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Can competition and the fear of litigation drive one to retirement?

2008; Elsevier BV; Volume: 61; Issue: 6 Linguagem: Inglês

10.1016/j.bjps.2008.04.009

1878-0539

Surajit Bhattacharya,

Diversity and Career in Medicine

The article written by Rod J. Rohrich, Mary H. McGrath and Thomas W. Lawrence of the American Society of Plastic Surgeons Workforce Task Force and published in Plastic Reconstructive Surgery regarding practice pattern, satisfaction and retirement plans of Plastic Surgeons over the age of 50 in the United States of America, is indeed a very thoroughly researched document of gloom and doom.1Rod Rohrich J. Mary McGrath H. Thomas W. Lawrence: plastic surgeons Over 50: practice patterns, satisfaction, and retirement plans.Plast Reconstr Surg. 2008; 121: 1458-1474Google Scholar Though the Plastic Surgeons there are, on one hand more satisfied in their clinical practice than their contemporaries in other specialities, yet they are retiring earlier because of rising malpractice costs, insufficient reimbursement, stress of practice and, hold your breath, increasing competition! So much for the famous Yankee tenacity which made the youngest continent in the world the most prosperous and the envy of one and all! Had their forefathers been such timid quitters their beautiful country would have been as arid and barren as the Australian outback! Now if the deductions of this research paper are true the question arises asking why is it so and why do I feel that such a mind set does not prevail in India? This environment of gloom suddenly seeps into a practice, which was agile, energetic and profitable till recently, because there is a marked difference in our and their understanding of the criteria of success. If monetary gains remain the sole criterion of success in a Plastic Surgery practice this outcome is inevitable, but if you are passionately in love with the speciality and the fact that it helps you to earn a livelihood too is a God sent gift which you gratefully acknowledge every day, I see no reason for despair. I know for certain that when I treat a patient I am thrice blessed – I get three benefits - happiness, fame and money. So long as the sequence of these benefits remain strictly in this order I know that there will never be an occasion in life when, if God keeps me fit enough to perform, that I will ever think of retiring. Retiring from what? This is my life; I eat, drink and live this life. If I am not treating patients I am reading, teaching, training, thinking, writing or talking about Plastic Surgery. Then how can I retire from all this just because there is more competition. Competition is in the market not in the mind. If someone is so scared of competition and so fed up of litigations is it justified to seek a legal divorce from one's life's love and passion and take to full time fishing or bird watching? With so many countries in sub Saharan Africa and developing Asia and Latin America still crying for Plastic Surgery service, why have these juvenile retirees never thought of taking their practice to the next level? They have all been outstanding surgeons in their prime days, now by sending competition in their midst God is giving them an opportunity to become outstanding human beings! They have trained their skills in the junior league and now when time comes to perform in the world stage in the true senior league they choose to hang up their boots! Is it not a pity that instead of reaching for newer horizons and exploring virgin and pristine territories where no litigation sharks are ever going to chase them, these surgeons are just dropping out? Where is the pride in quitting? Where is the passion in surrendering? Where is the dignity in giving up? I am of the opinion that in India we are in a much better scenario. Where as there are over 4300 Plastic Surgeons above the age of 50 years in the U.S, there are not half as many in total in India providing care for a much larger population. The question of competition driving someone out of practice is remote. Then again ‘competition’ is a big bully, when you step up to it and take it by its beards, you will be surprised to see clumps of hair coming out in your hands, as it was stuck there only to scare away timid adventurers! Patients in India are still, by and large, a happy and satisfied lot and so the level of satisfaction in practice for the surgeon is not just high but intoxicating. In such a work environment, if one stays physically fit, I find no reason to retire. Yes, priorities change in every stage of life, and from bustling commercial practice one can proceed to calmer teaching/training modules, or sedate rural practice but how can one give up enjoying the intoxicating smile on the face of a satisfied patient or the gratitude of his/her relatives. How can one give up the satisfaction of moulding young and impressionable minds into the Plastic Surgery icons of tomorrow? I don't see this happening in India, at least not in the near future. Yes, once the body and the mind fail to coordinate that is the time to quit! We are in competition with no one but ourselves. When our fading visual acuity makes microsurgery difficult we should gracefully opt for other options in Plastic Surgery and not make a caricature of ourselves. When one grows still older, hands tremble and feet can barely hold one up, one surely shouldn't totter into a hospital, stagger around the OT, struggle to get one's clothes on and off, and perform mediocre surgery; nor should one sit in a corner while a younger Plastic Surgeon operates on one's cases just to keep one's meter running. One surely shouldn't turn into an “I” specialist, repeating stories of good old days to anyone with an ear or worse still be bitter about the work of other more successful younger surgeons. That is the time for seeking nirvana! May I most humbly submit that Plastic Surgery to me is not just a profession, it is a passion, and it is a way of life! I am trained to approach a situation in a calculated way, plan my strategy astutely, have a couple of life-boat plans alongside, execute my plan to perfection and then learn from the experiences of my patients, my colleagues and myself. Retirement too is one such situation and having been a Plastic Surgeon all these years I can not approach it any differently. Trivialities like competition, litigation, stress, insufficient monitory gains, on call duties, increasing regulations in medicine, decreasing clinical autonomy are certainly not going to be my excuse for seeking nirvana! When I put all these demons on one end of my satisfaction scale and put the smiling face of a single child whom I have operated for a cleft lip, or the simple “thank you” from the school going son of the only bread earner of a family, whose crushed hand I was fortunate enough to treat, on the other end, I find all these ghostly demons slipping into oblivion. And so as long as I can perform to my satisfaction, I choose to perform. I am of the opinion that if one stays physically fit the question is not whether one can afford retirement financially, the question is whether one can afford it emotionally, and in our motherland, with so many waiting for our attention – ethically.