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\begin{document}

\title{Retiring as a Physician during the 2020 Coronavirus Pandemic}



\author[1]{Philippa Sprinz}%
\affil[1]{Hasbro Children's Hospital}%


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  \date{May 13, 2024}


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\emph{TITLE PAGE}

Title: Retiring as a Physician during the 2020 Coronavirus Pandemic

Author: Philippa G. Sprinz, MD, MSc

Hasbro Children's Hospital

Division of Pediatric Hematology/Oncology

593 Eddy St

Providence, RI. 02903

philippa.sprinz@lifespan.org

Corresponding Author: Philippa G. Sprinz, MD, MSc

Hasbro Children's Hospital

Division of Pediatric Hematology/Oncology

593 Eddy St

Providence, RI. 02903

philippa.sprinz@lifespan.org

phone: (401) 444-5171

fax: (401) 444 -8845

Main Text Word Count: 1194 words

No Tables, Figures or other material

Keywords: Retiring, Pandemic, COVID 19,

Congratulations! Well done! Bravo! Our compliments and best wishes! I
sat outside, looking up at the night sky trying to make sense of
everything. I could not. I had hoped, in the silence of night, that I
might be able to find some peace and understanding, something positive
to hold on to, some equipoise with where I was at in my life, in the
midst of a global pandemic. Unfortunately, the cloud ceiling was too
low; there were no stars to be seen, to add perspective to my life. I
could not grasp my retirement from clinical practice, at this globally
distressing time.

My retirement was planned before Covid-19 was a name in the medical
lexicon.

I thought I had planned appropriately. Our son-in-law matched for his
clinical fellowship some 2600 miles away. I was 65 years old, and had
had a wonderful career as a pediatric hematologist/oncologist, training
in the UK but moving to and practicing in the US for almost 40 years. My
new job was going to be to help with grandchildren, so our children
could pursue their own medical careers. As I clearly could not work and
commute 2600 miles on a regular basis, I reasoned that I should retire
from clinical practice.

Practicing as a physician has been incredibly satisfying. It has been my
identity. It is how I presented myself to my family, colleagues and
friends. I have given so much of my life to my work. At the same time,
unfortunately, I had not taken the time to develop other skills that
were anywhere near as rewarding. I acquired some hobbies: diversions
from the responsibilities of helping and supporting `my' patients and
colleagues, but not skills to keep my mind or body active when I stopped
working. As I contemplated no longer working clinically, I developed an
anxiety for `my' patients. I knew I had excellent colleagues to hand my
patients on to, but I could not escape the thought that I would be
letting my patients down by not continuing to care for them, myself. I
argued that I knew their health care needs `best'. Only, surely I was
doing right by our kids and grandkids by helping them at this time.

I found myself thinking over my years in practice. During that time, I
saw the five-year survival rate of children with a cancer diagnosis
increase from 58\% to 86\% \textsuperscript{(1)}; Hodgkin Lymphoma
essentially became straightforwardly curable (5 year survival rate of
99.5\% by 2016) \textsuperscript{(1)}. Even brain tumors experienced a
twenty percent increase in their overall cure rate, (57.2\% to
76.3\%)\textsuperscript{(1)}. For individuals with sickle cell disease
(SCD) (my particular area of expertise) the survival gain has been more
modest: in the 1970s (ten years before the start of my fellowship) 80\%
of individuals with SCD died by age 30 years \textsuperscript{(2)}. In
the 1990s females with sickle cell anemia had an average life expectancy
of 48 years and males 42 years \textsuperscript{(3)}. Despite these
improvements, the care of individuals with SCD still needs new drugs and
better curative approaches. Life expectancy, for patients with SCD, is
currently 54 years for both sexes \textsuperscript{(4)}. This is still
signifiantly less than the non-SCD population of 76 years in the
US\textsuperscript{(4)}. I do, nevertheless, look to the future in my
field with optimism. Immunotherapy is in the forefront of cancer care,
and sensitive molecular tests are allowing earlier diagnoses and
hopefully, more successful treatments. There are a number of new, albeit
expensive, drugs now being marketed for SCD. Stem cell transplantation
is accepted as a `curative' option for the disease, and gene therapy is
not too far in the future.

