The myriad issues and stresses of practicing medicine and practicing ophthalmology don’t seem to lessen year to year—and most certainly not this past year. For many of our brethren, this was the year to either execute a previously planned retirement or to throw caution to the wind and just chuck it all. And I’m sure there are more than a few younger colleagues who were wishing they could just hang it up.

 Aside from our frustration with the lemons life has given us, is the more nuanced question: How do you know when it’s time to hang it up? In an otherwise ‘normal’ year (has there been one recently?), how does one know when it’s time to step back from patient care, either surgical, medical or both? When is it time to step back from running the practice? In truth, no one wants to be that doctor who should have stepped down months/years ago. Yet, most all of us have spent our entire careers exceeding expectations, and almost none of us has had someone else tell us what we can and can’t do.

And the answer to this question, or at least the implementation of it, depends on your specific practice situation: Private or corporate? Solo or group? Equity or non-equity? 

Let me address one of these: Private practitioners, especially solo, who started their practices, are among the most loathe to give them up. No matter that the check from private equity or the local hospital system has cleared their bank accounts, it’s still—in their heads at least—their practice. But then, one day, it isn’t and they will have to deal with this new reality—and with the new managers and providers who show up to take over. If we’re going to be charitable, we would totally understand. But just like end-of-life decisions in general, the last years in practice are rarely without messiness and drama. I’m surprised that the desire to have a gracious exit doesn’t outweigh their ego’s need to control things to the end. And trust me, I’m not usually that kind in my assessment of human nature.

Much has been written about the convoluted relationship between self-worth and work, and the more validation you get from work, the more difficult it is to not become addicted. Let’s admit it, ophthalmology is a very rewarding career. How can you not feel gratified, if not superhuman, restoring sight? That’s quite an addictive drug. We’ve all felt that we can’t leave our patients unattended, that no one knows or cares for them better. It’s tough to get off the merry-go-round. 

Add to that those rugged individuals who built their practices from the ground up and then spent 40-plus years creating, nurturing and being lord and master of all they survey. It’s extremely difficult to just walk away from that even if it was your choice. 

Your practice is like your child, and losing your child isn’t something anyone is prepared for. Wrapping your head around the fact that someone else, clearly not as gifted, is going to take your baby’s hand and guide it forward can be mind-blowing. Walking away from what you created isn’t something you think much about until it stares you in the face. There aren’t books or self-help courses specifically for this. Add to that your patients—your friends who came to see you at the same time every year—will now be under the care of strangers … Kids! ... Millennials! … Lord help us. However, this process of stepping down happens to everyone eventually. 

So, as the new reality arrives, while you attempt to hold your head high, the benighted ruler abdicating the crown, it’s likely all you’ll be able to think of saying is: “Get off my lawn!”

Dr. Blecher is an attending surgeon at Wills Eye Hospital.