Physician retirement--questions, thoughts, considerations...

I have been a practicing physician since finishing medical school in 1986. The year after that, I started my internship at the Johns Hopkins Hospital on the Osler medical service. I remember how excited I was about my salary of $17,000 that year. I called my mother. She was so proud. It was plenty to cover my food, apartment, gas for my VW Rabbit and essentially nothing else since I worked all the time.

By the time I finished my medical residency I was 28 years old and lived in Seattle where I was able to buy a house with my boyfriend (now husband) who was a scientist in a company that paid him a decent salary. My first job out of residency was with a healthcare cooperative, doing primary care and consulting internal medicine. After 4 years of that, I moved to rural Idaho where I have been ever since. For 17 years I was a "traditional internist" meaning I took care of my own patients in the office, took care of them when they were admitted to the hospital and provided some other services for the hospital and community as needed. I was on call every third or fourth weekend for myself and my partners and most evenings for my own patients. I was part of a larger clinic, but we were not salaried, keeping what patients or their insurance company paid for our services minus about 50% for overhead related to administration, billing, supplies and building costs. Primary care was not highly paid and I worked 3-4 days a week, so my earnings didn't go up much at all over the course of my career, which was actually fine. I lived close to my work--could ride a bike or walk when the weather was good, even skied to work a few times! No complaints. Still, it was a lot of work and a lot of responsibility and I fantasized almost every day about retiring, despite the fact that retirement was clearly decades away. As I fell asleep, I would think, "I will retire tomorrow and just lie in bed and read books." 

In 2011, I decided I was due a sabbatical and quit my job to learn new things, do locum tenens in 5 states, refurbish my internal medicine knowledge base and do some international medical work and teaching. Eventually I also took a position at my home hospital as a staff hospitalist, in addition to away work. My jobs were intense, well paid and I had significant stretches of time off. Many of my locum tenens assignments as a hospitalist were in places where the hospital system was dysfunctional and the workload high and most were far enough away from home that I slept in a hotel or airbnb and spent a day on either side of my 7 day work week just in transit. I learned a ton, met lots of people and provided good service, but it was exhausting and stressful. By 2019 I was done. 

Since then I have been employed as a consulting internist at a couple of community health centers in my area, 30 hours a week, 3 ten hour days plus commuting. (Also I teach ultrasound in my spare time.) I no longer take care of patients in the hospital and I do not take call. I get a salary and benefits. It is no longer grueling, only occasionally intense, and I still get to do what I love, which is see patients and work on solving their problems, relieving their misery and sharing their successes. Occasionally there are corporate bureaucracy related frustrations and I am not my own boss. But the main thing that creates tension (and we all know that tension leads to a good narrative) is that I am not retired.

I have practiced medicine for 36 years. I have a retired husband who would love to be able to go camping or hiking or canoeing or skiing with me when the mood hits. I have friends all over the country who I would love to see and I have never been to Yellowstone or the upper peninsula of Michigan. Not to mention I would love putting my back into battling climate change and hanging out with my twin sister. 

So what would it mean to be retired? What are the issues?

1. Enough money: I have looked at the internet on this question and realize that it's a very individual question. As a person without a boat or a plane or children in college or expensive hobbies, I'm fine. If inflation or climate apocalypse throws a curve ball, I feel confident in my ability to downsize and still be happy. I also have some salable skills if it comes to that.

2. Clearing my schedule: There are some things that I have agreed to do that I need to complete. I will need to avoid committing to things that mean retirement will let people down.

3. Am I really ready to quit being a doctor? Here's a big one, and one reason why some doctors work forever. Possibly why interventional radiologists retire early--that's more of a job and less of an identity. (Plus they make a ton of money.) When will I let my licenses lapse? My DEA certificates? My present job takes care of malpractice--when I leave I will have only the "tail" to take care of suits that might arise during the time I worked there. But without a practice, I should need no malpractice so I guess that's ok. Will I continue to update my knowledge base, and would I even remember new knowledge without a chance to use it? Right now this seems like amputating a healthy limb. And yet...the point of retiring is to start a whole new chapter. 

4. How long will I be retired? At what age am I planning to die? Not soon, for sure. I might have around 20 years of potentially vigorously healthy life ahead of me (knock firmly on wood) and then maybe 10 years of being very old. Is this too many years to be retired? Will I be irrelevant? Or will I slip back into the habit of being necessary and overscheduled? Will I simply slip out of the frying pan and into the fire?

5. Why am I retiring? Obviously I want to do all of the things that I can't do now. Wake up late, get rid of the stuff that I haven't had time to sort, sell, give away or throw away. Read those books. Write more. Learn to play more instruments. Paint the inside of the house, refinish that beautiful table with the water stains on it. Train the dog better. Just get in the car and go wherever it takes us. Teach more. Volunteer more. Work on climate change. Sew things. Make art. See old friends. Learn a few languages. Learn computer programming. To name but a few... 

There are deeply unpleasant things that I would not have to ever do again. And, despite the fact that I love taking care of patients, I have ethical misgivings about the practice of medicine.

6. Is it selfish to quit? It cost lots of money to train me. With 36 years of practice so far, I haven't exactly squandered my training, but I am still capable and I have skills that have accrued from many years of doing what I do. So perhaps I should continue to work until I keel over in my white coat, or my osteoporotic bones are finally squashed beneath the weight of my stethoscope. Shy of that, though, maybe doing good for people in the way I have been best trained to do it is important and I should do it at least until I'm obviously losing my edge. But who will notice? There is some wisdom in leaving at the top of my game.

7. Can I change my mind? Doctors do come out of retirement, or so I hear. After a few years, I will still have the intuition and some of the skills I need, but I might have to take a board preparation course and re-do my medical board exams to make sure I'm up to date. There are many classic old doctor options including teaching medical students, acting as a director for a nursing home, being a hospice doctor, reviewing charts for insurance companies, consulting, becoming a member of an advisory board or a consultant. A friend of mine served on the state legislature then went back to practicing medicine very part time. Experienced doctors are in pretty high demand. 

So...when shall I retire? I will continue to sit with that question. Perhaps I do not need to retire completely. Maybe a middle way exists. Or maybe I'll just retire tomorrow and stay in bed and read books.