This is it.
Eighteen years of practice is now condensed to my final four days seeing patients in the practice I built. While I am not bitter about what has happened (in fact, a large part of me is delighted), there is a sense of finality in this as one of my life’s major passings. This has been the stage on which I’ve been asked to perform, standing beside the stories of people’s lives and living out my own drama as theirs unfolded. This is where my life most intersected others, where I saw pain and joy, birth and death, suffering and triumph. I helped these people and learned from them in the process. I was teacher and student, helper and helped, healer and healed.
Whether I’ve profited most or gave myself dry (I’ve felt both often), it has been what I’ve done. Now I walk off of that stage onto another one, still dimly lit with little substance. I walk from the known to the unknown, the familiar to the hypothetical. I have great ideas, but now those ideas must become reality, and that reality must work well enough to justify leaving what I have left. Enthusiasm and innovation don’t pay the bills or heal the sick; it takes work.
A friend called me “courageous” in taking this step, which may be true. But courage doesn’t exist without fear, and fear is a lot of what I feel at this point. Yes, I do think I am doing the right thing, but that is no guarantee of success. Many good ideas have been dashed against the rocks of life for many different reasons. Courage is overrated, as is faith. Both courage and faith call to step out in fear and ignorance, trusting in something that isn’t visible at the moment. It’s not fun.
So I take a deep breath as I enter into this last week of my old life. I pray for the serenity to accept what is, not fear what I can’t do anything about, and live in the moment I’ve been given.
Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind)where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.
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$50/month is out of the budget of some of my Medicaid and Medicare patients – more in proportion compared to the insured – but not out of the budget for many. I know you are being ironic here, but there is a wide array of patients from rich to poor, and it’s wrong to paint any with a single brush. Some are truly poor and have no chance to pay, but some will forego the eating out or cigarettes to have better care. Many kids with Medicaid have uninsured parents (very, very common) and older siblings without Medicaid. Nobody feels secure in their insurance situation and my solution offers them some solidity whatever the insurance does.
Rob —
How can your low income Medicare and Medicaid patients afford the subscription fee when we keep hearing from liberals that Medicaid patients are too poor to be expected to pay even a nominal co-pay for healthcare services? Something doesn’t add up here.
It’s been interesting how stereotypes about who is gets this and who doesn’t are not true. A lot of my low-income Medicaid and Medicare patients get very excited about it, while my wealthy insured folks just don’t get it or see why. I am getting the feeling I will have a waiting list from the start.
Best wishes to you. Keep your patients foremost and you’ll do fine. Keep writing!
Dear Doctor Rob,
Good luck with your new endeavor. I left traditional primary care 2 years ago after 12 years in practice for similar reasons and started an independent concierge model practice. It was very frightening for the first twelve months, but I can now say that my practice is more fulfilling in terms of the depth of the patient-physician relationship, and that my income has (after 24 months) recovered. It’s still a moving target, but I’m certainly happy that I made this change to support a style of practice that I think is much better.
Cheers.
Rob –
I wish you the best. You’re doing what you think is right and best for yourself as well as the patients who will follow you into your new practice as well as the new ones who will join it. Whatever happens, you won’t have to look back and wonder if it would have worked out or not. You will find out because you had the courage to make the change.
Keep blogging. We learn from you.
I’m on the cusp of a big change myself. Feelings of a continuing mix of optimism/exuberance and anxiety.
Wisdom there is, in this post.
Good luck. You are making the right decision, It’s clear you know that by reading what you’ve been writing recently.