Douglas G. Burnette Jr., MD, CFP®

After over 30 years in the radiology trenches, I have raised the white flag and left the field of battle. Surprisingly, I have not missed it. More precisely, I haven’t missed the stress and pressure, the nights and weekends, or the sick-to-the-stomach feeling when I realized I missed something. The only thing I do miss is the people and, to them, I am and will always be grateful.

It is often said that you should be nice to the people you meet as you climb up the ladder of success because you may need them on your way down. Like the golden rule, I have always tried to treat others the way I wanted to be treated but, regrettably, I know that I haven’t always been successful and, for that, I sincerely apologize.

I want to thank my teachers, professors, fellow residents, partners, and all who have shared their knowledge and experience with me. I want to thank all the radiologic technologists who pointed out obvious misses as kindly as possible. I want to thank all the transcriptionists who caught my mistakes and put up with my absurdly long dictations until I matured in the profession and figured out what was important to say. I want to thank the ER docs who picked up the phone and gave me additional information or notified me of an error or omission in my reports in a timely and constructive way. I want to thank all the referring physicians who treated me like a valued colleague, consulted with me on their patients, and allowed me to feel that I was helping them care for their patients. I want to thank all the patients who have patiently endured my efforts to develop and improve my technical skills.[[{"type":"media","view_mode":"media_crop","fid":"34993","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7430722541087","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3726","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 195px; width: 160px;","title":"Douglas G. Burnette","typeof":"foaf:Image"}}]]

I am especially grateful to my radiology partners who allowed me to transition gradually from my first career to my second by allowing me to work part time. As I have said before, retirement isn’t for sissies and requires careful planning. In the financial planning circles it is frequently said that people spend more time planning a single vacation than they do planning for their entire retirement. We advise our clients to “practice” retirement both in a budgetary sense and lifestyle sense before they actually retire so they can minimize some of the rude surprises that await.

Retirement is not the never-ending weekend of relaxation and fun that many imagine. Everyone should plan for their retirement and develop a purpose and structure for this final phase of their lives. For many physicians, their identity is closely tied to the profession of medicine and the loss of their work identity is extremely difficult. In my case, I rarely used my title of doctor outside the hospital or felt my identity was closely related to my profession. I found it quite humorous that at my retirement party many of our neighbors and acquaintances were surprised to find out that I was a radiologist.

Radiology has been a great profession. It has provided well for me and my family. I am grateful that I had the opportunity to help my fellow man. I believe I did more good than harm. Radiology has undergone tremendous change during my career and I will be a very interested observer in how radiology and medicine continue to change in the coming years. Farewell and thank you, radiology. I wish you well.

Articles

Farewell, Radiology

“May you live in interesting times.”- Old Chinese curse

I always marveled at the changes that my grandmother witnessed in her lifetime. She was born the year the Wright brothers made the first powered flight, rode in horse-drawn buggies, lived through two hot World Wars and one cold one, saw the dawn of the atomic age, and lived to see men walk on the moon.

Likewise, my career in radiology has spanned a time of great change-very interesting times indeed. I have seen red goggles worn prior to fluoroscopy, great barrels of barium sulfate to be mixed into oral and rectal preparations, rectilinear nuclear medicine cameras, B-mode sonography, handmade angiography catheters, IV cholangiography, water bag head CT requiring several minutes per slice, and MRI when it was called Zeugmatography and thought unlikely to ever be clinically useful. I have used mirror optic fluoroscopy. I have performed Pantopaque myelograms, dacrocystograms, a pneumoencephalogram, marathon lymphangiograms, and had fluoroscopy schedules with over 20 patients in a morning.

I experienced the halcyon days of radiology income, the “Golden Years.” In those days, the numbers and types of new procedures were years ahead of the CPT codes, and Medicare reimbursement was a good thing. In those days, not everyone wanted a piece of our turf and there wasn’t all that much to do (or could be done) on call. Weekends consisted of a few hours on Saturday and Sunday and call backs were relatively infrequent.

I have witnessed tremendous change in the landscape that is medicine and radiology. I have experienced the explosion in the numbers of images, volume of studies, speed of performing studies, and increased stress that is part of the job of being a radiologist today. I have experienced the transitions from analog to digital imaging, xero to digital mammography, transcription by humans to computerized speech recognition, the change from a relatively active, highly interactive day to an isolated and sedentary workday, the depersonalization of medicine and disappearance of useful medical information and relevance, the ratcheting downwards of reimbursements, and the annexation of our turf by other specialties.[[{"type":"media","view_mode":"media_crop","fid":"32531","attributes":{"alt":"Game over","class":"media-image media-image-right","id":"media_crop_8908078475103","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3434","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©wongstock/Shutterstock.com","typeof":"foaf:Image"}}]]

This change has been painful, as most change is, and it seems to be accelerating at breakneck speed. Health care is under scrutiny from all sides and the government is taking it over (or has taken it over depending on your point of view). Our specialty is at particular risk because we have never really been understood or appreciated by patients or other physicians. It is at risk because we don’t have an effective voice and because we don’t appear to work very hard for what we earn. In fact, we are rarely “seen” working.

