…to retire from medicine
By Michelle Pannor Silver, PhD
For many highly qualified health professionals, taking retirement feels like a kind of death. For them, retirement comes not as a welcome reward after a career of dedicated service, but as a fearful venture into a void. It is viewed as something to postpone indefinitely, if not avoid altogether.
I know this because medical professionals have been sharing their feelings about retirement with me through my work with the Academic Physician Project, a University of Toronto study examining the relationship between a physician’s workplace identity and retirement. In collaboration with the Department of Medicine’s Faculty Development Committee, this study seeks to develop policies and support systems that might help ease a doctor’s transition from his or her professional role toward a smooth, engaged and dignified exit. Here I offer a sampling of reasons why some people find retirement an almost unthinkable prospect and a few suggestions for retiring from a fulfilling career.
Sense of identity
One well-known disease specialist explained to me that the praise and recognition he received from patients, colleagues and other world leaders in his field had come to form his core sense of self-worth. Being a world-renowned specialist continually brings prestige and cachet, he said; being a former world-renowned specialist would bring mere distinction. To him, giving up his practice meant giving up all the affirmation that had come to feed his sense of identity. “What is your value as a person when you are finished being a doctor?” another participant asked rhetorically in a series of focus groups I ran with specialists at teaching hospitals. “What is your value and what are the things that make you happy, make you feel fulfilled? What will fill the void of work?” He offered no reply.
For many academic physicians, “work-life balance” remains a foreign concept. Many face periods of time when they are consistently on call. Many must make life-and-death decisions. The demands of leading a team of medical professionals and students at a large hospital can be onerous and the stresses enormous—but the rewards can be exhilarating, even addictive.
The teamwork demanded by many medical fields nurtures a powerful sense of belonging, many doctors say. “There is this family feeling,” one said. “It seems more than just a job, which makes leaving all the more difficult. I have members in my division who think of retirement as leaving their family. They think of it almost like ending their lives.”
One oncologist contemplating retirement said that throughout her career she had made a point never to miss a birthday party for one of her children. She had always been physically present, she said, but had often found herself mentally and emotionally absent. As she watched her child blowing out the candles on the cake, she would be thinking about a procedure she had performed that afternoon, or mentally preparing herself for one the next day. Every night for decades she had brought work home with her. For her, being on top of her game at the hospital meant constantly thinking through her patient cases. As she grew older, she realized she would not always be able to keep up with the job’s demands. But when asked to imagine retirement, she seemed to draw a blank. She had not given it much thought, she said. She imagined that what she called the “normal” life of retirement would be dull when compared to hospital life. She knew she would have to retire at some point, but was not quite sure how. In theory, being free to focus on herself instead of others held some appeal, but finding solutions for patients was what she was good at. She had little experience serving her own needs.
Perhaps surprisingly, financial worries also enter the picture. By most people’s standards, top medical specialists are well paid. If their “family” loyalties are to their co-workers, however, and not to their spouse and children, divorce can result, along with second and third marriages. Financial settlements and support payments become part of the equation. A continued income stream for as long as possible begins to look essential. Moreover, doctors are essentially self-employed; they have no pension plan or employer-directed retirement savings incentives. Despite their earning power, many plan poorly for retirement and may feel they must keep working to avoid living on a reduced income. The gastroenterologist who knows how to laparoscopically resection a bowel might not be as skilled at managing personal finances.
Because of the demands and satisfactions that can come with an elite medical practice, many doctors neglect to develop outside interests and skills. Many doctors told me they do not really enjoy anything outside medicine. As experts in their fields, many did not take time to develop or pursue activities, such as golf, particularly if they were not good at them. The idea of developing new interests or skills in retirement struck many as something that other people might do. Several doctors told me they had not taken more than two weeks off in 40 years. They had worked almost continuously, partly for the money but partly because they disliked taking time away from what they loved.
Many specialists nearing retirement age delude themselves into thinking they are indispensible. They have pursued an all-consuming career, and have reached the top of their profession. They can only imagine the health system falling apart without them, which might be a cover for their fear that they might fall apart without the structure and demands of their work. After a lifetime of taking care of people at their most vulnerable, the idea of being the vulnerable one in need of care can be disconcerting and scary.
However, for doctors as much as anybody else, retirement can be a rewarding opportunity. Retirement can be an opportunity to gain something. A rich life after medicine awaits any doctor who prepares for it. My ongoing research suggests many ways in which academic physicians—and perhaps other highly skilled autonomous professionals with strong work identities—can prepare for a happy and healthy retirement.
Michelle Pannor Silver, PhD, is an assistant professor at the University of Toronto Scarborough and Institute of Health Policy, Management & Evaluation.