For a mere biennial fee of $525, I remain part of the medical community with a newly renewed medical license from my home state. I still have time to make a decision on renewal for the state from which I retired two years ago, only because their board extended its deadline three months to allow its physicians to complete the CME that our pandemic made more difficult.

It costs less but regulatory hoops obtainable with effort demand a greater commitment. My subspecialty board certification expires this year, as does my DEA registration. Having no intention of resuming patient care or even wondering sometimes if I remain up to the task, these ties have little economic value. Whether the psychic dollars obtained offset the green dollars spent can be part of an ongoing discussion with the inner me.

Being a good medical citizen with no jangling closet skeletons, renewals take two components: willingness to pay and willingness to study.

At each extreme, the answer easily emerges.

A DEA renewal sets me back a sum that I could use for some other indulgences like visiting my kids, even though renewal only involves filling out a form — not worth it.

My ABIM specialty renewal, decided against the day after the current certificate arrived ten years ago, costs mucho dinero. Neither my check nor my credit card would bounce, but the size of this expense was a deterrent.

I enjoyed challenging myself with new information — including the schedule of ABIM modular self-exams that can be a lot like a factoid scavenger hunt. But the MOC process, the relative complicity of some of the professional organizations that I otherwise most admire, submission deadlines when I have more urgent professional priorities, to say nothing of a high-stakes exam from an organization that trusts the vein print from the dorsum of my hand more than it trusts me did little to endear either the credential or sponsoring organization.

Moreover, with an expected attrition of memory neurons as I approach the Biblical threescore and 10, exercising my independence by declining this opportunity proves something of a no-brainer.

For that sum, I can have a nice time in a place on my bucket-list or buy a new recliner as reparation for overdue hedonism that MOC takes away.

The licenses, though, merit more serious consideration of renewal, even if re-entry to compensated medical care has disappeared from my personal or professional initiatives.

My subscription to the New England Journal of Medicine started as a third-year student. Even in retirement, I pace myself to read two articles a week. Though they did not offer a post-retirement discount as my parent organization, the Endocrine Society did, their annual subscription remains a good value along with a portion of my identity.

For license renewal, I only need to read two of the ones that offer an hour’s CME, then answer the questions. CME options have moved in a more appealing way in the two years since my last renewal.

Previously I would attend an annual meeting, pick up half my needed credits there, local conferences added a similar amount, and the rest would come mostly from a subscribed course, with the computer providing the requirements unique to the state where I saw patients.

It’s different now with CME that no longer comes to me passively as an occupational by-product.

Don’t separate yourself from the community, advised the sage Hillel. The increasing professional burdens that doctors experienced in the final decade of my own career can be a powerful inducement to dropping out.

Escape may not be the optimal solution to burnout, though. Proving myself worthy when the patients and paychecks have disappeared emerges as a very important incentive. I can still watch a 30-minute video on a subject extraneous to endocrinology or any patient I have seen and learn how the newest, most innovative medicines work.

I didn’t even know what an orexin receptor antagonist was or even which organ made orexin or why we have it, before scrolling through some electronic CME options.

As the mandated heart data on the newer SGL2s started to appear in reports right before my retirement, I wondered whether they might be prescribed more by the cardiologists and nephrologists than by my endocrinology colleagues.

We, endocrinologists, have been there before — developing statins and bisphosphonates only to have cardiologists and OB’s absorb this capacity to their practices. With the CME mandates, I accessed the answer on our versions of medical professor YouTube.

SGL2s have great non-diabetic utility. Had I stayed active with patient care, my own approach to patients would have moved in a less glucocentric direction.

License renewal requirements made me appreciate this trend, suspected a few years ago, realized now.

Patient responsibilities disappear, obligations to other doctors disappear, my interest does not disappear, nor does my desire to have a tangible measure of being a physician beyond my survivors appending MD to my name in perpetuity on a headstone.

A limited selection of achievements cannot be taken away. I will always have a bar mitzvah, my original ABIM certificate from the era before mandatory recertification and the university diploma endowing me with a doctor of medicine degree.

While these establish themselves as permanent possessions, they do not make for permanent relevance. That comes with being part of medicine’s progress, irrespective of whether I contributed to it. It requires staying part of the medical community, even if as a learned observer.

The easy state license now sits on my desk, printed through my computer, though I think I deserved more substantial frame-worthy card stock from the state. The other state requirements now have the mandatory CME certificates, needing only a computerized form and credit card authorization.

The Endocrine Society wanted me as part of their community. I’m not sure my states of practice and residence do. My many colleagues may or may not miss me two years after departure, but I’m pretty sure none would begrudge my remaining among them, even if only nominally.

Richard Plotzker is an endocrinologist who blogs at Consult Maven.

Image credit: Shutterstock.com