Why I Am Retiring from Obstetrics

Many have asked why I am retiring from obstetrics. Here is an attempt to explain.

First a description of the style of obstetrics I practiced. My style of obstetrics was low intervention, mother centric like the out of hospital midwives. This is in contrast to most obtetrical practices that are high intervention, medical system and practitioner centric. The benefit over the out of hospital midwives was having the options that are available in a hospital Since there was only one doctor, it was very personal. As a family doctor I could offer a wide range of services outside of just obstetrical care, including caring for the baby and whole family after the birth. I delivered at a hospital that accomodated my style very well.

It has saddened me that the style of obstetrics I practiced is now not available anywhere in our area. I struggled with the decision to retire from obstetrics, but ended up doing so for the following reasons:

1. I am tired. Obstetrics is an all consuming practice, especially as a solo doctor. When you are caring for pregnant women, there is never a time you do not have one ear on alert, waiting for a call. Days off are never truly off, as most of them you have to go to the hospital to round and frequently, if someone is in labor, you spend the day. Being awake at night and then seeing patients in the office the next day is physically tiring. In addition to the workload, the constant concern that something can go wrong in a field as high risk as obstetrics is emotionally tiring.

2. I owe it to my wife to retire from obstetrics. We have been married for 31 years. For those 31 years my life has been consumed by medicine. I was in medical school when we were married, then residency, then solo practice with obstetrics. Frequently I cannot do things with her because of the demands of my medical practice. The hardest part of obstetrics practice is the unpredictability of it. She could not plan anything with the assurity that I would be there. We have never taken a vacation for longer than a week and for the last several years, our “vacations” have been less than a week. It is time for us to do more things together and for her to be able to plan things with the confidence that she can count on me.

3. It is time for me to do some other things in my life. I am very thankful for the opportunity I have had to be a physician and in particular the wonderful experience of assisting new babies to be born. Being in solo practice, while doing that, allowed me to provide a level of personal service to my patients that is not available in any other setting. The consequence to me personally is that I am pretty limited on what I can do away from my practice. At some point in my life I would like to travel both inside and outside our country. I would like to do some medical mission work. I would like to do some classroom teaching. I cannot do these things while waiting for babies to be born. Now is the time to get started on those things.

4. I have no confidence in my longevity as a practitioner. I am 55 years old. I have had cancer and have risk factors for heart disease. I am very thankful that I have never experienced a health event that kept me from practicing for more than a few days, but how long until I experience a prolonged or incapacitating health event that would abruptly make me unable to deliver care and thereby leaving my pregnant patients in a difficult position?

The world of American medicine is in turmoil. Doctors everywhere are under incredible pressure. Every interaction with a patient is a potential law suit. Trying to keep up with the burgeoning regulations is impossible. The government is now routinely auditing doctors, trying to find errors and the breaking of regulations. After the audit, they have the power to impose penalties or restrictions on your practice for unknowingly not following one of these ever changing and growing regulations. A recent survey said forty percent of physicians want to retire from medicine in the next five years.

When one agrees to care for a woman during her pregnancy you have made a seven to eight month commitment. Between possible health events and the potential that I will reach my limit on tolerating the insanity of American medicine and the risk that the government will decide I do not toe the establishment line, therefore need to be sanctioned, I no longer believe I can make a seven to eight month commitment. I currently have no plans to retire from practicing medicine all together, but when that day comes, I do not want to leave pregnant women in limbo.

Who knows what the future holds. I already miss being part of this event in people’s lives. My wife and I definitely need some R&R and our first stop is two weeks in Alaska. After that, we will see. In the meantime, I pray another young family physician picks up where I left off.

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