60 plus and still hammering away

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caligas

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I look at some of my partners in their 60's who are still gobbling up call and hammering away 60-80 hours. I don't totally get it. I understand that **** happens: divorce, bad investments, expensive lifestyles, kids....But even with that, making 300, 400, 500k year after year for decades, spouses with decent jobs themselves and with markets that have done well over time, shouldn't you still have 5-10 million? Or is it the love of working, or simply the mental inability to back down? I suppose it's a mix of the above, maybe I'll work up the nerve to ask in person, but that seems a bit rude.
 
Sometimes boredom is intolerable compared to all the problems with this job.
 
Physicians as a general rule are workaholics. (I was going to say "older physicians", but I will avoid the flames.) Not many - especially the older ones - are happy sitting all day in front of the TV.

I know a neurosurgeon who was still working full time well into his 80's. The neurology department chair when *I* was in medical school is still going at it full time and he has to be at least 90. Same thing with a urologist I know, he was department chair well into his 80's (although the death of his wife in a tragic accident certainly had a lot to do with it.)

As hard as it may be to believe, some physicians actually love their job and prefer doing it to almost everything else.
 
I look at some of my partners in their 60's who are still gobbling up call and hammering away 60-80 hours. I don't totally get it. I understand that **** happens: divorce, bad investments, expensive lifestyles, kids....But even with that, making 300, 400, 500k year after year for decades, spouses with decent jobs themselves and with markets that have done well over time, shouldn't you still have 5-10 million? Or is it the love of working, or simply the mental inability to back down? I suppose it's a mix of the above, maybe I'll work up the nerve to ask in person, but that seems a bit rude.

I think that it varies from person to person.
-Some people are ****ty savers and ****ty investors and need the money.
-Some people made other bad life choices and need the money.
-Some fail to cultivate outside interests.
-Some people get emotional satisfaction and social interaction that they just can't get anywhere else.
 
Physicians as a general rule are workaholics. (I was going to say "older physicians", but I will avoid the flames.) Not many - especially the older ones - are happy sitting all day in front of the TV.

I know a neurosurgeon who was still working full time well into his 80's. The neurology department chair when *I* was in medical school is still going at it full time and he has to be at least 90. Same thing with a urologist I know, he was department chair well into his 80's (although the death of his wife in a tragic accident certainly had a lot to do with it.)

As hard as it may be to believe, some physicians actually love their job and prefer doing it to almost everything else.

You couldn't pay me to go to a 90 year old neurosurgeon. I don't care if he was an all star in his prime. At some point biology catches up with you.
 
You couldn't pay me to go to a 90 year old neurosurgeon. I don't care if he was an all star in his prime. At some point biology catches up with you.

From what I have heard he wasn't doing the operating himself. He was a team physician, teaching, and I believe supervising senior residents who were operating for billing purposes and handling rounds. Not to the same work level as an assistant professor, but still working.
 
plenty of docs in their 60s now were the ones day trading stocks in the tech boom and they took a beating financially. I suspect many of them weren't fully invested in stocks for much of this run up. Others spend too much and don't save enough so they also need to keep working to support their habits. A few others just can't see themselves not working.


Personally I'm more than happy to back off to 1/2 time in my 50s should my nest egg be large enough. As much as I like my job, I like not being at the hospital even more.
 
I don't know a lot of things with 100% certainty in this world, but I'm 100% certain I won't be taking 24 hour calls when I'm in my 60s.

Left the hospital at 5 AM today after 22 hours nonstop, passed out when I got home, woke up a couple hours ago, and it'll be Wednesday before I feel fully human again.


I knew a 70-something yo orthopod who could always be counted on to fill his weekend calls with cases. I didn't mind so much (wouldn't have taken the calls in the first place if I wasn't willing to work) but there was something sad about seeing the old guy hammer away at some guy's ankle on a Sunday afternoon because he had 3 or 4 ex-wives collecting alimony, and a jet payment to make.
 
I don't know a lot of things with 100% certainty in this world, but I'm 100% certain I won't be taking 24 hour calls when I'm in my 60s.

Left the hospital at 5 AM today after 22 hours nonstop, passed out when I got home, woke up a couple hours ago, and it'll be Wednesday before I feel fully human again.


