From License To Loneliness

By Richard Plotzker, MD

My email delivered a terse reminder. The board of medicine notified me that they had not yet received my license renewal application, just 1 month until the expiration of my current license.

For a mere $100, I could sit through the required online child abuse reporting course and answer the questions as they arise. My CME is more than ample, as my other state license requires far more and is distributed over specified categories. After I authorize a credit card payment for an additional $425, I will remain within the fraternity of my home state's laudable physicians.

No go this time. No go 2 months ago either, when my state of practice license also expired -- $360 for that one plus $425 for this one plus $100 for the mandatory course totals $885.

Being retired these past 4 years, the eligibility for liability coverage for any locum interests I might have once had has long since expired. My DEA registration, a certificate costing mucho dinero, has also long since lapsed without renewal, as had my time-limited board certification.

My rational self, which generally prevailed with a few lapses in my years of active patient care, tells me that a healthy elder like myself can have a few pretty good experiences to add to my cumulative lifetime memories for $885. The expired certificates can either stay tacked to a bulletin board for lack of any more personally fulfilling replacement, or go into a folder where my hoarding inclinations has filed auto registrations from four cars ago, or recycle now. My heirs, who ultimately will bear the onus of purging their late Dad's stuff, probably already have 1-800-GOT-JUNK on their smartphone directory.

Despite a decision to let the two licenses expire without renewal, I still maintained more than enough CME. I am provided a credit or two each week for challenging myself with a research article or two that I would have pursued just out of interest or maybe to sustain my self-identity as a doctor who remains worthy, despite no more patient responsibilities. Just read the article, answer the questions, second chances allowed, and log my credit.

One state requires patient safety education. This need only accumulated 12 hours over 2 years, readily available online from premier institutions that open their grand rounds to anyone on a variety of topics that I'd still open even if it came passively to me in a non-medical news feed. That leaves only 2 hours of opiate training and 2 hours of child abuse reporting. I can be a sport if it's free. I did not want to spend the money, but I did not want to declare myself lazy for not doing the work. Never a lapse in trustworthiness to do what was expected in my working years, and can fulfill the same commitments to myself beyond my working years.

Come the end of the month, for the first time in more than 40 years, I will no longer be a licensed physician. Initially, recruiters added me to their contact list for locum opportunities. I responded to only two within driving distance, but never in an assertive way.

My decision to discontinue patient care at the chosen time was purposeful, the date set as a birthday present to myself 5 years previously. I did wish to remain among other physicians, at least for a while. I would drive to our monthly regional specialty society meetings, taking an appropriate interest in the subject and chatting amiably with the sponsoring pharmaceutical representatives and with whoever occupied my dinner table. COVID brought the meetings to Zoom, and I attended electronically for a while, but it wasn't like being around other physicians.

My medical center established a monthly meeting for late-career physicians, meeting live pre-COVID and Zoom afterward. They even asked me to make two presentations, for which I received small honoraria. But the group being highly dependent on a physician champion, it dwindled on his departure.

I also maintain my national specialty society membership. Dues are discounted, annual meeting tuition discounted to reasonable, and travel expenses prohibitive unless it returns to my town. None of these activities offer suitable surrogates for being immersed in the pageant of daily practice, the patients that you see, the colleagues you admire, the residents who challenge you, and even the insurance company service deniers at the other end of the telephone line that you have to try to outsmart.

Numerous studies, from a recent perspective on "Social Isolation and Loneliness as Medical Issues," to a massive prospective study of the Harvard College class of 1938, which tracked them for their lifetimes, identify loneliness as a negative determinant of longevity. The ability to stay engaged certainly challenges many a retired physician, me among them.

A license to treat patients in the absence of patients does not make a good surrogate, nor do endless talking heads on Zoom, whether for worship, committee meetings, or educational forums. As telemedicine becomes a norm in many practices, even physicians still engaged professionally might have less personal contact with people.

In retirement, finding the hands to shake, fast quips to exchange, clerks to compliment, or attending live meetings takes some effort. Those two licenses nominally keep me in the physician fraternity but from afar. But $885 can be repurposed, allocating it to immersing myself with more people in more public spaces. It seems a much better destination for a senior physician than supporting activities of the state boards. And the CME engagement remains on my personal self-worth agenda too.

Richard Plotzker, MD, is an endocrinologist.

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