The Ninth Inning of FOMO

Off we go into 2026, where we get another chance to cleanse, reflect, and reset as well as take a hard look at where we are going as practitioners, as a specialty, and as grown-ups…yeah, right, who am I kidding? Everyone is probably still hungover, scrambling to make resolutions, and doubling their GLP-1 doses to undo the holiday damage. Resolutions, rejoice vs remorse, and even reflection…all part of the turn of the calendar.  For many of us, the year begins with an optimistic review of the schedule and the roundabout of meetings, only to end with the glares of family members when the suitcase appears. My boys, now 11 and 8, aren’t fooled anymore. I haven’t been in an airplane in almost 5 weeks as I write this, yet they really want to come along (mostly for a Lava Flow and screen time). More importantly, they have perfected how to twist the knife when I miss a game, a school event, or just sitting with them playing games at home. FaceTime helps, but those missed moments leave a mark, and when everyone reminds me that in a few more years they won’t even care, it somehow hurts even more.

We all try to outrun the clock to stay relevant, to be everywhere at once. But a broken clock is still correct twice per day and no matter how glamourous the travel itinerary may seem, there is always something we miss and something left behind. The road, believe me, is still undefeated.  

Choices all have a price, and in the 7th to 9th innings of life, FOMO (fear of missing out) becomes a very powerful force to overcome. Whether it comes as not being asked back to a meeting, seeing your niche disappear, or simply having your wings clipped by Father Time, the emotions of FOMO carry more weight when we must let go of the wheel. The hardest part might be recognizing that those we once called O.G.s are aging in front of us. The sun seems to be setting faster than it rose, and despite our best efforts to ignore it, the inevitability is there. When someone calls you the O.G., the mirror gets a little sharper. And if I’m an O.G. Dracula now, dodging sunlight, I suppose that’s how it goes, according to the Tame Impala song: “We both saw this moment coming from afar… now here we are.” The transitions in the past few years have been sobering. Retirements, consolidations, colleagues stepping back—or worse, passing on—have reminded me that at 58, I’m not young in this game. Even as we make sure to take our BP meds and statins, most of us don’t slow down until something forces us to. And that force is rarely physical—it’s ego. The day you realize that you are being replaced, accepting that the bubble in which you were once appreciated now mandates that you should fade into the shadows is a very difficult pill for many to swallow. In the end, Dracula’s fade into the darkness is not an easy transition.

The tale of Dracula (in many ways an O.G. in his own right) as it relates to dermatologists is about establishing a legacy and learning when it comes to an end…or at least to embrace what there is to show for it.  So many of the vampires have been the ones who made their marks with their patients, who changed the narrative of how we practice and advocated for our specialty, and who wrote the books instead of just reading them.  

As the 9th inning approaches for many of us, the pitches seem faster, nastier, and the swings harder to time. The FOMO will get worse before it gets better. It’s no longer about being at the next big thing. It’s about wondering if you’re still part of the thing at all.

So instead of fading quietly, we choose perseverance. Maybe we mentor. Maybe we stay in the box and take a few more swings—not to prove something, but to leave something. To pass the baton while we still have the strength to do it right. Because what matters isn’t just how long we played, but what we left on the field.

As a heartbroken Brewers fan, I know what it’s like to dominate the regular season only to fall short in the postseason. The 9th inning means one of two things: it’s the end, or it’s time to go all in. One day—sooner than we’d like—we’ll all walk off the field, so I choose to follow the lyrics:  In the end, I hope it’s you and me…In the darkness, I would never leave…