Reflecting on a recent meeting about upcoming audits by regulatory agencies, I couldn’t help but notice a significant shift. As the lone male leader and the second eldest person present, surrounded by a dynamic group of younger women, I couldn’t deny the passage of time since I embarked on my journey in administrative and public psychiatry. Far from lamenting, I welcomed this change, recognizing its necessity and long-overdue arrival. Witnessing this evolution firsthand filled me with a sense of optimism.

However, as I approach 64, the lyrics of Jerry Garcia’s “Old and in the Way” resonate with me. I’ve found myself lagging behind the rapid transformations in health care. The proliferation of acronyms, the role of IT, and the jargon of regulatory agencies often elude me, contrasting sharply with the ease with which my younger counterparts navigate these discussions. It’s akin to being a bystander, nodding along without truly grasping the conversation.

Over my 35 years in administrative psychiatry, I’ve weathered numerous Joint Commission and State Office of Mental Health surveys, each more perplexing than the last. It’s become a specialized language, spoken by a minority within the health care realm, leaving me reliant on interpreters to decipher its intricacies.

As chairman of a department, I grapple with evolving norms among health care providers. The younger generation approaches their work with defined hours and workload boundaries, a departure from my own experience. While I commend the pursuit of work-life balance, reconciling this with the demands of a bustling public hospital presents a conundrum. I catch myself echoing the sentiments of my grandparents, reminiscing about a bygone era.

Even in my clinical practice, I find myself struggling to keep pace. Psychiatry has burgeoned, its knowledge expanding exponentially. Yet, my years afford me a depth of insight and diagnostic prowess that eclipses my earlier self.

Questions arise about my continued relevance in this landscape. Should I yield to younger, more adept individuals, acknowledging my wisdom but recognizing my limitations in day-to-day operations? In times past, transitioning to “emeritus” status within a structured faculty allowed for a graceful passing of the torch, fostering a sense of generativity without impeding progress or becoming “old and in the way.”

Constantine Ioannou is a psychiatrist.