Peter S. Moskowitz, MD
INTRODUCTION
Chaos has become the predominant environment in American Medicine. For many physicians, the joy of practice evaporated long ago. This outcome is the result of multiple complex forces including managed care, corporate acquisitions of practices, an emphasis on RVU production rather than effective patient care and communication, increasing patient volume and clinical complexity, excessive paperwork associated with electronic medical records, longer hours at work, and declining clinical income, among many other factors.
For many, the fun of medical practice is no longer fun. Professional burnout remains persistently greater than 40%, despite chief wellness officers, wellness programs, and institutional interventions to improve the culture of the workplace.
It is not surprising that there has been a massive movement of physicians toward early retirement, consults with physician career coaches, and the popularity of both clinical and non-clinical physician “side gigs.” This re-shuffling of the medical workforce is creating significant manpower shortages in most geographic areas and within most clinical fields.
My 27 years of experience as a career coach for physicians has taught me that the rush to early retirement often results in confusion, anxiety, regret, and poor outcomes, unless carefully planned well in advance
The focus of this feature is to discuss five important questions that a physician should ask themselves as they contemplate retirement. Answering these five questions well should facilitate a transition away from clinical practice and ease the way to a new life chapter.
QUESTION ONE: SHOULD I RETIRE OR PROTIRE?
The dictionary definition of retirement is enough to stop a physician in their tracks. “To turn away, to disappear, go into seclusion, sink out of sight.” Those definitions are not what a physician looks forward to. More importantly, because of the complexity of physicians’ lives, effective retirement should not begin six to twelve months before taking down the shingle, but long before. Career professionals call such advanced planning PROTIREMENT, originally coined by Frederic M. Hudson in his seminal book, The Adult Years. PROTIREMENT is the most effective strategy to guarantee an effective and successful retirement.
What exactly is protirement? It means to proactively plan for later life and career. To retire to pursue something else that will give life meaning. Ideally protirement begins early in one’s career and involves one’s spouse or partner in the planning process. I always recommend that a protirement plan be prepared in conjunction with a certified financial planner. A CFP will help you evaluate and plan for the many financial challenges of moving from an active practice income to a post-practice income that may be lower and/or less reliable. With your spouse or partner you will develop a vision of what your lifestyle in retirement will look like and develop an income stream plan to support that lifestyle. In resolving differences in opinion about choices and/or finances it is important for couples to seek win/win strategies. Most importantly one must re-visit their protirement plan on at least an annual basis, as your family grows, your physical health changes, and your nest egg grows.
QUESTION TWO: WHO SHOULD RETIRE?
Although it is the plan of most physicians to retire in their 60’s, the current milieu in healthcare is pressuring many physicians to retire much earlier than planned. That said, there is a cohort of physicians who would do well to retire at non-traditional times. Physicians with age-related cognitive impairment, often not recognized by the physician but recognized by colleagues and staff pose increased dangers of medical errors, threaten patient safety, and increase the risk of malpractice litigation.
Physicians with significant emotional and/or psychiatric disability, addictions refractory to treatment, or psychosis that is unresponsive to psychotherapy and/or psychopharmacology also pose risks of error, patient safety and malpractice litigation. Such physicians should retire.
Physicians with significant physical disabilities may impair patient care when they are unable to keep normal hours, cannot take call, or may require mind-altering pain medication. Such physicians should also retire.
Physicians with multiple malpractice judgements, especially those in close time sequence pose another unique risk to patient safety and effective care. There may be underlying issues with substance abuse, other addictions, mental illness or substandard knowledge, or poor technical skills. These physicians are typically identified by medical/hospital boards and suffer appropriate practice restrictions. Such physicians should retire voluntarily rather than be forced to do so as the result of legal imperatives.
Physicians who have a compelling new life or career vision should be encouraged to pursue those interests. Such new careers usually require transitions from full-time practice to full or partial retirement to gain the necessary time required to develop their new ventures or adventures.
QUESTION THREE: WHEN IS THE RIGHT TIME TO RETIRE?
As a career coach for physicians, I am asked this question frequently. The simple answer in my experience is that when the proper time comes, you will suddenly become aware of it. You may wake in the middle of the night or realize when you first wake up in the morning there is a voice that says, “The Time has come; I don’t want to /cant/t do this anymore.” Trust that voice, it is your inner wisdom speaking to you. No doubt you have been working on this problem on a subconscious level for a very long time.
It is also time to retire, when a physician reaches various key milestones. The most common is that your retirement financial portfolio has reached your “number.” That is the amount of money that your Protirement Plan has calculated to meet the needs of you and your family in retirement. You can find detailed discussions of this topic on multiple blogs and websites by physicians who write about financial matters.
