Physician retirement: Why it’s hard for doctors to retire

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Seventy-year-old William Keimig, MD, doesn’t like to think about what’s coming.

“I’ll feel really old when I retire-really old,” says the internist with the Henry Ford Health System in Detroit. Keimig is past the average retirement age for physicians, but he’s still working 55-hour weeks and hasn’t set a date for when he will stop practicing. Maybe 2020, he says, adding that he doesn’t like to contemplate life as a retiree. “One of the most satisfying and cool things you can do is to be a physician,” he says. “I know I’ll really miss it.” Retirement by the numbers The popular stereotype of older workers is that everyone is counting the days until they can retire, but that’s not the case for many physicians, who have a more complicated relationship with retirement than do many other professionals. And as the country’s physician workforce ages, it’s an issue with which more doctors will have to grapple. According to the 2016 U.S. Census, 30 percent of physicians are 60 or older, up from 26 percent in 2010. And the average age of active licensed doctors is 51. In a 2017 survey of physicians age 50 and older by healthcare staffing firm CompHealth, respondents, on average, said they intend to retire at age 68. By comparison, the average retirement age for all Americans is 63. The reasons why If physicians, on average, work longer than other people, it’s partly because they started their careers later. Four years of medical school and three years or more of residency mean many physicians do not begin earning substantial incomes until they’re 30 or older, well after their peers who pursued most other professions. That means fewer years in which to accumulate enough savings for retirement while simultaneously paying expenses such as mortgages and children’s college educations. For doctors who combine an expensive lifestyle and a lack of financial acumen, that can mean working past the age at which they’d like to retire, says Joel Greenwald, MD, CFP, a Minnesota financial planner who works primarily with physicians. That’s not the case with Keimig, who says he can afford to retire now, but likes still having an income. “It is nice to have that paycheck coming in on a regular basis,” he says. Keimig, who has been with Henry Ford Health System his entire career, says the support of its administrative and medical staffs has made it easier for him to keep practicing by allowing him to focus on providing medical care rather than performing ancillary tasks. Identity crisis For some doctors, it’s hard to say goodbye to a career they’ve loved and one which has formed a large part of their identity. In the CompHealth survey, physicians identified losing social interactions at work, a loss of purpose and boredom/loneliness/depression as their top concerns about retirement. Cardiologist David Mokotoff, MD, says his decision to retire in 2015 at age 67 provoked something of an identity crisis. Being a physician was at the core of who he was and he worried how he would feel without the work and the status that accompanied it. On the other hand, he says, he wanted to retire while he was still healthy and able to enjoy physical activities. When a good friend and fellow physician contracted Parkinson’s disease and died, that convinced Mokotoff it was time to retire. “For me, time is something you can’t save up and you can’t replace,” he says. “It’s always a gamble. No one has a crystal ball.” Three years into retirement, the Florida resident is an avid fisherman and has become a tai chi instructor. He also blogs. He says he misses interacting with patients, but not EHRs and government mandates. “If I miss it too much, all I have to do is talk to my colleagues or go visit the doctor and they tell me how much worse it’s gotten,” he says. He advises physicians considering retirement to realize there is life and purpose after medicine. “The trap is when you assume that all you are is a doctor, because you can lose your identity,” he says. Alfred Narraway, DO, still dreams about making rounds and working in the catheterization lab. But the cardiologist has no regrets about retiring in 2015 after 40 years of practice. Retirement was a gradual process for him. He reduced his workload at an Idaho hospital over 18 months before retiring, then returned for three stints as a locum tenens doctor before stopping work for good and moving to Ohio to be near his grandchildren. In retirement, Narraway is doing a lot of reading about basic science, learning Spanish online and tending to his three acres of property. “I’m very busy and I can’t find enough time to do everything I want to do,” he says, adding that he did not keep his medical license current. “You’re either in or you’re out,” he says. “To be halfway in is no way to go.” Retirement extremes It’s uncommon for physicians to retire well before the traditional age, but that’s what Valerie Jones, MD, did in 2016. At age 37, the Maryland resident walked away from her practice as an ob/gyn, only seven years after completing her residency. “That was never the plan. I had intended to practice indefinitely,” she says. However, a health scare and a growing dissatisfaction with the state of medicine caused her to reassess her plans and retire. “(Medicine) had morphed into something I really