a strategic plan for savings and investing and nearly met our financial retirement goals before I decided to stop doing surgery. Our quality of life was not adversely affected. Additional money would not have changed our lifestyle.

Stopping surgery and no longer taking call for the hospitals was the right thing to do at the right time. I eventually felt the stress evaporate, replaced by an enhanced peace of mind. I see this not as an end but as another stage in life’s journey. But I’m not ready to retire yet.

After giving a lecture earlier this month, a third-year medical student came up to me. He said he was interested in pursuing ENT; his reasons being a good blend of clinic and surgery — some of the same reasons I chose this calling. He said that aside from tonsillectomies and nasal and ear procedures, he wasn’t aware we did surgeries such as thyroidectomies, parotidectomies, neck dissections, and the like, which fascinated him even more.

He asked how one gets to that point of doing such intricate surgery. I had that same fascination back when I was a lost third-year med student, not knowing what field of medicine to choose. The epiphany came during a series of lectures from a few of the ENT attendings, one of whom was a head and neck surgeon who later became my mentor (Bruce Campbell, MD). Like a slobbering, tail-wagging dog, I had approached him and asked pretty much the same questions that this third-year med student was asking me.

I chose ENT and never looked back. It has been — and continues to be — a most fascinating and rewarding career.

Saying goodbye to surgery is a pivotal and bittersweet milestone, but I look back at my surgical career with fondness and satisfaction. And despite no longer performing surgery in the OR, I still want to treat patients until I am unable to do so.

Following are a few lines from a speech to the graduating class of residents I was asked to give this year, which speaks to this very point:

“At this stage in my career, I still want to keep going. I still think of medicine as an adventure. I still find joy in our profession. I still learn; I learn from all of you. It’s been 27 years since I finished my residency, and I reflect back with a sense of satisfaction and pride and no regrets. Though I look forward to one day retiring, I’m hesitant to do so since what we do is so meaningful, absorbing, and worthwhile that I don’t want my professional journey to end. That’s by choice. Being a doctor is a part of who I am, embedded in my DNA. And hopefully, it is with you.”

Randall S. Fong, MD, is an otolaryngologist and can be reached at his website, as well as his blog.

This post appeared on KevinMD.

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