為什麼醫生不喜歡退休

為什麼醫生不喜歡退休 (翻譯)

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.

在過去的十年中，美國醫療實踐發生了巨大的變化。獨立的私人診所面臨消失的危險。由於各級政府的法規，保險公司的規定以及藥品津貼的規則，管理費用和繁文縟節快速飆升。此外，醫生還需要填寫多個電子病歷，而每個醫院的電子病歷各不相同，往往彼此不能「交流」。因此，看起來似乎醫生們將會大量離開醫療這個行業，但是，或許他們不會。

 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.

《時代》雜誌在2017年4月5日的一篇文章報道了各個行業的退休率。為了點到問題的關鍵，他們列出了各行中65歲以後仍在工作的員工的比例。在最可能65歲之後仍不退休的職業中，排在首位的是稅務員，14.6%的員工到了那個年齡仍在工作，藥劑師敬排未坐，只有4.3%。內科醫生和外科醫生沒有位於榜首，但是仍然有8%繼續工作。為什麼這麼多醫生到了年齡也不願意退休呢？我相信原因是多種多樣的。

 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.

對許多醫生來說，行醫是他們成年後的唯一職業。儘管現在醫生的收入和自主權【相對】有所下降，但他們仍然享有高於平均水平的財富和收入，並可能擔心這些在退休後會減少。我三年前就完全退休了，我的一些朋友已經退休了，部分是因為疾病。但是另一些朋友仍在工作，有些人沒有什麼愛好，害怕退休后無聊。這個擔憂並非不合情理。我們中的大多數人已經習慣於受到公眾的尊重，內心害怕失去這種尊敬。我父親就沒有任何業餘愛好，直到他去世的前一天，他還在內科行醫。當然，我現在被稱為「先生」比被稱為「醫生」的次數要多得多。對我來說，似乎失去了「初心」。維克多·弗蘭克爾在1946年出版的著名著作《人探求的意義》中有一句名言，似乎是這樣寫的：「你的工作不是你的價值」。 這是一個我們許多人難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.

雖然我的大部分職業生涯都是在私人開業中度過的，但我總覺得自己像個老師。我會教我的病人，我會教那些剛加入這個診所的年輕醫生，護士和藥劑師。隨著我的退休，這一切都消失了。我讀了和寫了很多東西。我喜歡釣魚和打太極拳。我很快就會成為太極拳教練，也許會去填補一個位置。我的一位釣魚的朋友從經常在路上和空中旅行的銷售崗位中退了下來，他說他不明白為什麼醫生不願意退休。我不想說出我的評判。對他而言，他過去只是有一份工作。而對於許多醫生來說，我們覺得有一種使命的召喚。因此每年的1月份對我都是一個決定性的月份，在這期間我可以申請恢復我的佛羅里達州的醫療執照。但是我回歸開業的可能性很低，放棄申請的舉動意味著我確實不再回頭了。

 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.

最後，退休生活確實是一個人生命的「最後階段」，值得引起了人們的強烈關注。雖然我們每天都要處理垂死或死亡的患者，但當這是「我們自己的」垂死或死亡時，這又是另一回事。醫療企業化和工業化的困擾將繼續影響醫生的退休率。然而，對於許多從事這一職業的人來說，沒有醫學工作的生活實在是太可怕了。

 英文原作者David Mokotoff是一位心臟病專科醫生，他在自己的網名David Mokotoff上發表博客。原載KevinMD.com

 Yunmu翻譯後記：作者抱怨的醫生要花費很多精力在電子病歷上，而每個醫院的電子病歷各不相同，往往彼此不能交流。其實這也是目前大多數醫生的抱怨。14年前在電子病歷仍然處於初級階段時，就有人提到過這個問題。 大多數人同意：與其將來要寫大量程序讓來自不同公司不同格式的電子病歷彼此交流，還不如建造一個統一的全國性的電子病歷讓所有醫院使用來得省錢。有人按照當年的美元價值來估算，在美國要建成一個統一的電子健康報告系統需要當年價值1560億美元的投入和5年的時間，再加上每年相當於當年480億美元的運營成本：「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.。但是政府拿不出這筆錢啊。

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