I was at a meeting discussing issues concerning upcoming audits by various regulatory agencies and noticed a change that made me aware of the fact that many years have come and gone since I started this journey in administrative and public psychiatry. I was the only man in leadership at this table. I was the second oldest person at this table. Surrounded by a group of younger, intelligent, and energetic women, I realized how much life has changed in the field. I am not going to complain; in fact, I applaud this change. I believe that this has been a long time coming and was needed. To see it occur in front of me left me with positive emotions.

Yet, I could not help but realize that as I approach the age of 64, I’ve become “old and in the way.” This is a lovely song played by Jerry Garcia and his bluegrass collaborators and one that has always touched me. I see that I can no longer keep up with the changes in the health care setting. I am not up to date with the various acronyms. I do not understand the role of IT in our lives, nor do I often understand what the various regulatory agencies are actually talking about. The young individuals at the table all did, communicating easily with each other. I felt like a deaf grandfather looking on, nodding even though I did not really understand a word that was said.

I have lived through at least 12 Joint Commission surveys, between 10-20 State Office of Mental Health surveys, and countless others during my 35 years in administrative psychiatry. Each one has become more and more difficult to understand. It has become a unique language that a minority of the people working in health care speak, and without someone interpreting it for me, I cannot follow the discussion.

As a chairman of a department, I also have to deal with changes in the norms of the health care provider. Both faculty and residents approach the field differently than I had. It is more of a job with set hours and workload limits. While I applaud many of these changes, especially the idea of balance when it comes to people living their lives, I am not sure how to balance the demands of a busy public hospital and the need for wellness in my clinical staff. I have started acting like my grandparents, citing the way things were when I was their age.

In my clinical work, I also find myself falling behind. The field of psychiatry has exploded, and the knowledge base has expanded to the point that I cannot keep up. But there are places where my aging is helpful. I am a better therapist and a better diagnostician than in the past.

Is there a point in my continuing on this path in my work? Or do I step aside and allow younger, more energetic individuals who are savvy to the changes to take over? I feel that, at some point, my wisdom is great, but my practical knowledge of day-to-day operations is poor. When a true faculty structure existed, I could move off into “emeritus” status and allow others to steer the ship. This allows us to feel as if we are generative without interfering and being “old and in the way.”

Constantine Ioannou is a psychiatrist.