I knew a 70-something yo orthopod who could always be counted on to fill his weekend calls with cases. I didn't mind so much (wouldn't have taken the calls in the first place if I wasn't willing to work) but there was something sad about seeing the old guy hammer away at some guy's ankle on a Sunday afternoon because he had 3 or 4 ex-wives collecting alimony, and a jet payment to make.

Those "all-nighters" start taking a bigger toll on you once you reach your early 50's. The number reason for early retirement in our field is the call. If the job doesn't involve that much night work or you can get 5+ hours of sleep most nights I can see some wanting to work into their 60s. I have no intention of retiring early even though I'm financially set right now. I like working and doing cases; it's part of who I am at this point in my life. Instead, my goal is to transition to a less stressful job with less call for 10 years (about 60-70% of my current position) or so then go half time (20-25 hours per week) until my health no longer allows it. I'd love to be able to work until my late 60's or early 70's if my health allows it.

Many surgeons work way past their "prime" and their skills deteriorate substantially. Whether that happens at 68, 70 or 72 is hard to say exactly but it does happen and all too often the surgeon refuses to recognize it and the hospital/Chief of Staff won't do anything about it. I'd like to think that I'll recognize my "issues" when they occur and gracefully retire from the specialty.
 
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I get wanting to work some to 65 and beyond. I'll always work some, be it for money or volunteering abroad. But what puzzles me most is the desire to pile on the OB and trauma calls at an older age.
 
I get wanting to work some to 65 and beyond. I'll always work some, be it for money or volunteering abroad. But what puzzles me most is the desire to pile on the OB and trauma calls at an older age.

Money is a huge motivator even at age 60 when you have a "lifestyle" which needs to be supported. Many need $350K post tax for that lifestyle or even more. I've met a few in my day who needed to clear $500K to pay all the bills and keep the yacht fully fueled; or, alimony payments of $20-$25K per month to the ex-wife.
 
Money is a huge motivator even at age 60 when you have a "lifestyle" which needs to be supported. Many need $350K post tax for that lifestyle or even more. I've met a few in my day who needed to clear $500K to pay all the bills and keep the yacht fully fueled; or, alimony payments of $20-$25K per month to the ex-wife.

25k! Ouch, remind me not to sleep with any nurses.
 
It all depends on the acuity of calls whether you can work in your 60s.

My former practice 5 of the 11 docs were in their 60s taking full calls q5. Age 60, 60, 60, 63, 66. So it was older group. Of course there was my cohort age 40-42 who did all the extra calls for extra money.

But calls aren't bad. Crna's cover ob. Only do cases after 10pm maybe 10-15% of the time. Very low acuity. Which is why those guys can still work and take a full load.

I can't imagine taking trauma 1/2 calls being up night though at age 60.

What's ironic is 4 out of the 5 docs over age 60
Dont need to work full time. They aren't divorce. Set. Think they are bored. Like others said. Spouses are home. They probably get treated better at work.

The one who needed to work was the 63 year old who has lifetime alimony he's paying in Florida. $6000/month. And he just quit. Very balsy of him.
 
I think that it varies from person to person.
-Some people are ****ty savers and ****ty investors and need the money.
-Some people made other bad life choices and need the money.
-Some fail to cultivate outside interests.
-Some people get emotional satisfaction and social interaction that they just can't get anywhere else.

- Agree with these and will add another: -Some work in order to escape whatever they have going on at home, sadly.
 
Agree with aneftp and Blade. Night Call intensity is everything as you get past 50. Almost Everything else pales in comparison.


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I look at some of my partners in their 60's who are still gobbling up call and hammering away 60-80 hours. I don't totally get it. I understand that **** happens: divorce, bad investments, expensive lifestyles, kids....But even with that, making 300, 400, 500k year after year for decades, spouses with decent jobs themselves and with markets that have done well over time, shouldn't you still have 5-10 million? Or is it the love of working, or simply the mental inability to back down? I suppose it's a mix of the above, maybe I'll work up the nerve to ask in person, but that seems a bit rude.

Not sure where exactly you live but I do think cost of living is a big factor as well. I am very content living in a medium sized city in the Midwest and am able to put a decent amount away for saving while still having a comfortable lifestyle. If I lived in New York City or San Francisco with this same salary (or even a 50% increase) I would likely have to work a lot longer before retirement.
 
