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The retiring type?

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By Warren R. Heymann, MD
April 23, 2017

“Tell me, Dr. Heymann, when do you plan to retire?”

Patients seem to ask me that every day.

My usual response: “Why do you ask, do I look that bad?”

“No, you look pretty good for your age.” (According to my rabbi, there are three stages of life — youth, middle age, and “you look good.”)

“Do you think I’m not as sharp as I used to be?”

“No, you’re great. I just know that a lot of doctors your age are packing it in —  they’re burned out; tired of all the changes, regulations, insurers, and such.”

“I have to admit, I think about it a little more than I used to — I’d like to do some more traveling, but I’ll keep going for a while. The right time to stop is when I wouldn’t choose to go to myself as a doctor.”

I usually don’t comment on commentaries, but the JAMA Professionalism essay “Is it time to retire?” is worthwhile reading for physicians of all ages. The authors present the dilemma of a 70 year-old endocrinologist who may not be quite up-to-date on the literature, with no passionate hobbies, and a financial outlook that could be better. They offered four options: ultimately concluding that the third and fourth choices were reasonable in his circumstances, although none were mutually exclusive.

1. Start planning his retirement now, which is sooner than expected, leaving him with less income than he had expected to have in retirement.
2. Consider partially retiring so that he can still see patients with simple clinical problems.
3. Talk with his medical director and ask for feedback on his performance to gain insight into whether there are problems with his clinical skills.
4. Enroll in continuing medical education (CME) activities to gain new knowledge and test himself to determine if his clinical skills are current.

The importance of physician retirement cannot be overstated for physicians and society at large. Approximately 25% of the physician workforce is older than 65 years (1). There are about 500 dermatologists entering practice each year with roughly 325 leaving (2). Despite the maldistribution of dermatologists, Glazer et al state “many regions will most likely experience a continued supply shortage of formally trained dermatologists over the upcoming years.” (2).

Nobody is going to base their decision to retire on workforce needs — the decision will be entirely personal. One of the great difficulties for physicians is the reality that practicing medicine is often an identity as much as it is a career (3). Aside from financial issues, a vital question is asking what will fill the intellectual and social voids that may occur once one leaves medical practice.

Last week, John Stanley, the former Chairman of the Department of Dermatology at the Perelman School of Medicine at the University of Pennsylvania, informed me that his retirement is imminent. I told him that I found that hard to fathom, given his brilliance in the translational medicine of autoimmune blistering disease, administration, clinical medicine, and teaching. How can he leave? He assured me that he will be fine. He’s a person of diverse interests and apparently has no qualms about his decision. (Prior to publishing this post, I asked John for his approval to print this — he graciously agreed, but wanted to clarify that he is “hedging his bets” by remaining in his lab at a fraction of his current commitment.)

I wish John all the best in the next phase of his life. For the record, I will be Medicare minus three (62) next month. I still feel like a youthful resident learning the business, but I know that I’m in the “red zone.” Life catches up with all of us. My institution (Cooper Medical School of Rowan University) has implemented a policy that every physician undergoes cognitive testing at age 72. The next decade will pass in an instant. What I should do is find hidden talents and passions (I’m afraid that I don’t have any, so that will be a challenge) and enjoy them while I’m physically and mentally able. For now, I look forward to telling my patients that they can still plan on seeing me. My mother taught me not to overstay my welcome. I’d prefer to leave when people are sorry to see me go, rather than hear them whispering behind my back hoping that I would retire already.

1. Levinson W, Ginsburg S. Is it time to retire? JAMA 2017; 317: 1570-1.
2. Glazer AM, et al. Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatol 2017; 153; 323-5.
3. Collier R: The challenges of physician retirement. CMAJ 2017; 189: e90-1.

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