Author + information
- Spencer B. King III, MD, MACC, Editor-in-Chief, JACC: Cardiovascular Interventions∗ ()
- ↵∗Address correspondence to:
Dr. Spencer B. King III, Saint Joseph’s Heart and Vascular Institute, 5665 Peachtree Dunwoody Road NE, Atlanta, Georgia 30342.
One of the sessions at the recent Transcatheter Cardiovascular Therapeutics (TCT) meeting in Washington was titled, “Late Career Decisions for the ‘Experienced’ Interventionalists.” The invitation to be on the panel to discuss these issues was, I pretended, sent to me in error but when I checked my birthdate I had to admit that I was qualified, if not enthusiastic, for this assignment. David Williams was charged with chairing this session that could be dubbed either an elder care “Portnoy’s Complaint” or, more charitably, a thoughtful reflection on what it means to be completing a long run in the cath lab. The panel was not totally representative of all senior interventional cardiologists as Alice Jacobs, George Vetrovec, Peter Block, Gus Prichard, Bill O’Neill, and I joined David in giving advice. All of us have been involved in academic endeavors and perhaps some of us have had the advantage of being able to shift out of the lab to other related activities more easily than our colleagues in private practice. But I am not sure about this. Nor am I sure there is much private practice anymore as most interventionalists are now employed by health care systems. In the United States, as compared with Europe, we have been historically able to practice for almost as long as we want to. The age at which we are expected to retire has certainly changed. “Old” used to be 65, now what is it? Seventy-five? Mandatory retirement may become the norm, but as long as we have a say in it, we have to make decisions. The perception of when we should hang it up may be different for all physicians. People say, “he/she will never retire,” implying that if you do you are a quitter. Other professions are not held to the same standard. Lawyers and business people who retire are congratulated, not queried about what their new career will be. It is a compliment that medicine is still perceived as an honorable and respected service and that we have an inbred need to continue until we drop. Indeed, the perception of ourselves and the respect we have received may be the major thing that differentiates the retiring doctor from the retiring accountant or engineer. It is hard to think of ourselves as simply a person without “doctor” in front of our name.
As hard as it is for doctors to stop, is it also hard to leave the cath lab? For some, the answer is yes, but you can get over it. There are actual reasons to stop cathing or performing interventions that are acceptable. Orthopedic problems due to occupational hazards are accepted and engender sympathy. A football player who destroys his knee is not thought less of when that career ends. But when we leave the cath lab because of the “lateness” of our career, how do we adjust? Some choose to continue to work and see patients, some in academic institutions teach or continue research, and some actually retire. Regardless of what the transition out of the lab will be, the time to do it and how to do it will face all of you. Until you do stop, be certain that you are capable of performing at the highest level. Do not depend on others to notice that you have fallen off in performance or judgment. For me personally, the decision to stop performing procedures occurred because other obligations were resulting in me becoming a low-volume operator. As the lead author of the competence document, I had recommended that volume matters and realized that that applied to me as well. I have been very lucky to remain completely immersed in interventions as editor of this journal and as an active contributor to the training program. It has worked for me and so I have been able to avoid post-transcatheter stress disorder. Among the panel at TCT, the participants and those white-haired commenters from the audience, various bits of advice for transition from an “interventional warrior” to a “normal human” were offered. Hobbies are great, new volunteer careers are noble, learning to relate to your spouse and family without the “on-call” distractions are blessings to some. Although, my wife said that she married me for life, not for lunch. Remaining a “doctor” is essential to the psyche of many of us, and there are many opportunities to do that.
Finding ways to stay engaged with interventional cardiology is icing on the cake. People ask me, “What will you do with your spare time?” I don’t know what spare time is but look forward to someday finding it. When I do, maybe I will read some of the many books I have intended to read but are collecting dust on my library shelves. Will I travel more? Hopefully for me the answer is “no.” But, if I do it will be with others and to places to be, rather than to places to see. My undergraduate university has allowed me to serve on its Board of Trustees, and the opportunities there are rewarding and unlimited. Chairing the New York State Cardiac Advisory Committee and several Data Safety Monitoring Boards also keeps me busy. No, spare time is not something I worry about.
When the session at TCT ended, I had the thought that there should be no whining in interventional cardiology. We have enjoyed an incredibly demanding and rewarding experience, and now letting someone else spend 3 h opening that chronic total occlusion is okay with me.
- American College of Cardiology Foundation