The 60 plus crowd that works because they want to, not because they have to, have found fulfillment in work. Many people (including doctors) that retire, wondering what to do with themselves with all the idle hours, will die an early death. When a generation steeped in the value of work (very much unlike millennials that find work a disgusting perfunctory exercise necessary only for survival) and have skill sets that later generations will never achieve, there is satisfaction with the interactions one has with their clients and their colleagues. Not everyone finds nirvana by strumming a guitar, playing video games, or participating in protests.
 
Agree with aneftp and Blade. Night Call intensity is everything as you get past 50. Almost Everything else pales in comparison.


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I think night call intensity starts to get to you long before 50. I am in my 30s and take busy 24 hour in-house calls with trauma and OB and it takes me 2-3 days to fully recover afterwards. When I was in my 20s, I could do a Q3, 30+ hour micu call and be out partying on my post-call night with no problem.

The 60 plus crowd that works because they want to, not because they have to, have found fulfillment in work. Many people (including doctors) that retire, wondering what to do with themselves with all the idle hours, will die an early death. When a generation steeped in the value of work (very much unlike millennials that find work a disgusting perfunctory exercise necessary only for survival) and have skill sets that later generations will never achieve, there is satisfaction with the interactions one has with their clients and their colleagues. Not everyone finds nirvana by strumming a guitar, playing video games, or participating in protests.

Oh yeah, and damn millennials! They hate work. 🙄
 
I think night call intensity starts to get to you long before 50. I am in my 30s and take busy 24 hour in-house calls with trauma and OB and it takes me 2-3 days to fully recover afterwards. When I was in my 20s, I could do a Q3, 30+ hour micu call and be out partying on my post-call night with no problem.

:

A bad night bothered me in my 30s. Thoroughly disliked it in my 40s and totally dread it now past 50. I give some calls away. Which has helped. Looked into a no call position, but the hit to status and income in my group is pretty high. Was willing to take the hit in income. But drop in status was too much for me at this point.




Sent from my iPhone using SDN mobile app
 
It all depends on the acuity of calls whether you can work in your 60s.

My former practice 5 of the 11 docs were in their 60s taking full calls q5. Age 60, 60, 60, 63, 66. So it was older group. Of course there was my cohort age 40-42 who did all the extra calls for extra money.

But calls aren't bad. Crna's cover ob. Only do cases after 10pm maybe 10-15% of the time. Very low acuity. Which is why those guys can still work and take a full load.

I can't imagine taking trauma 1/2 calls being up night though at age 60.

What's ironic is 4 out of the 5 docs over age 60
Dont need to work full time. They aren't divorce. Set. Think they are bored. Like others said. Spouses are home. They probably get treated better at work.

The one who needed to work was the 63 year old who has lifetime alimony he's paying in Florida. $6000/month. And he just quit. Very balsy of him.

That permanent alimony crap is insane. That would keep you working for sure.
 
That permanent alimony crap is insane. That would keep you working for sure.

Alimony is often modifiable upon retirement or disability. A lot of this is based on state law and the individual judge's discretion. Of course, final divorce/dissolution settlements often compel maintaining of life and disability insurance on the breadwinner with non breadwinner spouse as beneficiary so they can meet their obligations even if dead. Alimony is less likely to be modified by judge if one has enjoyed a high income for a long time and saved little.


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A bad night bothered me in my 30s. Thoroughly disliked it in my 40s and totally dread it now past 50. I give some calls away. Which has helped. Looked into a no call position, but the hit to status and income in my group is pretty high. Was willing to take the hit in income. But drop in status was too much for me at this point.




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What do you mean by "drop in status?"
 
What do you mean by "drop in status?"

Lots of places, including my own, "partner" means " I take call". If you aren't going to do the overnights anymore, get ready to discuss a day-track position with your former partners and new employers.

So this is why lots of older guys still take call. They want to maintain the income, maintain the # of vacation weeks, maintain post call days off, maintain job security.. all of which come with full partnership. As partner you make decisions about the schedule, run the board, make hiring and firing decisions, other financial decisions and advantages (shareholders in other businesses etc..)

When a full partner decides to take less call/hours, they maybe have 1-2 years of this part time work before fully quitting IME
 
The 60 plus crowd that works because they want to, not because they have to, have found fulfillment in work. Many people (including doctors) that retire, wondering what to do with themselves with all the idle hours, will die an early death. When a generation steeped in the value of work (very much unlike millennials that find work a disgusting perfunctory exercise necessary only for survival) and have skill sets that later generations will never achieve, there is satisfaction with the interactions one has with their clients and their colleagues. Not everyone finds nirvana by strumming a guitar, playing video games, or participating in protests.