Then February 2020: SARS-CoV-2 arrived in the US. This virus has
impacted so many lives in so many ways, in circumstances much, much
worse than mine. For me, however, it reformatted my retirement. I could
not travel to help our children: borders were closed and international
travel all but halted. I would stop work with `nothing to do'. I
suddenly needed to understand `Retirement from being a full time MD',
without a `plan B'. I recognised that not having to share
life-threatening diagnoses with families, would take a weight off my
shoulders. Instead, nonetheless, I would cease to be one of a team
working painstakingly to help children and their families understand
life-impacting illnesses: to hopefully feel better, for at least some
periods of time. Despite sadnesses, `pedi heme-onc' definitely has many
rewards. Retirement from it includes the loss of deep family
relationships and also daily interactions and stimulating meetings with
friends and colleagues.

I then wondered: why does one retire when one has a secure job (and no
new occupation to move on to), with rewarding work, and a sense of
serving `the greater good'. This, particularly if one is without
`burn-out' that over the years I have watched some of my colleagues
experience? Does one really have to retire? A critical aspect of
retirement may be to afford practices the opportunity to replenish the
workforce with younger, more adaptable workers. Individuals trained
recently on newer, clinical approaches and disease management present
new skills and may improve efficiency. Does the fact that junior doctors
have lesser salaries than those who have been in practice for many years
make a difference? Recognising my predicament, I suggested I could help
part-time during the pandemic. The coronavirus was not causing so many
childhood illnesses, however, to need more pediatric staff and I am no
expert in adult medicine.

Notwithstanding concerns over my retirement, I did have an excitement to
think that my leaving would afford a younger physician the opportunity
to take a leading role in patients' care and eventually have as
rewarding a career in pediatric hematology/oncology as I had. So, I took
stock: maybe I could volunteer in the community? I reached out to a
number of organisations, all of which were very happy to have my help,
`just not now', in the middle of a pandemic. I listened in to as many
medical and non-medical on-line lectures as I could. I `attended'
virtual conferences, easily, regionally and nationally, without any
travel, and contributed to `Zoom' teaching at my own institution. I
worked for an online publishing company and reviewed manuscripts. I was
in touch with `everyone' and tried to support all the vulnerable people
I knew.

Ten months into the pandemic, nevertheless, I am still struggling to
come to terms with not being a clinician. Did I devote too much time to
my patients -- that could not be? Should I have paid more attention to
hobbies and have developed a `Plan B'? Probably `yes'. Will there be a
time, after the pandemic has passed, when again I can contribute to `the
greater good' and do more clinical work? Perhaps it is true: `once a
doctor, always a doctor'. But it is more than that: having spent all of
my working days caring for others, with responsibilities of making
accurate diagnoses, recommending potentially curative management and
providing compassionate care when the cure did not come, I now have to
learn a new life: a life of giving back without the rewards of clinical
practice.

References:

SEER (Surveillance, Epidemiology and End Results program,) 2017

Platt O et al Mortality in sickle cell disease. Life expectancy and risk
factors for early death: N Eng J Med. 1994, Jun 9; 330(23):1639-44

3) Lanzkron S, Carroll CP, Haywood C Jr. Mortality rates and age at
death from sickle cell disease: US, 1979 -- 2005. Public Health Rep.
2013; 128: 110-116 4) Lubek et al Estimated Life Expectancy and Income
of Patients With Sickle Cell Disease Compared With Those Without Sickle
Cell Disease: JAMA Network Open. 2019;2(11):e1915374.
doi:10.1001/jamanetworkopen.2019.15374, accessed 12/26/2020

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