Guest Blog Post by David Mokotoff, MD
The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit rules. Added to that are multiple electronic medical records that need to be implemented, vary from one hospital to another, and often do not “talk” to one another. Thus, it would seem obvious that physicians are leaving their practices in large numbers. Perhaps. Perhaps not.
An April 5, 2017 Time Magazine article broke down retirement rates by professions. They charted the percentage of workers still working after age 65. It seems that this is an accurate yardstick to measure the issue. Topping the list of working professionals least likely to retire after 65, were tax preparers. 14.6 percent them were still working at age 66 and beyond. Pharmacists were at the bottom with only 4.3 percent. Although not near the top, physicians and surgeons were still in the top third at 8 percent. So why then do so many physicians resist retirement? I believe there are multiple reasons.
For many physicians, medicine is the only employment they have had in their adult life. Despite drops in salaries and autonomy, they still enjoy above-average wealth and income and may fear loss of this post-retirement. I fully retired three years ago. I have friends who still work and others who don’t. Illnesses play a role for sure. Some have few hobbies and fear boredom. That is a reasonable concern. Most of us are used to being respected by the public and inwardly fear that loss as well. My father, who had no hobbies, worked as an internist up until almost the day he died. Certainly, I am called “mister” a lot more these days than “doctor.” For me, however, there seemed to be a loss of “purpose.” Victor Frankl’s famous 1946 book Man’s Search for Meaning has a great quote that goes something like this: “Your work is not your worth.” This is a concept that is difficult for many of us to accept and grasp.
Although I spent most of my career in private practice, I always felt like a teacher. I would teach my patients, younger doctors joining the practice, nurses, and pharmacists. That all disappeared as soon as I retired. I write and read a lot. I like to fish and practice tai chi. I will soon become a tai chi instructor perhaps filling one need. A good fishing friend of mine who retired from sales and many years on the road and in the air, doesn’t understand why doctors are reluctant to retire. I don’t want to be judgmental, but for him he had a job. For many doctors, we feel as if we have a calling. For me, every other January is decision time. That is when my Florida medical license is up for renewal. Although the likelihood of me returning to active practice is low, the mere act of giving this up would mean that there really is no going back.
Lastly, the act of retirement brings into hard focus that this is indeed the “last stage” of one’s life. Although we deal with the death and dying of our patients daily, when it is “our” death and dying, well, that is a different matter. The hassles of corporate and industrialized medicine will continue to affect physician retirement rates. However, for many of those in the profession, the idea of life without medicine is just too scary to contemplate.
About the Author
Dr. David Mokotoff is a retired MD-Cardiologist with a passion for writing. He has authored many scientific as well as medical interest articles. His publications include “Remembering Earl” in The Journal of the American Medical Association (JAMA), “Why I’m Leaving Private Practice” in Physicians Practice Magazine, “Why I Brought Spirituality to My Medical Practice” in Integrative Medicine: A Clinician’s Journal, and “Never Too Late to Fall in Love” in Florida Sportsman. He has been interviewed many times in local Tampa and St. Petersburg newspapers and on television and radio. He has authored a memoir, “The Moose’s Children: A Memoir of Betrayal, Death, and Survival” and most recently “Dark and Light: A Short Story Collection.” He may be contacted via twitter @DavidMokotoff, his website, www.drdavidmokotoff.com, or email davidmmokotoff@gmail.com.
Retired at age 58. Loving everyday since then.Other reasons some physicians don’t retire is they have 1 or more alimonies to pay, kids from more than 1 marriage they have to support and send to private high schools and colleges, and poor investment decisions. This is what many of my fellow physicians told me when they said they wish they could retire but couldn’t. That said, I also continue to renew my licenses every 2 years because that is a tough final step.
If I could afford to retire I would be fine without my career. I do not need the “prestige” of being an actively practicing physician. I could find plenty of things to do as hobbies, and I could surely find some fantastic volunteer activities in my community to avoid boredom. Think outside the white coat!
One simple explanation is that many surgeons reach the peak of their career around age 63. Clinical practice is fun if maintained smartly, even over decades. Staying in touch with the “next generation”, either by teaching affiliations with our own colleagues or by simply staying involved in our children’s lives has broadened my options beyond pure surgical work. Financially happy physicians make for happy patients. Having hobbies besides the operating room is important – physical fitness, art, travel etc. even when working full time is important. Financial ineptitude, unfortunately, is too often at the root of delayed retirement. It is bred early in the career of many! I enjoy my practice because I do not pay off mortgage debts, cars, or divorce settlements. I believe a Dave Ramsey seminar should be part of every medical school curriculum.
I agree with everything you say, especially the Dave Ramsey advice. Furthermore, the practice of medicine and surgery is a privilege and should be perused with great reverence for as long as possible.
I plan on working until I’m 70, assuming my body holds out. (Dentistry is exceedingly physically taxing.) My husband wants to retire when he’s 66 and travel while we’re still able. My husband, while he finally likes it, works at a job. I “play” with my profession, and truly enjoy my staff and patients – my Dental Family. A compromise is achievable. I plan on taking 1 to 1 1/2 weeks vacation each quarter to travel with my husband until I do retire. I am already hoping to either work part-time or volunteer at the time because I know I will miss the broad human interaction. I am currently beginning to pay off all personal debt. My license is in New York State; my Board exams from decades ago are valid only in the northeast region, so when I retire south I won’t be able to practice as a dentist. Therefore, my biggest problem will be finding a dentist who doesn’t want to replace all of my fillings with composites (an estrogenic) or crowns.
You mentioned that you felt lesser sense of purpose. I can tell you that your writing is of high value to many of us and though it doesn’t replace the work you did as a clinician, it’s incredibly valuable. Cheers mister!