I am 65 yr old, retired 6 mo ago.

That getting bored thing... that doesn't happen. It is too sweet having a week filled with 6 Saturdays in a row and a Sunday.

That said, I am still working "Supplemental Staff" a day or two a month, just to talk to the patients, nurses, and unit clerks. They all have to laugh at my jokes, my wife doesn't.

I have no call, so that's not an issue.

I will quit that in a year or two, when I feel my modest skill set begin to decline.
 
Lots of places, including my own, "partner" means " I take call". If you aren't going to do the overnights anymore, get ready to discuss a day-track position with your former partners and new employers.

So this is why lots of older guys still take call. They want to maintain the income, maintain the # of vacation weeks, maintain post call days off, maintain job security.. all of which come with full partnership. As partner you make decisions about the schedule, run the board, make hiring and firing decisions, other financial decisions and advantages (shareholders in other businesses etc..)

When a full partner decides to take less call/hours, they maybe have 1-2 years of this part time work before fully quitting IME
One doc I worked with was telling me they have a 2 year "retirement track" for the guys on their way out which basically just takes them out of the call pool... But they get the last choice in rooms which often places them in the rooms that work a lot longer so he thought it wasn't worth it.
 
For some folks it probably has become a habit and if they break that habit, they risk losing their purpose in life and become miserable. Like a withered flower, slowly fading away.
 
I get in now, but at first I was reading this as "drop-in status" as in: "John used to work hard, but now he will just "drop in" during the day and go home."

That's how all the partners at my current place of employment view their role. They "drop in" a couple times a week.
 
The 60 plus crowd that works because they want to, not because they have to, have found fulfillment in work. Many people (including doctors) that retire, wondering what to do with themselves with all the idle hours, will die an early death. When a generation steeped in the value of work (very much unlike millennials that find work a disgusting perfunctory exercise necessary only for survival) and have skill sets that later generations will never achieve, there is satisfaction with the interactions one has with their clients and their colleagues. Not everyone finds nirvana by strumming a guitar, playing video games, or participating in protests.
Lmao
 
The 60 plus crowd that works because they want to, not because they have to, have found fulfillment in work. Many people (including doctors) that retire, wondering what to do with themselves with all the idle hours, will die an early death. When a generation steeped in the value of work (very much unlike millennials that find work a disgusting perfunctory exercise necessary only for survival) and have skill sets that later generations will never achieve, there is satisfaction with the interactions one has with their clients and their colleagues. Not everyone finds nirvana by strumming a guitar, playing video games, or participating in protests.
early 20s here. when im in my 60s im gonna be on a boat, if not married, there will be many hot females in my company.
 
I would make a strong argument that it's just plain harder to retire nowadays. The cost of living is higher and real estate is higher in desirable places for retiree. Also if you have a kid, plan on putting off retirement for at least 20 years. There are docs around here that are still paying credit cards, rent, and paying mortgages for their mid 20s kids (which is stupid IMO).

A person a few posts back had it correct......
Stay in the midwest/south
Save your money
Be faithful.....seriously, do whatever you can to keep that lady happy because the alimony monster is no joke. And let's be real, alimony doesn't always play out the same for the wife that leaves her husband which is why I specifically said keep the "Lady" happy.

even after all of that you MAY be able to retire in FL or AZ, probably not HI
 

Seems like a legit site. There are a lot of ridiculous assumptions made in the article as well as in the original Washington Post article that was linked. The study quoted in the article...as well as in the original Washington Post article...looked at unemployment in young men without a college education. Somehow that got twisted into a study on "millenials" as a whole in the article on the awarding winning website "Red Alert Politics."

So let's see, we can blame NAFTA, immigrants, the Chinese, liberal coastal elites, and now video games on unemployment in white males without a bachelor's degree. Anything else I am missing?
 
I think the opposite is actually the case- the young millennials without a college education are indeed unemployed at an alarming rate, but even the college educated millennials are struggling. Those who could not make it in college (no do-overs) revert to the halcyon epoch of their childhood when playing video games was a source of "good feelings" since they could WIN with little effort. Their past-time as a youth becomes a psychological crutch for their failures in real life as an adult. Their social ineptitude manifest by a generation texting instead of actually talking, created a large group of misfits for the current job market, that for the most part relies on traditional forms of communication. Their "friends" are video sobriquets that they will never meet and live thousands of miles away, likely to pop out of their lives when the "friends" acquire a real job or when their video account runs out.

