Retiring gracefully

If we are fortunate enough to live a long time, all of us must eventually retire. Even though a yearly RRSP contribution should remind us of that, reality doesn’t usually strike until the first CPP cheque arrives. Few of us devote the same energy to an exit strategy from medicine as we did to getting started. Sure, there are many workdays when we wish for retirement, but in reality we mean an extended vacation rather than a terminal event.

Most of us are too busy to give the matter much thought; besides, who is going to look after all our patients? Retirement brings changes in income, friendships, status, stimulation, and, perhaps most of all, one’s sense of identity and purpose. Dr Alan Roadburg, in his book Life After Medicine—Roadmap to Retirement Happiness[1] describes the need to “re-tire” and find new stimulation and purpose when considering retirement. The development of a secondary career before retiring from medicine would, of course, obviate some of these concerns. However, if you are one of those few who could permanently live without an alarm clock, thrive under the monotonous sunshine of Palm Springs, and golf every day without having an existential meltdown, read no further.

Most physicians elect instead to ease into retirement rather than change careers. This strategy is easier for nonhospital-based physicians. The benefit of a gradual retirement strategy is that it provides for a less-precipitous decline in income and status and may also keep peace on the home front with a spouse unaccustomed to a daytime intruder.

Semiretirement does have some costs and commitment considerations. According to the College of Physicians and Surgeons of BC regulations, physicians must work at least 2 months per year in order to remain licensed. Moreover, the cost of CPD compliance, membership in the CFPC or RCPSC, CMPA, Doctors of BC, and College dues will erode the profitability of part-time work.

Not wishing to be encumbered by administrative and management obligations, many physicians will opt to work as a locum or in a walk-in clinic. This might seem like a good plan at first glance, but physicians should know their limits and be realistic about the neurocognitive decline that inevitably attends normal aging. Fluid cognitive abilities, which include analytic processes, spatial manipulation, and mental speed, peak in the third decade and decline more deeply in the seventh and eighth decades. Among the most important physiological changes are reduction in dexterity, short-term memory, problem solving, and the ability to adopt new ideas and critically examine old ones. Older physicians draw more on prior experience, relying on nonanalytic crystalized cognition. One of the hallmarks of age-related neurocognitive decline is “premature closure.”[2] The interviews tended to be abrupt, with many interruptions, history taking was not comprehensive, data-gathering was incomplete, important management strategies were not considered and important details were left out of the patient records.

It is this that too often gets the older physician into trouble and triggers complaints from patients who are much less forgiving than those former patients with whom the physician had a long-term, caring relationship. In addition, high patient-volume situations, particularly prevalent in walk-in clinics, can quickly overwhelm the older physician accustomed to treating known patients at a comfortable pace.

A safer strategy for physicians contemplating semiretirement is to continue to care for familiar patients in a well-organized office with support from colleagues, patients, and staff. Even more so, working with younger physician colleagues can be invaluable.

Many older physicians may continue to practise safely in carefully selected settings that play to their strengths. At the same time, patients must be assured that physicians continue to practise competently, and this will result in increasing scrutiny of older physicians by medical regulatory authorities.

Retirement should be voluntary and planned. It is never too late to make retirement plans, even knowing that circumstances may change. A timely retirement, deliberately and thoughtfully managed with the best interests of patients given priority at every stage, is a professional obligation. For all of us, the reward for a successful end to a career in medicine should always be lifelong pride in our accomplishments.
—WRV

References

1.    Roadburg A. Life after medicine: Roadmap to retirement happiness. Thornhill, ON: Second Career Program; 2005.
2.    Eva KW. The aging physician: Changes in cognitive processing and their impact on medical practice. Acad Med 2002;77:S1-6.