meaning and purpose – Go Retire Psychiatrist

I recently read an article about Maintenance of Psychiatry (MOC) written by Dr. Henry A. Nasrallah, MD and published this month in Current Psychiatry. The title is “Revamp the maintenance of certification program.” It brought back memories of my crusade to do the same thing in past years.

I lost my connection to that crusade when I was in my last year of my phased retirement contract. In a way, though I don’t miss MOC itself, I miss the sense of meaning and purpose I had while I opposed MOC through working with the Iowa Medical Society, through a petition to oppose Maintenance of Licensure (MOL, a state based version of MOC), and through writing articles and blogging about why I think psychiatrists and physicians in general don’t need these expensive, time-consuming activities which have led to anti-trust lawsuits being filed against certification boards.

In his article, Dr. Nasrallah criticizes the MOC as a monopoly perpetrated by the American Board of Psychiatry and Neurology (ABPN) and cites his own informal survey of 319 Current Psychiatry readers. He found that 86.5% of them recommended abolishing MOC. He tends to agree there should be an alternative to it. He recommends bringing back the oral exam.

I think it’s an interesting suggestion and I respect Dr. Nasrallah’s effort to not just oppose MOC, but to come up with another way for Psychiatry diplomates to keep their knowledge and skills up to date.

I remember my own oral board certification exam. It was very anxiety provoking, but I passed on the first try. There are reasons in addition to the anxiety they caused for why the oral boards were phased out after 2008. You can find them on the first page of a very entertaining post by Dr. Maria Yang. It’s a very long article, but the gist of the reasons for abolishing the oral boards is outlined on the first page. It was almost impossible to eliminate the wide variability of the live patient interview experience for diplomates while not being a guaranteed method for assessing a candidate’s knowledge and skills.

Dr. Yang lists several horror stories that make up the unverifiable yet terrifying lore about the process.

Even Dr. Nasrallah admits that the usual way the oral exams were conducted back in the day was almost unbelievably complicated logistically and also extremely expensive. He suggests that conducting them by videoconferencing could cut down on the costs, which is plausible. The justification for reinstating oral board exams is that it provided examiners a method for assessing a candidate’s interview skills and ability to collect and synthesize history and observation into a thorough diagnostic assessment and comprehensive treatment plan.

In fact, the academic medical center where I taught held what are sometimes called mock oral board exams regularly, which produced a tolerable mimic of the oral board experience in a less anxiety-provoking environment.

Making the oral exam, even in virtual format, the alternative to MOC would probably still make candidates nervous. It could also by logistically challenging as well. Would they be vulnerable to some sort of hack, such as Zoom bombing?

I spent a lot of time opposing MOC while I was working. It was frustrating. On the other hand, I thought it was important for me to let trainees know that life after residency would include challenges in addition to patient care and teaching, and that lifelong learning activities they engaged in might cost them a lot of money and personal time that they might find burdensome. I thought of myself as an example of a responsible protester in basic agreement with the principle of lifelong learning and improvement, although objecting to the certification boards’ methods.

The anti-MOC movement was a crusade that gave me a sense of purpose. I’m retired now. I salute Dr. Nasrallah.

As you know, I’m back in the saddle at work, according to the terms of my phased retirement contract. When I’m off service, I feel less pressured. However, when I’m on service, I’m like a fireman, thriving on pressure. I’ve done Consultation-Liaison (C-L) Psychiatry for so many years that, when I stop to think about it, I realize I get a good deal of my sense of meaning and purpose through my job.

I sometimes tell residents and medical students that I “do it for the juice.” That means I work for the adrenaline: rushing to emergencies, making quick decisions (some of them far from perfect), teaching on the run, telling funny stories about how my work as evolved over the years.

When I spent less time on the job during the first two years of phased retirement, I felt lost. There’s no better word for it. That’s not as much of a challenge now, but meaning and purpose in retirement can be difficult for a fireman to define.

I had a blog called The Practical C-L Psychiatrist until I dropped it last year. There were a couple of reasons. One of them was the expectation that bloggers write their own Privacy Policies in response to the European Union’s General Data Protection Regulation (GDPR) going into effect. I rebelled against it.

Please read my Privacy Policy on this blog. I worked pretty hard at it. I asked a few attorneys for guidance and only one of them got back to me, humbly admitting he didn’t know anything about it really, but had a helpful suggestion nonetheless.

The other reason I dropped The Practical C-L Psychiatrist was that it was less relevant to my stage of life in that I’m not racing all over the hospital nearly as much nowadays. I don’t have as much to write about that life anymore.

But I still love to write and so I swallowed my pride, wrote the Privacy Policy and decided on making a chronicle of my transition into retirement, which is this new blog, Go Retire Psychiatry. So far, I’ve more or less just made jokes about it. I realize that’s a defense. I need to move on and confront the search for meaning and purpose in retirement.

I’ve done a lot of fun things on the job over the years. I used to have mascots for the C-L service, like the one below. You can tell that it was from some time ago. The mascots were usually inflatable animals I bought from the hospital gift shop. The residents, medical students and I gave them silly names. The trouble was that the mascots, being balloons, were always running out of gas.

And that meant that somebody had to take the mascot for a walk all the way across the hospital back to the gift shop to get a healing shot of helium—and walk all the way back. The volunteers there got a big kick out of an old geezer doctor walking the mascot. It was an exercise in humility, which I admit I often needed.

And I took group pictures of trainees and me at the end of rotations by using an app on my old iPad. It’s called CamMe. The way it worked was that I set the iPad up on a stack of books or something; then we all stood for the shot. I would hold up my hand and make a fist to start a 3-2-1 countdown, which gave you just enough time to make a big smile for the automatic group selfies. Everybody got a kick out of it.

I was so proud of those pictures I thought nothing of posting them on my blog, with nary a thought about their privacy. All of them thought they were fun.

That’s about enough on meaning and purpose for today.