I retired as a physician at age 70, when COVID-19  came to town and the clinic I was working closed. During these past three years, I have had the luxury of a long view of my career. Every now and then, I feel the urge to pick up my stethoscope again and return to the practice of medicine. I’m tempted by the several good aspects of being a doctor.

The good

The conversations with patients were often remarkable, offering insight into other people’s lives. For example, the wealthy white man who seems to have it all tells me his wife is being treated for cancer. He has donated money to a cancer center nearby and is seeking cutting-edge treatment for her. Unfortunately, his wife has metastatic cancer that is beyond any known treatment. It turns out no amount of wealth or influence will stand in its destructive way. I know that. He will eventually come to know it as well. Doctor Death makes no exceptions for wealthy men and their loved ones. My heart goes out to him. He will learn the same life lessons the rest of us have had to learn.

Other patients were just plain amusing. For example, I saw Mr. Gillman in a rural clinic. I had been seeing Mr. Gillman for some time already. I asked about his wife and the farm. This Mr. Gillman answered me hesitantly. It turns out this was a brother. The two men looked alike. Thus Mr. Gillman did not have a wife. He was trying not to hurt my feelings by saying as much. My nurse explained the situation to me after he left.

The intellectual component of doctoring was also rewarding. Most doctors enjoy solving medical puzzles, dipping into the medical lore one had worked so hard to acquire. Now, the extent of my medical challenges is limited to family members. They may or may not want to hear my insight on the brother-in-law who just got four cardiac stents. Or the sister-in-law dealing with Alzheimer’s dementia.

I wrote a memoir about practicing medicine in rural Kentucky for 20 years. That book has more about the good parts of doctoring, stories that gladden the heart, and medical puzzles that challenge the brain.

What other part of doctoring do I miss? I miss the income stream. That was nice, making good money. With retirement, I am somewhat limited. I must dip into savings and retirement accounts to pay for trips for my children and grandchildren. The latter demographic is not terribly understanding of why they cannot go to the beach in Mexico for spring break.

The bad

Then there are several reasons I do not miss doctoring. For the sake of symmetry, let’s call these reasons “the bad.” It turns out there are structural disincentives in the profession. About which I knew nothing when I started medical school. Below are three things I found out along the way and why I will remain retired:

Topping the list is the fear of being sued for medical malpractice. It is like touching a live wire. The shock it delivers can destroy your enthusiasm for the practice of medicine. The AMA reports that 50 percent of doctors over age 55 will have faced lawsuits sometime in their careers. An altogether unpleasant experience.

Also unpleasant is the experience of working in a clinic owned by a corporate entity. They try to cut costs. Support staff gets thinned out: medical assistants replace RNs. The medical ranks get pruned: physician assistants replace physicians. Not to mention the overscheduling – expecting the provider to see 30 patients daily when the natural flow of things would allow doctors to see 15 patients daily with adequate time to talk to patients.

The last development of concern is the mandated use of EMRs. A provider’s attention is divided between what the patient says and what the EMR asks. The EMRs, in my experience, suck your life out with their demand for endless clicking and useless data. Perhaps there are newer iterations out there that offer a more streamlined experience for doctors and patients. One can hope.

And the ugly

The initial response to COVID. Leaving millions of front-line medical workers unprotected at the onset of the pandemic. There were no masks available. There were no tests available. Plus, the misinformation campaign telling people that doctors were plotting against them and that the vaccines were dangerous was ugly.

So there you have it: the good, the bad, and the ugly. What I did not know when I started working as a physician. And why I am retired now with minimal regrets.

Janet Tamaren is a family physician.