Never too late to change

Deciding to leave my GP practice for a new role brings with it a certain sadness, but also a feeling of liberation.

At the end of September, I will be leaving the practice where I have worked for the past 16 years. I arrived here in July 2005, an eager, wide-eyed GP registrar with an anti-hospital bias [see recent column] and pro-primary care enthusiasm. I loved having my own little room, with my own electronic diary and full electronic health record for each patient. I didn’t have to run around a huge hospital trying to find the right form for the right department only to be told that department actually now just accepts the blue forms, not the red ones. I was able to satisfy my need for control and order, with the luxury of extended consultation times and close supervision from my trainer.

Of course, things changed as time went on. After graduation, I was fortunate to be offered a locum position in the same practice (not before I had taken six weeks off to travel across Canada. Priorities, like.) Then I stayed on as a salaried assistant. The hours were great, with long lunchbreaks and defined finishing times. I was able to build up relationships with patients and get a feel for how a large practice operates. I was drawn towards the intricacies of management and was intrigued by the business of medicine almost as much as the medicine itself.When the offer of a partnership arose, I don’t think I hesitated for a second. I was eager to get more involved in the nuts and bolts of maintaining, developing, and improving the practice structures and was keen to have a greater involvement in the decisions that would affect my day-to-day life. I even embraced the “Gordian Knot” of practice support subsidies, determined that I would finally figure out how the hell they are calculated. I was keen to make changes that would hopefully improve the patient experience.

As with all organisations, some changes were easier to incorporate than others, and my utopian vision of harmonious autonomy was sometimes dented. But life proceeded, as it does, and I never gave any thought to the possibility of starting somewhere new elsewhere. My professional future would be within these walls, and the opportunities and developments that I needed for personal fulfilment would all happen in the parameters of my ‘Job for Life’. One day last summer, though, a sudden and stunning thought entered my head. I could leave. I could do something else. I had been reading some of Nora Ephron’s essays and came across her famous quote,

It dawned on me that

I had never even contemplated

the notion of doing something

different with my life

“Every 10 years or so there was a moment when I’d say, even subconsciously, ‘Is that all there is?’” She famously moved from journalism to screenwriting, writing the exquisite When Harry Met Sally in her mid-40s. It dawned on me that I had never even contemplated the notion of doing something different with my life. Of course, Covid played its part; the tumult that it induced was certainly a kick up the butt. It also brought opportunities for online learning and communication that had not previously existed. I applied for a Diploma in Leadership, which I would never have considered if it required regular trips to Dublin, as it would have done pre-pandemic. Once I had made the decision to up sticks, it was liberating. But of course there was a sadness and a sense of loss for what I would be leaving behind. The colleagues, friends, and patients that have been part of my life for most of my career so far. The joy of sharing good news with a patient and the bittersweet satisfaction of finally solving a diagnostic conundrum. While I expect to return to clinical practice in the future, for the moment I will be leaving behind the intimate relationships that I have built up with men, women, and children that know me as ‘The Doctor’. I know that some of them will struggle with building up that relationship with someone new and I feel guilty for leaving them in the lurch.I am now working with CervicalCheck as Primary Care Clinical Advisor. After a few weeks of figuring out a whole new way of working, I think I might be getting the swing of it. I am proud to have joined an organisation that has overcome a huge amount of difficulty and is consistent in its goal to provide a world-class screening service to the people of Ireland, led by the indefatigable Dr Nóirín Russell.Any regrets?I still have no idea how practice support subsidies are calculated.