By PAUL NATINSKY
I understand very clearly the deep concern about the future of medicine and the frustrations attached to that concern. Other professionals with similar levels of academic and practical credentials and similar licensing requirements practice much more autonomously and with much more freedom than physicians.

As a patient and healthcare writer, I have exposure to the sense of defeat physicians increasingly feel toward their careers, particularly those who are near end of their practicing years, a career phase that arguably makes them among the most valuable of practitioners. Experience and the wisdom that comes from decades of practice cannot be replaced.

Several years ago, my family’s terrific pediatrician retired early. She is an intelligent, vibrant woman with children of her own who had a joyful, warm greeting for us at each visit. She had the low-key self-assuredness of a very accomplished professional who enjoyed plying her craft. She was in her early sixties and told me she would have liked to work another 10 years. Changes such as required computer entries on a rolling cart after each patient visit took the joy out of practicing for her. She didn’t need the money, but her patients and the medical profession would have benefitted from 10 more years of her service. The other physicians in her five- or six-doctor practice were all young physicians who lost a valuable mentor. And my kids lost a great practitioner with several years of pediatric practice yet to go.

In a related matter, my primary care physician announced his retirement in September. He, like me, is in his late fifties—although I look much younger than him, J. In his letter to patients, he specifically said that changes in the affiliation agreement he had with a hospital system made continuing to practice not worth it anymore. That same letter informed patients that no one in the practice would be accepting new patients.

I found another doc, whom I met for the first time this month. He is a pleasant chap of about 35 and asks the right questions. The jury is out, but you can’t really replace experience, especially in a specialty like primary care, can you?

So I get it—from a policy perspective and at ground level. What I wonder is okay, what does a reformed system with physicians at its center look like and how to we get there from where we are now? How do we keep these doctors practicing for an extra decade, bringing their value to patients?