Radiology will survive, but will probably not be recognizable by those of my generation. Radiologists will likely be employed by hospitals or large mega-groups. They will be shift workers processing large volumes of digital information with little or no access to the patient or the referring physician. Computer generated studies such as bone densitometry will bypass us entirely. Many studies such as ultrasound will be reported directly by the technologist. Vascular access and dialysis maintenance procedures will be performed by non-physician personnel, as will the few fluoroscopic procedures still being performed.

This evolution will be painful but there will eventually be a generation of radiologists who have none of my memories. They will have no idea why reporting an urgent study would be called a “wet reading” or that there was a time when we were the doctor’s doctor and our expertise spanned all specialties. This generation of radiologist will be making more money than they ever have before and will not know there was a time when radiologists earned far more. They will be content. The interesting times we are living in will have been forgotten.

This, Too, Will Be Forgotten

I have a good friend who has a theory that your various body parts have a limited number of uses, thus explaining the proliferation in joint replacements and “little blue pills.” I wonder if the same is true for the number of decisions a person can make in a career or the number of radiology reports one can read.

When I started out in radiology, the maximum number of images in a study was in the tens. Now, with CT and MR, the maximum number of images is in the hundreds and even thousands. The digitization of radiology has played a large role in this. In the days of matrix cameras and manually processed image cassettes, the fact that the techs had to load and unload matrix camera cassettes and insert the films in a processor was probably some deterrent to large studies, and I remember complaining to an ultrasound technologist that she wasn’t giving me enough images on the studies she was submitting back in those days. Nowadays, I feel like I’m viewing an ultrasound video frame by frame with image counts sometimes approaching a hundred. I know, be careful what you wish for.

At the end of a long day of reading imaging studies, I frequently feel like I can’t make any more decisions (much to my wife’s chagrin when she wants to know what I want for dinner). I want to believe that the quality of my decisions is as good as ever, but I am haunted by a statement I made half a dozen years ago when I made the decision to go part time. When asked how long I intended to practice part time, I said I didn’t know but believed once you cut back, the clock starts ticking and one’s ability begins to atrophy.[[{"type":"media","view_mode":"media_crop","fid":"31533","attributes":{"alt":"blue pills","class":"media-image media-image-right","id":"media_crop_7757579860016","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3329","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

It is true that my sense of enjoyment practicing radiology was revived temporarily by being able to choose when and how often I worked, but the decreasing frequency of call and weekends made them even more unpleasant when they occurred as the months went by. I am sure that some groups have discovered ways of minimizing stress and increasing individual longevity. There are, after all, radiologists practicing into their 70s and I know of one in his mid-80s.

Most groups I have worked in believe that everyone has to pull their weight, and that means call and weekends. Perhaps implementing a shift system that limits the number of hours worked similar to airline pilots and truck drivers will prolong careers in the future. Perhaps someone will invent “a little blue pill” for radiologists. What do you think?

Does Radiology Need a Little Blue Pill?

I have a client who is in Federal law enforcement and is faced with mandatory retirement at age 57. To be forced to retire at a relatively young age is potentially traumatic and definitely calls for careful and thorough planning, which is why he sought us out. He has mixed feelings about his retirement and feels that he still has a lot to offer. He is not on the front lines anymore and the reasons for retiring him from his desk job seem a bit arbitrary.

Upon further investigation, he is not alone. A friend of mine is an air traffic controller and told me that he, too, has a mandatory retirement age that is fast approaching. Based on my own 30 year experience in radiology, I asked if he thought it was a waste of talent and experience to force him to retire. He looked at me with sad eyes and said, “It’s a young man’s game.”

I have been most fortunate that my former radiology group allowed me to retire at age 59 and continue to work for them on a part-time basis for the last five and a half years. That allowed me to transition from radiology to financial planning. It has been good for me in many ways but it has also been good for the group. My availability to work a day here or a day there, swap weekends or give them some extra vacation has been much appreciated. Before I went part-time, there was very limited flexibility in the work schedule.

I remember the night I told the group of my intentions. They asked me how long I planned to work part-time. Other partners had retired and started to work part-time but quickly quit and retired full-time. Acknowledging the philosophy of “If you don’t use it, you lose it,” I prophetically stated that once someone goes part-time, the clock starts ticking and the skills start atrophying. I didn’t know how long I would last.

Last month I stopped working weekends. Words cannot express how good that felt. Our weekend call has become onerous and exhausting. We typically take call from 4:30 PM Friday to 7 AM Monday with an assist from an internal night hawk. Weekend call is sandwiched between two full work weeks. We don’t get days or afternoons off. The volume of work on weekends has skyrocketed. One of the two weekend rotations covers three different hospitals. Usually at least one of the hospitals is really busy and when all three are busy and you get called out to do a hospital procedure or have to stand by for a contrast injection at an imaging center, things get outright frantic.

So there isn’t a mandatory retirement age for radiologists, but maybe there should be. It is, after all, a young man’s game. Unfortunately, even the young radiologists I know are feeling the pressure.

Other industries have mandatory retirement ages, should radiology?

Author | Douglas G. Burnette Jr., MD, CFP®

Articles

Farewell, Radiology

This, Too, Will Be Forgotten

Does Radiology Need a Little Blue Pill?

Radiology: It’s a Young Man’s Game