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    Life beyond Medicine: The Joys and Challenges of Physician Retirement
    Life beyond Medicine: The Joys and Challenges of Physician Retirement
    Life beyond Medicine: The Joys and Challenges of Physician Retirement
    Ebook208 pages4 hours

    Life beyond Medicine: The Joys and Challenges of Physician Retirement

    By Sharon Romm and Paul Wick

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    Physicians retire at all ages—older doctors forsake medical practice when tired of it or when forced to do so by age or illness; younger practitioners leave because of burnout, disillusionment with the medical system, or a desire to engage in new activities. But research and literature about physician retirement is scanty. Given the limited resources available, many physicians who want to retire from medicine remain mired in indecision, wondering how their life might be different if they left medicine. Sharon Romm has written the definitive guide to help health care professionals of all ages prepare for the joys and challenges ahead.
    LanguageEnglish
    PublisherDartmouth College Press
    Release dateJan 2, 2019
    ISBN9781512603323
    Life beyond Medicine: The Joys and Challenges of Physician Retirement

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      INTRODUCTION

      I sit with a dozen physicians around a table for lunch in the hospital cafeteria. Some have their sandwich in one hand and a paper cup of soda in the other, eating as fast as possible.

      They start talking about retirement. A well-liked colleague in his late fifties, the chief of dermatology, had unexpectedly retired. He left, a young dermatologist at the table explained, to spend more time with his rock band. Really.

      A fairly junior internist says wistfully that she wishes she could go too. She wants to return to seriously practicing the piano. She’d made her choice between pursuing a music career and going to medical school and wasn’t sure she’d made the right decision.

      The infectious disease specialist says in a voice conveying envy, I can’t wait to go too. I’ve got until the end of June, then I’m out of here. My farm and my garden are waiting for me, and my wife is ready to have some help.

      When I retire, I don’t know what my wife will do with me around all day, said the endocrinologist who is already beginning to withdraw from clinical work.

      An older surgeon says emphatically, I’m never going! I hope I can do one last case before they have to carry me out! I’ve taught my residents well. If I die while operating, I expect that the resident will shove my body aside so he can finish the case.

      And so the interchange went. Twelve people with different concerns and attitudes.

      I realized then that there wasn’t a serious book addressing the multiple issues and concerns about leaving a medical career that may have lasted for a few years or for decades. It was time to write one.

      For many reasons—burnout, disillusionment with the medical system, illness, or a desire to seek new activities—physicians retire. The number of older physicians is increasing, and the proportion of physicians who want to leave clinical practice is rising.

      According to the Association of American Medical Colleges’ 2015 State Physician Workforce Data Book, about 250,000 active physicians were 60 years of age or older. In a 2016 census, there were about 200,000 physicians between ages 60 and 69, and close to 100,000 were over the age of 70. Practitioners over 60 had increased by 70,000 since the last count in 2010.

      In 2017, there were almost one million physicians in the United States. Approximately one quarter belonged to the American Medical Association, with 53,000 over age 65 automatically belonging to the Senior Physicians Section whether working full-time or part-time, or, as were 14,000 members, fully retired.

      Although absolute numbers are unknown, the trend appears to be that many physicians are leaving clinical medicine with a mean retirement age of 67. According to the 2016 Physicians Foundation’s Survey of America’s Physicians, more than half of physicians of all ages rate their morale as somewhat or very negative. Half experience burnout. A quarter of those aged 56 or older indicate they will retire in the next few years, while 15% of doctors of all ages announced a similar plan. In addition, by 2016 half of the practitioners asked said that they would hasten retirement due to changes in the healthcare system, and many planned to reduce work to part-time or shift to nonclinical medical work.

      The retirement process and what follows are far from easy. After years of preparation and then practice, the physician’s identity has evolved. Doctors traditionally hold a respected place in society and in their own social sphere as well. It is not easy to relinquish what has taken a good part of a lifetime to achieve. A physician may start asking questions: Why should I retire and when and how should I do this? How will my relationship with my family and friends change? How will I keep from getting depressed? Should I leave medicine completely behind? How will I spend my time? What’s in my future?

      When a practitioner finally decides to leave medicine, support may be needed. Retirement doesn’t mean retreat. Moving forward, discovering new meaning, and making changes enhance life at every stage, but making that transition can be difficult. Life beyond Medicine provides the information and advice to help ease into this major life change.

      BURNOUT

      Burnout—the state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress—can undermine a physician’s career and life. Feeling overwhelmed and unable to meet constant demands make daily activity a burden. As the stress continues, interest and motivation dwindle, and thoughts may surface of quitting a specialty or completely abandoning medical practice.

      Burnout can affect physicians at any career stage and result in a deterioration of values, spirit, dignity, and will, starting a downward spiral from which it is almost impossible to recover. This phenomenon can ambush physicians in early and midcareer and create chaos in their lives. If a physician ultimately leaves the workforce, the loss is a detriment to the healthcare system.