Other important signs that the time is right include a realization that your professional life is no longer fun or satisfying. These feelings may also represent symptoms of burnout and should suggest the need for professional support from a counsellor, therapist, or coach. However, when these feelings persist despite professional support and a real effort on your part, it is time to give serious thought to retirement. It is a time to leave this kind of work for something else of greater interest, meaning, and less stress.
QUESTION FOUR: WHY SHOULD I RETIRE?
There are at least eight good reasons why you should retire. They are described briefly, below, in no particular order. I think they are all self-explanatory. I discus them in greater detail in Chapters 15 and 16 of The Three Stages of a Physicians Career.
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- Because you can AFFORD to retire, based upon your Protirement Plan.
- You’re satisfied with the sum of your career/practice contributions.
- You are confronting your own or a loved-one’s physical or mental health limitations.
- You have lost interest in your work, and you’re convinced it’s not burnout.
- You’ve been outpaced by technology and can’t/won’t be able to catch up.
- You’re chronically over-stressed and are resistant to psychotherapy and coaching.
- You are always depressed and can’t see a solution to the multiple problems of healthcare.
- You have a burning desire or passion to launch a new business, side-gig, or new career.
QUESTION FIVE: WHAT WILL I DO AFTER LEAVING PRACTICE?
Initial Priorities: Potential Pitfalls
There are several necessary priorities for a newly retired physician’s time First, be prepared for potential pitfalls in early retirement. These may include a loss of identity, confusion, anxiety and/or depression. Physician’s self-esteem and self- identity are tightly connected to their professional work. Once the work ends, they may feel lost. For many, the antidote is to plan to maintain friendships with other doctor friends, colleagues, and contact with the professional organizations they have always enjoyed.
Addition potential pitfalls include boredom, loneliness, and a lack of meaning and contribution. Solutions again involve maintaining old friendships, making new friends, finding new activities, and finding opportunities to volunteer that take advantage of your skills and experience.
One often unexpected pitfall is new friction at home. The physician’s spouse/partner is accustomed to having the freedom to pursue their own priorities and private time. Suddenly the physician is in the house all day long, wanting contact, conversation, and lunch together. As the saying goes, “You marry for better or worse, but not for lunch!” To avoid friction, the couple should discuss before the retirement date how they each will respect the other’s privacy and private time, without ridicule or judgement. Shoot for “win/win solutions.
Initial Priorities: Self-Care and Maintaining Health
Although physicians spend their entire careers taking care of patients, they often do a poor job of taking care of themselves. In retirement, that should change. Now there is ample time for improved self-care and improved general health, a process I would call Instituting Personal Wellness.
Personal wellness should include the following: build self-awareness by spending time alone, journaling, or meditation. Utilize Values-based time and money management, because physicians commonly “overspend” on both. It is important to stay connected to friends and family. Make time on your daily schedule for FUN! Repair relationships that need improvement, healing. Look for ways to expand your network of good friendships. Challenge your intellect through reading, online learning, and formal course work. Finally, give away your personal gifts; that is, those things you are uniquely skilled at.
Second Priorities: What Do You Want to Do in Retirement?
Perhaps the greatest deterrent to a physician contemplating retirement is a chilling fear of “what in the world will I do once I step away?” “Medicine is all I know how to do.” Truthfully, physicians’ intelligence and multiple transferable skills mean that they can succeed at anything they find interesting and pursue with intent.
Typical retirement activities of retired physicians include travel, spending time with family, enjoying sports, new or old hobbies, part-time clinical work, medical teaching, and new formal learning.
A New Career: Finding a new Calling
Numerous physicians in retirement today choose an exciting new direction: launching a new business venture or a new clinical or a non-clinical career. While this pathway is certainly exciting, such transitions are complex, take significant time and effort, and are best developed and instituted with the support of a certified career professional, such as a physician career coach.
Physicians seeking a new career path face a daunting yet exciting process of self-discovery. Details of how to find and then develop a new calling are beyond the scope of this feature article. A series of steps, briefly outlined below, provide a fundamental strategy for finding a new calling or a new non-clinical career.
- Secure the services of a certified career coach, preferably a former physician.
- Determine your unique gifts. (Your motivated or transferable skills).
- Clarify your PURPOSE for your next life chapter. (2-5 years)
- Learn to listen to your inner voice by spending time in solitude regularly.
- Volunteer your time in areas of new interests and talents.
- Find potential ideas by returning to childhood hobbies and interests.
- Develop new skills and knowledge thru education and/or new training.
- Be open and willing to take risks and “leaps of faith.”
Responding to these five questions thoughtfully and starting well in advance of a planned retirement (your Protirement Plan) will prepare you for a happy, meaningful and successful transition to a new life chapter.
