I always knew it wasn ’ t for me - retirement that is . My father , an internist , worked until three weeks before he died at age 80 , and my mother , an LMFT ( licensed marriage and family therapist ) provided counseling to seniors and their support teams until she was diagnosed with a prognostically unfavorable malignancy at 76 . So , it is fair to say that neither genetics nor modeling would predispose me to a Margaritaville life after leaving clinical practice .
Actually , I prefer to be busy and useful . One of the worst jobs I ever had was during my high school years when I was hired by a temporary agency to work in a business office . I can ’ t remember the exact nature of the assignment , but what I do remember was having so little to do that I watched the second hand go round and round on the clock on the wall until it was time to leave : existential torture . Of course , feeling bored was never a problem during my career as an OB-GYN , especially the 20 or so years that I spent running a solo private practice . If I wasn ’ t in the OR , in a room with the patient or reviewing results at my desk , I was negotiating insurance contracts , pricing supplies or managing staff . My transition to hospital employment was associated with the tradeoff of management responsibilities for the burden of the electronic medical record and hours upon hours of charting . The only clock checking I did then was prompted by feeling ravenous and realizing it was 7 or 8 p . m ., and I really needed to go home for dinner .
In 2017 , dismayed by the challenges my patients were having with costs and access to care , as well as the pre-authorization hassles experienced by both my patients and myself , I decided to return to school for a Master ’ s degree in Public Health . I felt that this would enable me to act as a more credible advocate for providers and consumers of health care . I left practice in 2019 , and the six months I spent catching up on decades of uncompleted tasks , albeit somewhat satisfying in terms of checking them off my to-do list , reinforced my anticipated dissatisfaction with being unemployed . I was restless and bereft of a sense of purpose . I was determined to find a way to use the knowledge and skill sets that I had acquired by experience and education to improve the health care delivery system .
So , where did this lead me ? Upon discovering that the job I wanted didn ’ t exist , I created it . In 2021 , I founded The Asclepius Initiative ( TAI ), a 501 ( c )( 3 ) non-profit organization . TAI has a 17-member board comprised of individuals with relevant
8 LOUISVILLE MEDICINE
LIFE AFTER MEDICINE
My Unretired Retirement by SUSAN BORNSTEIN , MD
backgrounds in health policy , health care law , health economics , marketing , communications , labor , health benefits , health literacy and education , public health , accounting , health care workforce , behavioral economics , DEI ( Diversity , Equity , & Inclusion ) and hospital administration . Our mission is to improve the health and economic stability of Kentuckians , and ultimately everyone residing in the U . S ., by educating , inspiring and mobilizing the public to advocate for a universally accessible , affordable , equitable and high-quality health care delivery system . Our hope is to facilitate uptake and correct misconceptions between what the data shows is the benefit of a tax-funded health care financing system for everyone , and what the public believes about this type of system with respect to cost , access and quality of care .
I am aware that this undertaking is a Herculean task . I also understand that there is an inherent societal resistance to change . In fact , I am personally both risk-averse and set in my ways . However , I am also a physician scientist , and I know that facts and evidence are the foundation of our advice to our patients , to our colleagues who request consults and to our friends and families who want to know who they should see , what they should do and where they should go for the best health care outcomes . Evidence shows that a tax-based universal coverage system , one which is not completely dependent on employment , can save money AND save lives . In fact , TAI ’ s 2022 survey of 1,000 adult Kentuckians 1 found that secondary to cost , 59 % of Kentuckians have avoided going to the doctor , 53 % skipped or stopped follow up care , 43 % skipped or stopped medication , 31 % were unable to purchase food and 10 % declared bankruptcy . In aggregate , 86 % of those uninsured and 64 % of insured Kentuckians surveyed avoided , skipped or stopped medical care or medications due to cost . It doesn ’ t have to be this way , and I plan to devote the rest of my working life to fix it . I hope that you ’ ll join me . 2
References
1 https :// www . asclepiusinitiative . org / 2022-survey-results-v2
2 https :// www . asclepiusinitiative . org / join-us
Susan G . Bornstein , MD , MPH is founder and CEO of The Asclepius Initiative , Inc , a 501 ( c )( 3 ) non-profit organization . To learn more , visit www . asclepiusinitiative . org