How old are you in ‘doc years’?

Physicians of a certain age will recall that canine imagery was once part of housestaff lore and lingo. When dinosaurs roamed the earth and the idea of work-hour restrictions was unfathomable, it was not uncommon to find oneself routinely designated as the “call dog” or, worse, the “scut puppy.” For a lot of us, almost every day was a dog day.

Sitting one night with my wife and our beloved canine companion, a 5-year-old male Vizsla named Blaze, I pondered his chronological age and made the usual seven-for-one calculation, placing him at healthy early-to-mid-adulthood. Given the variable and the differential, I concluded that he and I would soon, and synchronously, be “old dogs” together.

I am, in strict Julian chronometry, 64. I just retired after 30 years as a cardiac surgeon. It occurs to me that due to the nature of medical practice, we physicians, scut puppies and call dogs probably do not age at a constant 1:1 rate. If we’re going to accept the idea of dog years, then maybe we need a new metric for healers:

Doc Years.

So, submitted for your approval and lacking any substantive scientific basis whatsoever, I offer Doc Years as a real-world assessment of the market price of a life in medicine and an estimate of the temporal taxes paid along the way.

First, a couple of baseline assumptions:

• All physicians are their true chronological age on the day they graduate from medical school.
• All specialties are equally stressful, i.e., no extra points for being a neonatal nephrologist versus a small-town family physician.

Now that we agree that everyone toes the Starting Line at the same spot, I propose the following adjustments to our mortal coil epochs:

Training

After three years: Add 0.25 years of age for each additional year of residency/fellowship

I did say no extra points for specialization, but the length of time required to train in some branches of medicine deserves recognition.

Debt

Zero debt at graduation: Subtract 2.5 years
Less than $250,000 debt: Add 2.5 years
More than $250,000 debt: Add 3.5 years

If you miraculously graduated with no medical school debt to your name, it won’t be hanging over your shoulder for the next several years. Meanwhile, if you’re like the majority, saddled with tens if not hundreds of thousands of dollars of debt that will follow you for the next decade of your life or longer, add accordingly.

Call (post-residency)

No call: Subtract five years
1:4 call or less: No additions or subtractions
1:3 call: Add 0.25 years per year
1:2 call: Add 0.5 years per year
More than 225 days a year: Add 1.25 years per year
More than 300 days a year: Add two years per year

Training programs may have tight restrictions on how long you can work or how much sleep you can be deprived of, but the real world does not. Call is what wears down the tread on your tires—so adjust your mileage appropriately.

Practice structure

Self-employed/solo: Subtract five years
Self-employed/group: Subtract three years

If hospital-employed:
-Physician (MD/DO) CEO: No additions or subtractions
-Non-MD/DO CEO: Add five years

If your direct administrative superior is a:
-Practicing physician: No additions or subtractions
-Non-practicing physician: Add 2.5 years
-Clinical nonphysician: Add five years
-Nonclinical/nonphysician: Add 7.5 years
-Physician in name only (PINO): Add 10 years

Physicians, by nature, crave autonomy. We are trained to be independent thinkers; to evaluate and then make decisions, most of them difficult and critical. The quantity of misery is proportional to the degree that this hard-won autonomy is taken away. We all have undergraduate and medical doctoral degrees. Many of us have additional Master’s degrees or even PhDs, plus years of intense post-graduate training and real-world experience.

Having decisions made for us by individuals with far less education, training and experience is more than a bitter pill. Worse yet is the PINO, who often feels compelled to find fault with those who are actually taking care of the patients.

EHRs

One EHR in the last five years: No additions or subtractions
Two EHRs in the last five years: Add 2.5 years
More than two EHRs in the last five years: Add five years

EHRs may well be, as R.E.M. sang, “The End of the World As We Know It.” They eliminated nuanced and thoughtful assessments and replaced them with drop-down menus, cut-and-paste notes, and comically mangled voice recognition dictations. No one feels fine about this one.

Teaching

Teaching (medical students): Subtract one year
Teaching (residents): No additions or subtractions
Teaching (fellows): Subtract two years

Teaching makes us smarter; it makes us better at what we do. It is truly its own reward.

What’s your age?

You could argue that any of these suggestions are capricious, subjective and arbitrary. They are. But we need to start somewhere.

The stresses of providing modern medical care are incredible, whether you’ve been at it for a lifetime or are just starting out. Physicians are burning (sometimes flaming) out at an alarming rate, not because of the patients and their problems, but because the milieu has become toxic, actively vacuuming the joy out of every aspect of what is, for most of us, not just a career but a calling.

As medical practices become increasingly dominated by health care accountants, we become less of the dear and glorious physician and more of the monetized medical commodity, judged solely by our “Work RVUs” and our latest satisfaction scores.

It doesn’t have to be this way.

We can find ways to subtract those years from our age and add them to our careers by refusing to cede health care to finance majors and middle managers.

We are a community of healers and the health care system is ill—so who better to treat it than us? It’s an old maxim that happy people live longer. Medical practice today so often imposes a chronic unhappiness—but fortunately for us, not an incurable one. Most of the items on my list are changeable. This is our profession. Let’s start actively reducing the things that age us prematurely and focus instead on those which sustain us.

In case you’re wondering, I did do the math on my own career. Without going into numerical details, let’s just say Methuselah is looking over his shoulder.

I suspect that at this point Neil Young would posit that, all things considered, it’s probably better to rust. So let’s put ourselves back in charge. To paraphrase Cassius in Shakespeare’s “Julius Caesar,” if we want to take back medical care and have longer, better careers, then that opportunity, dear colleagues, is not in our stars, but in ourselves.

Related reading:

Burnout prevention should be taught in residency

Scope of practice expansion: Patient safety sacrificed for greater access