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OK Boomer, What Happens Next?

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As the weather slowly warms and vaccine rollout programs gather speed, however haltingly, we look for some long-hoped-for return to normalcy. New outbreaks spurred by over-optimistic behavior as well as breaking news that one vaccine (Johnson & Johnson) is being evaluated for any possible association with very rare but potentially severe side effects serve to dampen our enthusiasm. Regardless of these setbacks, we can at least start to wonder what normalcy will look like in the coming months and even years. But what of those whose decisions aren’t centered on where they work, but whether we should work at all? In other words, how many psychologists’ decisions regarding retirement are affected by the pandemic? Many of us came of professional age when another virus (HIV) was reshaping individual and societal behaviors in fundamental ways. We must now face the consequences of a new microscopic threat to our lifestyles—and lives.

While the deadly consequences of the current virus cannot be gainsaid, we should learn to savor—and perpetuate—the longer-term positive effects wrought by the pandemic. As I’ve written earlier, forced confinement has caused many of us to turn to our gardens and our kitchens, to rely less on purchased or processed foods, and to center our activities around family and others in our own ‘bubbles.’ We fly less, consume less, pollute less—and, perhaps, reflect more. I have noticed that a number of colleagues seem to be realigning their work-life priorities. A colleague who is a university president decided to end her term at a short (but still respectable) six years. Her decision was I believe influenced by the loss of several colleagues and family members to the virus—and her ensuing awareness that her remaining years would be more fulfilling spent on her beloved land in the Texas hill country than in a college president’s office. While I wish her every happiness in a long and contented retirement, I also know that she will leave a large professional vacancy. As a college president, she was absolutely devoted to expanding higher education to those who’d never seen college within their reach, perhaps the greatest contribution of any university leader. While we can applaud those presidents whose focus is on expanding endowments, dedicating new buildings, or creating new research institutes, our highest honors should be reserved for those who make education available where it once was not. Who will take her place?

I used to say, only partially in jest, that psychologists never retire. We might give up a full-time teaching load or cut back our practices, but we often manage to stay professionally engaged throughout what others might consider a retirement phase of life. It is my impression that a larger number of psychologist colleagues are rethinking their own work-life priorities and are considering what others would call a ‘normal’ retirement at an earlier age. Fortunately, at least at present, there does not seem to be evidence that state licensing boards are seeing a larger number of psychologists giving up their licenses than before, but perhaps this is something we should as a profession give some thought to.

What is good for the individual may not be good for the profession or society, given the ever-increasing demand for mental health services. As the cohort of psychologists who came of age in the pre-managed care era retires, we risk losing not only workforce capacity but equally importantly the cumulative wisdom of this generation of practitioners. In the past this wisdom was not infrequently passed down in semi-retirement, via consulting, part-time clinical instruction, and mentorship. Will we lose this important conduit for the transmission of accumulated professional wisdom?

It is true that those of us of the baby boomer generation are often beset by challenges to our core beliefs. Many of us who were ardent participants in the civil rights movement of the 1960s find our roles and even our credibility challenged by a new generation of activists. Those of us who celebrated sexual diversity and championed the rights of sexual minorities face a gender fluidity that would have been unrecognizable as recently as a decade ago. Those of us who were brought up in a more classical educational style find the abandonment of more structured pedagogy to be perplexing. Not that the fresh eyes of a new generation can’t improve learning, far from it. The dominance of what is quaintly called the “Western Canon,” has long been challenged, but that, in any case, is an issue more for undergraduates. The canon of the discipline should also be subject to ongoing scrutiny since we know that many of its assumptions are based on values and methods that are no longer reflected in society. How to winnow out what is truly precious and enduring from what we merely were taught was so is an evergreen challenge. But it is a challenge we must face. Like our parents before us, we are confronted with the necessity to adapt to a new cultural ethos or endure the inevitable fate of reactionaries: obsolescence.

This complicates, but does not negate, the professional obligation that boomers have to transmit their accrued wisdom to new generations of psychologists. We cannot forget that the right to bill independently for psychological services is of that generation and its doing. Our ability to serve as independent expert witnesses in judicial proceedings, previously the purview of physicians, is likewise, as is our ability to serve as forensic experts, disability evaluators, and a host of other functions that early career psychologists take as given. Boomers gave psychology prescriptive authority, and boomers applied to real-world problems a psychological science that had previously been confined to the laboratory. The activism of the boomer generation, while different in tenor and scale from the activism of today, holds many lessons for the profession. The context may be different but the objective is the same. A profession, particularly a health care profession, that does not continually evolve to be responsive to the needs of its patients will not and should not survive. But any new synthesis requires a solid foundation and it is on the lessons taught by previous generations that this must be built.

PLEASE DON’T FORGET

As I wrote about last month, the Department of Health and Human Services Information Blocking rule is now in effect. While applying only to psychologists who use electronic health records, all of us, if we haven’t done so already, should be writing every progress note with the expectation that patients will have full access to it and other elements of the patient record. While HHS does allow for some exceptions such as patient safety, and the separately kept process note is exempt, it behooves each of us to conform to the reality that the record belongs not to us, but to our patients.

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