      The three dimensions of burnout syndrome are emotional exhaustion, a feeling of failure, and depersonalization, the state in which one’s sense of identity is lost. Thoughts and emotions seem unreal, and sufferers experience detachment as if they were watching themselves from outside of their body. Exhaustion and detachment are associated with job dissatisfaction, deteriorating mental health, and as a consequence, poor patient care. Productivity declines, participation in professional activities wanes, and it becomes harder to resist the temptation to take sick days. Burnout can lead a physician to early retirement from medical practice.

      Burned-out physicians shortchange their families, their patients, their institutions, and themselves. They’re more likely to make mistakes, becoming vulnerable to lawsuits. Colleagues notice that they’re irritable and distant. They’re too exhausted to enjoy family and often cannot relax sufficiently to take pleasure in interests outside of medicine. Both professional and personal activities seem pointless. Why go to meetings or read journals? And when it comes right down to it, why bother to get out of bed in the morning?

      The psychological term burnout was coined by Herbert Freudenberger, a German-Jewish refugee who escaped Nazi persecution by emigrating from Europe. In New York City he studied psychoanalysis and, throughout his career, added respected contributions to the scholarly literature. The work for which he is remembered best is an exploration of emotional burnout experienced by caregivers in the human services professions. In his 1974 article Staff Burn-Out, originally developed from his work with free clinics in New York City and presumably based on the 1960 novel A Burnt-Out Case by Graham Greene, Freudenberger defines burnout as a state of mental and physical exhaustion caused by one’s professional life.

      The notion of exhaustion with medical practice was introduced by Sir William Osler (1849–1919), the first physician-in-chief at the Johns Hopkins Hospital, who was known for accurate diagnoses and advanced bedside teaching skills. He recognized the condition of burnout in the late 19th century and warned his medical students: Engrossed in professional cares . . . you may find, too late . . . that there is no place in your habit-stricken souls for those gentler influences that make life worth living.

      What Is Burnout?

      Burnout is a state of chronic stress that leads to feeling

      emotionally drained

      ineffective

      physically exhausted

      cynical toward work and life

      detached from social and work connections, activities, and life in general

      The onset of burnout isn’t heralded with fireworks and crashing cymbals. It can have an insidious beginning. The physician awakens on most mornings feeling it is impossible to face the day—too many patients, no vacation in sight, nothing that promises satisfaction. Formerly meaningful goals no longer resonate. Sadly, there are alarmingly few people with whom to share this misery.

      The physician worries more about completing the daily schedule without mistakes that risk a lawsuit than about caring for what patients experience. Suddenly, the realization becomes evident: the physician has lost control, and effectiveness in all aspects of life has dwindled.

      Full-blown burnout need not be a surprise. Our bodies and minds give warning. If you know what to look for, you can recognize burnout before it’s too late.

      What Are the Signs?

      Burnout represents a deterioration of values, dignity, spirit, and will. The physician may experience fatigue, anxiety, insomnia, depression, forgetfulness and impaired concentration, increased focus on and awareness of physical symptoms, pessimism, isolation, detachment, apathy, hopelessness, poor performance, irritability, declining productivity, or reliance on drugs and alcohol.

      Christina Maslach, a pioneer investigator on job burnout, is the author of the Maslach Burnout Inventory, the popular social science research instrument. This is a longer version of the Abbreviated Maslach Burnout Inventory, a tool that identifies those at risk. The tool requires individuals to rate the following statements based on their applicability:

      I deal very effectively with the problems of my patients.

      I feel I treat some patients as if they were impersonal objects.

      I feel emotionally drained from my work.

      I feel fatigued when I get up in the morning and have to face another day on the job.

      I’ve become more callous toward people since I took this job.

      I feel I’m positively influencing other people’s lives through my work.

      Working with people all day is really a strain for me.

      I don’t really care what happens to some patients.

      I feel exhilarated after working closely with my patients.

      I think of giving up medicine for another career.

      I reflect on the satisfaction I get from being a doctor.

      I regret my decision to have become a doctor.

      Who Suffers from Burnout?

      In one study reported in the Archives of Internal Medicine, over 7,000 US physicians drawn from the American Medical Association Physician Masterfile and representing all specialty disciplines were assessed for burnout and satisfaction with the balance of work and other aspects of life. Researchers then compared this group with the general US population.

      Half the physicians in the study reported at least one burnout symptom. Those in frontline specialties such as family medicine, general internal medicine, and emergency medicine were the most afflicted. Compared with a sample of 3,442 working adults, physicians were more likely to have symptoms of burnout (37.9% versus 27.8%) and to be dissatisfied with work-life balance (40.2% versus 23.2%). Other studies indicate that as many as 85% of physicians identify symptoms of burnout. Burnout occurs most frequently in midcareer but is evident as early as medical school, where half the students queried admitted feeling burned out and about 10% had thoughts of ending their

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