Unlike in European countries where trades are lauded equally to college, the millennials have no such fall back position since the solitary focus of the secondary education system in the US is to create attendees at college, not plumbers and electricians who are viewed as subhuman by educators. So, lacking the capability to fit into college and with no fall back position, the millennials slip back into what is comfortable- their gaming skills. These skills at least allow them some strokes that they would not get working as a convenience store clerk at age 25. Their mothers speak in whispers about their job to others when asked "where is Johnny working". The jobs they actually do land are typically quite transient, since millennials see a dead end job as the dead end job it is, and would rather live at home without having to support themselves, with no prospects for the future, and only a vague sense of wanting to be happy as the solitary goal in life. Industry, creation, work ethics, and long term concrete goals remain foreign to millennials as a group, since their focus is quite different from past generations. Getting a job, saving money, building a financially stable life is not nearly as important as finishing Halo 1-5 on Legendary mode.

So we can't blame the millennials for all the problems they face, but wouldn't it have been interesting had they not been given 3 do-overs on those classroom tests, or given extra credit for going to the theater to watch a non-sequitur movie for a class, or for just once, not have been given any one of their entire collection of participation trophies? The world might be a different place.
 
I think the opposite is actually the case- the young millennials without a college education are indeed unemployed at an alarming rate, but even the college educated millennials are struggling. Those who could not make it in college (no do-overs) revert to the halcyon epoch of their childhood when playing video games was a source of "good feelings" since they could WIN with little effort. Their past-time as a youth becomes a psychological crutch for their failures in real life as an adult. Their social ineptitude manifest by a generation texting instead of actually talking, created a large group of misfits for the current job market, that for the most part relies on traditional forms of communication. Their "friends" are video sobriquets that they will never meet and live thousands of miles away, likely to pop out of their lives when the "friends" acquire a real job or when their video account runs out.

Unlike in European countries where trades are lauded equally to college, the millennials have no such fall back position since the solitary focus of the secondary education system in the US is to create attendees at college, not plumbers and electricians who are viewed as subhuman by educators. So, lacking the capability to fit into college and with no fall back position, the millennials slip back into what is comfortable- their gaming skills. These skills at least allow them some strokes that they would not get working as a convenience store clerk at age 25. Their mothers speak in whispers about their job to others when asked "where is Johnny working". The jobs they actually do land are typically quite transient, since millennials see a dead end job as the dead end job it is, and would rather live at home without having to support themselves, with no prospects for the future, and only a vague sense of wanting to be happy as the solitary goal in life. Industry, creation, work ethics, and long term concrete goals remain foreign to millennials as a group, since their focus is quite different from past generations. Getting a job, saving money, building a financially stable life is not nearly as important as finishing Halo 1-5 on Legendary mode.

So we can't blame the millennials for all the problems they face, but wouldn't it have been interesting had they not been given 3 do-overs on those classroom tests, or given extra credit for going to the theater to watch a non-sequitur movie for a class, or for just once, not have been given any one of their entire collection of participation trophies? The world might be a different place.

Be honest, have you ever started a sentence with "back in my day" and then proceeded to enlighten everyone around you about all the challenges you've overcome hoping someone will be impressed? Maybe someone even told you that they could only dream of working as hard as you. Then you felt really good inside.
 
If I am still taking call at 60, someone remind me to quit and play video games instead.
I can see working past 60, but not outside of regular business hours.


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I agree- taking call would drive anyone to video games and a millennialesque life. As a prelude, stop carrying on conversations (unless it is about the environment, Trump, or the cause-du-jour) and make hand gestures that are not easily mistaken, or just devolve into guttural grunting noises as a form of higher communication. Work on your reflexes and speed prior to retiring to videogames. Use a glidescope on everyone and make it a practice to see how fast you can reset every alarm value on the anesthesia machine and monitor, several times an hour. Hone your courage under fire by taking apart the valves on the anesthesia machine (internal and external) then reassembling them and change the soda lime during a major vascular case or liver transplant. See if your hospital or surgery center will equip your monitors and anesthesia machine with PS4 hand controllers so you can control your entire world while sitting down. Or even more fun- join an anesthesia group videogame where 7 other players have control over your monitors and anesthesia machine while it is your job to navigate your real patient in the OR through the onslaught of things going wrong at the behest of your video opponents. This could be fun!
 
