A colleague texted me a few months after I went public about the Psoriatic Arthritis diagnosis. Not a friend from residency, not a partner at PRMA. Another surgeon, quietly dealing with a decline of their own, who'd heard enough about my situation to ask the question directly: what would you tell someone in my position? I didn't answer well that night. The honest version of the answer took longer to build than texting allowed.
This is the full answer I wish I'd had ready that night.
The instinct to hide it is the wrong instinct.
Every surgeon I've talked to since has admitted the same first move: conceal it. Push through it quietly, skip the case that worries you, tell yourself the bad week is just a bad week. I did exactly that, and told myself I was managing it fine. Compensation feels like control. It isn't. It's borrowed time.
That isn't recklessness. It's the same instinct that made you a good surgeon in the first place, the refusal to accept a lower standard, working against you now. It convinces you that pushing through one more case is discipline instead of denial.
Tell your partners before the system tells them for you.
The version of this that goes best starts with a hard conversation, early, with the people who will have to absorb the gap. I had that conversation as early as I should have, and I was accurate about it. They still couldn't quite picture it. The good days, with compensation, looked normal enough that the bad days were hard for them to imagine. That's not a failure of trust. It's the limit of what any relationship can carry when what you're saying and what they're seeing don't match.
Know your practice's buy-sell agreement before you need it. Know what your disability coverage actually covers, not what you assumed it covers years ago. Most surgeons discover the gaps in that coverage at the exact moment they can least afford to.
Your value was never only in your hands.
Every microsurgeon believes, on some level, that losing fine motor control means losing the identity underneath it. I believed that too, and it took me a long time to reconcile. What I hadn't accounted for was how much of what makes a surgeon good has nothing to do with the hands: judgment under uncertainty, pattern recognition built over thousands of cases, the standard you hold everyone around you to. None of that requires a scalpel to exist. It never did, even on the days I was operating at my best. The surgeons I've seen sustain a career the longest weren't necessarily the most talented. They were supported by a system that carried some of the weight their skill and judgment alone couldn't. You also need people willing to carry the caseload while you find your footing, and a system built to absorb the gap instead of exposing it. Surgeons who try to do this alone are the ones who burn out instead of transitioning.
That doesn't make the loss smaller. It makes it survivable.
The system either holds without you, or it doesn't. That's not about you.
We spent twenty years building PRMA into something that didn't depend on any single surgeon. I found out what that promise actually meant when I was the one it applied to. When I stopped operating, the practice kept delivering the outcomes it always had. That wasn't a credit to my absence. It was evidence that we'd built something designed to survive exactly this moment, which is the entire point of building it. I've written elsewhere about what that confirmed for me at the time.
If your group can't absorb your transition, that isn't a referendum on you. It's a finding about the system, and it's worth fixing before the next surgeon hits the same wall you're hitting now.
What comes after isn't smaller.
The forced transition doesn't have to be an ending. Mine became a different kind of practice: in addition to being PRMA's CEO, I now lead Clinical Operations at ARSA, building the infrastructure that lets physician-led care hold up across markets, not just inside one practice. That job didn't replace what I lost. It gave the same instincts a wider field to work in.
A forced transition doesn't ask whether you were a good surgeon. It asks whether you built something that outlives the answer.
If you're where my colleague was, staring down the same transition: talk to someone before the crisis forces the conversation for you. Your hands don't need to be the whole story. Build the part of your career that doesn't rely on them, before the moment comes when it already has to exist.
Related reading: What Psoriatic Arthritis Taught Me →
The Wall I Kept Hitting: Why Every Venture Started the Same Way →