“Do you mind telling your legions how long you intend to work?”

Certainly. The short answer is, “Indefinitely.”

The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts.

First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my office, I love my staff, I love what I do. Why would I ever want to voluntarily stop doing it?

Second, and the reason for the first: I love my patients. Well, most of them … no, pretty much all of them. Some drive me a little nuts, but the ability to (mostly) meet their needs, whatever they may be, is about as fulfilling as anyone could possibly imagine.

Is everything really all unicorns and rainbows at work? No. It’s been a real struggle financially of late; so much so that I’ve thought long and hard about various ways to address the issue. Sell the practice and become an employee of one of the competing local health systems? Take another job (or two, or more) at a nearby urgent care? Go concierge or direct pay? All those options and more have come under consideration, and all have been discarded.

Taking another job would mean being unavailable to my patients while I’m there. Selling my practice would be a nightmare for them. Many have come to me to get away from the huge practices that keep hiring more people for the “team” to supposedly help the doctor take care of them, but who in reality just serve as more layers between them and the doctor.

Switching to a concierge or direct pay model would be a betrayal to those patients who can’t afford to see me without insurance. I’ve hung in there this long; I have no plans to change that just yet. If more of the country moves toward direct pay, I may very well reconsider. But it has to be okay with my patients. They are and always will be my first priority.

I saw a new patient the other day who was totally charmed by me, by my practice, by my perseverance in getting a medication approved for him from his drug plan (quite an adventure, let me tell you.) He asked, as many patients have, the not unreasonable question to someone in their fifties, “You’re not going to retire any time soon, are you?”

I replied without hesitation, “Nope. I’m not going anywhere.”

I am in a long term relationship with my patients. I’m not going anywhere anytime soon.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.