I think the opposite is actually the case- the young millennials without a college education are indeed unemployed at an alarming rate, but even the college educated millennials are struggling. Those who could not make it in college (no do-overs) revert to the halcyon epoch of their childhood when playing video games was a source of "good feelings" since they could WIN with little effort. Their past-time as a youth becomes a psychological crutch for their failures in real life as an adult. Their social ineptitude manifest by a generation texting instead of actually talking, created a large group of misfits for the current job market, that for the most part relies on traditional forms of communication. Their "friends" are video sobriquets that they will never meet and live thousands of miles away, likely to pop out of their lives when the "friends" acquire a real job or when their video account runs out.

Unlike in European countries where trades are lauded equally to college, the millennials have no such fall back position since the solitary focus of the secondary education system in the US is to create attendees at college, not plumbers and electricians who are viewed as subhuman by educators. So, lacking the capability to fit into college and with no fall back position, the millennials slip back into what is comfortable- their gaming skills. These skills at least allow them some strokes that they would not get working as a convenience store clerk at age 25. Their mothers speak in whispers about their job to others when asked "where is Johnny working". The jobs they actually do land are typically quite transient, since millennials see a dead end job as the dead end job it is, and would rather live at home without having to support themselves, with no prospects for the future, and only a vague sense of wanting to be happy as the solitary goal in life. Industry, creation, work ethics, and long term concrete goals remain foreign to millennials as a group, since their focus is quite different from past generations. Getting a job, saving money, building a financially stable life is not nearly as important as finishing Halo 1-5 on Legendary mode.

So we can't blame the millennials for all the problems they face, but wouldn't it have been interesting had they not been given 3 do-overs on those classroom tests, or given extra credit for going to the theater to watch a non-sequitur movie for a class, or for just once, not have been given any one of their entire collection of participation trophies? The world might be a different place.

Yes, there is a lot of "over-parenting" that occurs now, but every generation has losers...including yours. For every antisocial video gamer there is a "millennial" starting a business. In fact, I think trades are actually making a comeback. There are an awful lot of leather craftsman, clothes makers, brewers, and other local small business owners in my community who may or may not have a college education. Many of them are young, enthusiastic, and have no interest in working a 9-5 for a corporation. If there is anything that characterizes "millennials" to me it is just that...the intense desire to do anything but punch a clock for some billionaire CEO. Maybe that "anything but" is playing video games for some, but certainly not for all.
 
"My generation" and GenX were responsible for the creation of the millennials, both figuratively and literally. We did not simply over parent- we had expectations they would follow in the long progression in American society of an ever better life than we had. We rebelled against our parents in some subtle and overt ways that were usually harmless, but in the back of our minds, we knew our generation could achieve whatever we wanted through hard work, dedication to a career, and singularity of focus. The over parenting we embraced for the over protection of our children did contribute to their rejection of the laser focus we had in our generation. But there were other influences and events we did not anticipate: coddling by teachers and school administrators, the hypersensitivity that was engrained through our school system and sports programs, and the sea change in technology that subjugated our influence over our children. The job market collapsed in 2007 and took years to recover, with Obama encouraging adult GenX and BBs to pursue their college dream since they were unemployed anyway. This mass influx of older adults into the job market displaced the opportunities for the millennials and when coupled with the inability to ever escape the yoke of ever increasing collegiate expenses in order to attain a degree, many millennials gave up on college. Even if they had a dream of college, it could not transpire because they may not acquire a job when they graduated and would be saddled with debt lasting a decade or more. The trades are making a comeback, but not because the educational system or many of the college educated BBs or GenXs encourage their millennial children to enter such trades. Many millennials do not want to be saddled with a professional 9-5 job or a trades 9-5 job or any 9-5 job. They find happiness (at this point) by playing video games as a diversion, just as my generation found TV as a diversion. Somewhere along the way, we lost the millennial generation's focus, and they found other ways to achieve happiness that is quite different than what we would have done. Times have indeed changed, and because of a number of transformations in society, it is neither their fault, nor their destiny that they will not fulfill the professional roles society had waiting for them. They do have start up businesses, mostly barely viable or unsuccessful, but they are living their dream, not ours. We now import professionals from other countries to do the jobs that should be occupied by the millennials. Of the entire health care workforce, 16% are foreign born, but 27% of all physicians practicing in the US are foreign born.
 
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