为什么医生不喜欢退休

为什么医生不喜欢退休 (翻译)

Why doctors don’t like to retire

The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit rules. Added to that are multiple electronic medical records that need to be implemented, vary from one hospital to another, and often do not “talk” to one another. Thus, it would seem obvious that physicians are leaving their practices in large numbers. Perhaps. Perhaps not.

在过去的十年中，美国医疗实践发生了巨大的变化。独立的私人诊所面临消失的危险。由于各级政府的法规，保险公司的规定以及药品津贴的规则，管理费用和繁文缛节快速飙升。此外，医生还需要填写多个电子病历，而每个医院的电子病历各不相同，往往彼此不能“交流”。因此，看起来似乎医生们将会大量离开医疗这个行业，但是，或许他们不会。

 An April 5, 2017 Time Magazine article broke down retirement rates by professions. They charted the percentage of workers still working after age 65. It seems that this is an accurate yardstick to measure the issue.  Topping the list of working professionals least likely to retire after 65, were tax preparers. 14.6 percent them were still working at age 66 and beyond. Pharmacists were at the bottom with only 4.3 percent. Although not near the top, physicians and surgeons were still in the top third at 8 percent.  So why then do so many physicians resist retirement? I believe there are multiple reasons.

《时代》杂志在2017年4月5日的一篇文章报道了各个行业的退休率。为了点到问题的关键，他们列出了各行中65岁以后仍在工作的员工的比例。在最可能65岁之后仍不退休的职业中，排在首位的是税务员，14.6%的员工到了那个年龄仍在工作，药剂师敬排未坐，只有4.3%。内科医生和外科医生没有位于榜首，但是仍然有8%继续工作。为什么这么多医生到了年龄也不愿意退休呢？我相信原因是多种多样的。

 For many physicians, medicine is the only employment they have had in their adult life. Despite drops in salaries and autonomy, they still enjoy above-average wealth and income and may fear loss of this post-retirement. I fully retired three years ago. I have friends who still work and others who don’t. Illnesses play a role for sure. Some have few hobbies and fear boredom. That is a reasonable concern. Most of us are used to being respected by the public and inwardly fear that loss as well. My father, who had no hobbies, worked as an internist up until almost the day he died. Certainly, I am called “mister” a lot more these days than “doctor.” For me, however, there seemed to be a loss of “purpose.” Victor Frankl’s famous 1946 book Man’s Search for Meaning has a great quote that goes something like this: “Your work is not your worth.” This is a concept that is difficult for many of us to accept and grasp.

对许多医生来说，行医是他们成年后的唯一职业。尽管现在医生的收入和自主权【相对】有所下降，但他们仍然享有高于平均水平的财富和收入，并可能担心这些在退休后会减少。我三年前就完全退休了，我的一些朋友已经退休了，部分是因为疾病。但是另一些朋友仍在工作，有些人没有什么爱好，害怕退休后无聊。这个担忧并非不合情理。我们中的大多数人已经习惯于受到公众的尊重，内心害怕失去这种尊敬。我父亲就没有任何业余爱好，直到他去世的前一天，他还在内科行医。当然，我现在被称为“先生”比被称为“医生”的次数要多得多。对我来说，似乎失去了“初心”。维克多·弗兰克尔在1946年出版的著名著作《人探求的意义》中有一句名言，似乎是这样写的：“你的工作不是你的价值”。 这是一个我们许多人难以掌握和接受的概念。

 Although I spent most of my career in private practice, I always felt like a teacher. I would teach my patients, younger doctors joining the practice, nurses, and pharmacists. That all disappeared as soon as I retired. I write and read a lot. I like to fish and practice tai chi. I will soon become a tai chi instructor perhaps filling one need. A good fishing friend of mine who retired from sales and many years on the road and in the air, doesn’t understand why doctors are reluctant to retire. I don’t want to be judgmental, but for him he had a job. For many doctors, we feel as if we have a calling. For me, every other January is decision time. That is when my Florida medical license is up for renewal. Although the likelihood of me returning to active practice is low, the mere act of giving this up would mean that there really is no going back.

虽然我的大部分职业生涯都是在私人开业中度过的，但我总觉得自己像个老师。我会教我的病人，我会教那些刚加入这个诊所的年轻医生，护士和药剂师。随着我的退休，这一切都消失了。我读了和写了很多东西。我喜欢钓鱼和打太极拳。我很快就会成为太极拳教练，也许会去填补一个位置。我的一位钓鱼的朋友从经常在路上和空中旅行的销售岗位中退了下来，他说他不明白为什么医生不愿意退休。我不想说出我的评判。对他而言，他过去只是有一份工作。而对于许多医生来说，我们觉得有一种使命的召唤。因此每年的1月份对我都是一个决定性的月份，在这期间我可以申请恢复我的佛罗里达州的医疗执照。但是我回归开业的可能性很低，放弃申请的举动意味着我确实不再回头了。

 Lastly, the act of retirement brings into hard focus that this is indeed the “last stage” of one’s life. Although we deal with the death and dying of our patients daily, when it is “our” death and dying, well, that is a different matter. The hassles of corporate and industrialized medicine will continue to affect physician retirement rates. However, for many of those in the profession, the idea of life without medicine is just too scary to contemplate.

最后，退休生活确实是一个人生命的“最后阶段”，值得引起了人们的强烈关注。虽然我们每天都要处理垂死或死亡的患者，但当这是“我们自己的”垂死或死亡时，这又是另一回事。医疗企业化和工业化的困扰将继续影响医生的退休率。然而，对于许多从事这一职业的人来说，没有医学工作的生活实在是太可怕了。

 英文原作者David Mokotoff是一位心脏病专科医生，他在自己的网名David Mokotoff上发表博客。原载KevinMD.com

 Yunmu翻译后记：作者抱怨的医生要花费很多精力在电子病历上，而每个医院的电子病历各不相同，往往彼此不能交流。其实这也是目前大多数医生的抱怨。14年前在电子病历仍然处于初级阶段时，就有人提到过这个问题。 大多数人同意：与其将来要写大量程序让来自不同公司不同格式的电子病历彼此交流，还不如建造一个统一的全国性的电子病历让所有医院使用来得省钱。有人按照当年的美元价值来估算，在美国要建成一个统一的电子健康报告系统需要当年价值1560亿美元的投入和5年的时间，再加上每年相当于当年480亿美元的运营成本：“One study estimates that creating one in the United States within 5 years would require $156 billion in capital investment, plus $48 billion in annual operating costs” Easing the way for the electronic health record， Feb. 2007 Vol. 2 Num. 2.。但是政府拿不出这笔钱啊。