Dr. Wayne Barry had a heart attack this year and was forced to leave the practice of emergency medicine. A few months later he had retooled his trajectory and was enjoying life more than he ever could have imagined.
“I retired six months too late”
Or so said my old friend Wayne Barry when I shared a cab with him from the airport to attend the ACEP Scientific Assembly in Denver.
Uh oh, I thought, what happened? “Do you want to tell me about something?” I asked cautiously. Bad news is something people often want to share with me, but I make no assumptions.
“Well, yes,” he said. “I had a heart attack in August. But I’m fine now, and in fact I’m enjoying life more than I could ever have imagined this time last year.”
Wayne is 64. He has been practicing emergency medicine since 1980, when I hired him, an internist, to work part time as an attending in Baltimore City Hospitals. He became board certified in EM, directed an ED in Baltimore, and has been part of a large ED group in Florida for many years.
In his fifties, Wayne experienced a very common shift in his ability to handle the stress of night shifts in a busy ED. His frustration levels were high working nights, especially when morning came and the place was overrun with patients who had to be handed over. He realized that he needed to change his night shift commitments, but met resistance from within his group.
He studied the literature and got involved with the ACEP Wellness Section, ultimately becoming a standard bearer for the issue of stress at the state level. He got a dispensation from his group that allowed him to pay others $20 an hour to take some of his night shifts. This solution worked well for several years, but in January he was transferred to another hospital and could no longer make this deal. He found himself working 12-hour shifts with half of them nights, and the old frustrations resurfaced.
Through an ED nurse who had transitioned into hospice care, Wayne was recruited to do some on call work for a local hospice group. He also began working in urgent care and doing some coding for his group. He says he noticed about a 90% reduction in stress levels, but felt somewhat down as it sank in that he would not be able to practice emergency medicine for the duration of his career.
Wayne reluctantly left the practice of EM on July 31, 2012. On August 18, without any warning, Wayne experienced a NSTEMI due to a 95% prox LAD occlusion. Fortunately, his hospital course was uneventful and he was back to providing urgent care five days post stent – six days post MI. He has had no residual symptoms, but carries (an unopened) bottle of NTG which he says he uses as a talisman to remind himself of what happened. He also takes a number of meds that have precluded skydiving, bucking bronco riding or skiing. “I am a different organism now,” he says with a wry smile.
He is also, he now knows, a more resilient organism. The prospect of urgent care was initially not at all exciting to him as an emergency physician, but Wayne now finds he loves the practice because he can visit with patients and families, people thank him for his help, and he can respect that they make responsible decisions about their health.
He also finds that hospice work is incredibly rewarding. His company does all home care. Wayne makes 10 to 20 home visits per week, working with nurse case managers as a team leader, doing histories and physicals, continuing care visits and comfort visits and making decisions about hospitalization when necessary.
“Sometimes I feel like a traveling salesman,” he says with a laugh (more like a “Welcome Wagoneer,” I’m thinking.) In addition to supervising the care provided by nurse managers, Wayne also acts as primary care doc for hospice patients who have elected to have him do so. In contrast to his ED days, he comfortably signs death certificates for these patients he comes to know so well. He writes prescriptions for medications without any fear that they will be misused or diverted. This attitude reversal alone has de-stressed his life enormously.
Wayne credits fellow EP Arlen Stauffer with having been a sort of pathfinder for him in the hospice arena as well as in urgent care. He explained to me how he wished he had known more about these options at earlier stages in his career so he could have planned to make the transition in a more orderly manner. His income has fallen somewhat since leaving emergency medicine, but it is an adjustment he is happily making considering the positive changes in his life. For example, he now has a social and a family life. In addition, he is able to do mission and relief work in Haiti, which he finds extremely gratifying.
Furthermore, there is an unusual positive side to palliative care. Patient satisfaction scores often reflect a desire that physicians see them more often. Since a hospice physician is paid by the visit, the income stream is relatively adjustable.
The future is looking brighter for emergency physicians who find themselves in Wayne’s shoes. ACEP’s Practice Management Committee and Wellness Committee and Section are becoming involved in Palliative care, pre-retirement and retirement issues for EPs, and it is now possible to become certified through ABEM in Hospice and Palliative Medicine. There is even a new section within ACEP for members interested in Palliative Care. Thanks to these developments, Wayne is optimistic that emergency physicians in the future may be better prepared for life’s transitions because of the acceptance that these are a necessary and important part of life and work.