I have just reached my first midlife crisis as a hospitalist. If I remember correctly–and with my advancing senescence, I probably don’t–when I started my career at age 30, the average age in our profession was only 34. Since then, our average age has managed to stay one step ahead of me, a fact that had not bothered me one bit.
Now that has all changed. At the ripe old age of 37 (at least until the end of this month), based on the Society of Hospital Medicine’s 2007-08 survey, I find that for the first time, my own age matches the average for our profession.
No, I haven’t bought the gold chains or the convertible Corvette, but I am thinking of buying a hybrid; too bad they don’t make them in convertibles yet. Last year’s New York Times article on midlife crisis by noted psychiatrist Richard Friedman, MD, titled, “Crisis? Maybe He’s a Narcissistic Jerk,” didn’t make me feel any better either.
It is no doubt natural to be traumatized by the discovery of one’s professional middle-aged-ness. As must be the case for physicians in other, more mature specialties, I find that suddenly those patients presenting with MIs in their 40s don’t seem quite so old. And increasingly, I’m treating patients with birthdates in the 1980s and, gulp, 1990s. Plus, I find it disconcerting to realize that most of the doctors I interview now for positions in my hospitalist program had not even started medical school by the time I started my career.
But enough already of my narcissism. Here’s the interesting question: What does it mean to be in an “aging” profession, albeit one still in its infancy? An average age of 37 still puts hospitalists only slightly above the average age of a senior neurosurgery resident. But it must still be a significant sign that we are approaching a degree of maturity as a field, right?
First, it is important to have hospitalists who are actually the same age or even older than the consultants with whom we work. Respect is earned, something our profession has clearly done, but a certain amount of reverence on the part of our peers will come only from the wisdom that is gained with experience. Like the senior surgeon who has been working at the hospital for the last 30 years, having hospitalists who fit that bill will prove to be invaluable to our continued professional ascent.
Second, as we age, I find that patients are actually beginning to understand that we aren’t residents–an assumption that folks make less and less these days, given my new flecks of gray and receding hairline. I find it quite rewarding when patients actually say as I begin my introduction, “Are you my hospitalist?” That’s no longer uncommon, even though five years ago, I would spend half my day explaining to patients that I had little to do with hospice. (I used to cancel cardiac stress tests for patients who didn’t suffer from that misunderstanding.)
Third, having “senior” hospitalists allows aspiring hospitalists to be mentored and perhaps proves to others that this is a sustainable career. And the advent of senior hospitalists has resulted in our promotion to very important leadership positions. First-generation hospitalists are now becoming chiefs of medical staff, key leaders at almost every level of quality committees and even hospital CEOs. I have no doubt that this trend will only accelerate with time.
I have heard it said that our profession, like emergency medicine, is a young person’s game. Instead, an aging hospitalist population makes the case that the rigors of inpatient medicine can be navigated by middle-aged physicians. I do notice that working the night shift and extended hours has become a bit more trying. But getting older hasn’t made much of anything easier.
I cannot predict how long my mid-career crisis will persist. At some point, our profession’s average age will plateau, while my age certainly won’t; hopefully, I can go on to worry about other issues. However, as hospital medicine becomes a sustainable career for thousands of physicians and with the continued exodus of older doctors from primary care to our profession, our average age might continue to climb for many years to come–leaving me, once again, behind the curve.
How high will it go? I believe we can reasonably expect that our average age will mirror that of all practicing physicians, which estimates now put at the mid- 40s. Perhaps the midlife hospitalist crisis I find myself confronting will last until my very own mid-existence crisis at age 50. (Hey, I am dreaming big.)
I am not sure if I could handle both at the same time. But as we often tell our patients, it sure beats the alternative.