wasn’t interested in anymore,” she says, citing the loss of autonomy, lack of time to form deep relationships with her patients and an ever-growing emphasis on productivity. The mother of three says she and her husband have lived frugally and invested well and that has allowed her to avoid having to get another job. Jones says she had a hard time adjusting to the new reality: “It was very strange at the beginning. So much of my identity was wrapped up in this, I didn’t have time to develop outside interests.” However, she hasn’t left medicine behind entirely. She keeps her license current, writes the blog OB Doctor Mom, and is considering volunteering, teaching, and writing a book about her decision to retire. At the other end of the age spectrum from Jones is James Hutchinson, MD, a 95-year-old family physician practicing in San Mateo, Calif. The solo practitioner graduated from medical school in 1950 and opened his practice in 1953. Now in his 65th year of practice, he still sees patients four days a week, including some great-grandchildren of patients he saw when he began practicing. Hutchinson, who until recently walked 10 miles a day to stay fit, has a ready answer for those who ask when he will retire. “I’ll practice until the river rises,” he says, noting with a laugh that there are no rivers in San Mateo. “What else can I do? I’ve done this all my life and I live in a one-horse town-there’s nothing else to do.” Having outlived his wife and eldest child, Hutchinson says spending whatever time he has left as a retiree holds no appeal: “I love what I’m doing. I enjoy people and I enjoy helping them. I’m not missing out on anything; I’ve had a full life.” An ideal retirement  For many people, retirement is attractive because it means no longer working at jobs they don’t like or find rewarding, but that doesn’t seem to be the case with most physicians. When respondents in the CompHealth survey were asked what they most looked forward to after retiring, traveling more, pursuing other interests, and spending more time on hobbies topped the list. Only 32 percent said they looked forward to no longer working while 48 percent said they intended to work part-time or volunteer. When he finally retires, Keimig says he might volunteer, teach an English as a second language class or even earn a master’s degree in literature, but none of those prospects is as alluring as continuing to practice medicine.   “General MacArthur said old soldiers never die, they just fade away. I think it’s the same way with doctors,” he says.   Practicing medicine after retirement When Patricia Kloser, MD, MPH, FACP, retired from her professorship at Rutgers New Jersey Medical School in 2013, she wasn’t ready to stop practicing medicine. Instead, the internist and infectious disease specialist has taken her practice on the road. Kloser, who is in her 70s, has been working as a locum tenens physician since retiring. Based in New York City, she has taken assignments in Georgia, Florida, Wyoming, and Alaska, among other states. “I absolutely love it. I can’t imagine doing anything else,” she says. Locum tenens assignments are one option for physicians who’ve retired, but there are many alternatives to the traditional retirement of leisure, hobbies and travel. Retired doctors who still want to use their medical skills can volunteer, teach, consult and even go back to work part-time. Kloser says she wasn’t ready to stop practicing medicine and locum assignments let her control where, when, and how much she works. A typical assignment is six to 12 months, and she takes breaks between jobs to enjoy her hobbies of hiking, travel and photography. When she’s home, she still sees some long-time patients. Locum work is not for everyone, she says, and requires flexibility as well as a tolerance for living in hotels and adjusting to unfamiliar surroundings. “I’ve done some really wonderful things,” she says. “The only downside is I’ve met some wonderful people and it’s hard to say goodbye, but I know there is an adventure down the road.” Like Kloser, George Meyer, MD, knew he would not spend his retirement on the couch. Since retiring from Kaiser Permanente in 2013, the 77-year-old gastroenterologist from Sacramento has been a medical volunteer through Health Volunteers Overseas, a U.S.-based nonprofit that trains healthcare workers in underserved countries. He has been to Mexico, Costa Rica, Uganda, Bhutan, Nicaragua and elsewhere. He also finds time to volunteer with The Flying Samaritans, which provides free healthcare in Baja California, Mexico, and he teaches a medical course in Japan each year. “It allows you to maintain your skills. It allows you to meet wonderful people while helping the countries develop medically,” Meyer says. “I get more out of it than I give. It truly is an absolutely wonderful experience.” An increasingly popular option for retirees is to become a telemedicine provider, which usually can be done from home on a part-time basis, does not require in-person interaction with patients, and largely deals with simple cases. The ideal retirement means something different for every physician, depending on their individual circumstances, desires, health and other factors. However, it’s clear that the valuable skills they spend their careers developing afford physicians the opportunity to continue to contribute even after they retire.