Doctor ! When Do You Want To Retire ?

I have had a very successful, very satisfying and very busy academic career. I have been asked how long I would continue to practice. My answer is “As long as it’s fun.” “No tiring, no retiring. Age is not a number but a state of mind. What is the right time for a doctor to retire? This is an oft-asked question. In any job, corporate or otherwise, it is mandatory to retire at a certain age. I think the wisdom of that is that you have a certain level of mental and physical fitness to function well.

In India, neither the MCI nor the Govt. has put in place any process to monitor if ageing doctors and surgeons are able to perform intelligently and with due diligence. In fact the Medical Council of India (MCI) has recommended raising the retirement age for medical teachers to 70. With a growing physician shortage, it will be very tempting to keep these old warhorses in harness. And really, we need them. Every time a physician retires, we lose 30, 40, or 50 years experience.

The question then arises, when must a doctor retire? The obvious answer is, when his physical and mental faculties start failing. In India, there are no norms. I know many doctors who continue to practice into their 80S, and surgeons who continue to operate well into old age. Many take assistants to help and increase their expertise as well. Most doctors do not receive a pension, and find it difficult to retire and make their financial ends meet, unless they are among the lucky few who have amassed great wealth.

Rosenberg, an 89-year-old cancer specialist (USA) who had developed a cure for Hodgkin’s Disease had said. “I am quite elderly, and I know what I know and I know what I don’t know. It is very upsetting that they make it difficult for me to get my hospital privileges,” He also said many younger physicians who were alcoholics or drug addicts were still allowed to function with their privileges intact.

Several factors have been identified that influence delay in retirement among physicians. These include flexibility of work hours, intensity of work hours, work satisfaction, other career opportunities (or lack thereof), resource adequacy, sense of intrinsic self-worth, convenience, financial incentives, relation-ships with coworkers, length of training and late entry into the workforce, attachment to work and related strong work identity, and the 4% rule. The 4%rule says that a person will need approximately 25 times his/her annual expenses in order to retire with a comfortable lifestyle over a 30-year period (anticipating that investments will yield 4%per year). For many physicians, it is difficult to save enough money to afford to retire comfortably using this equation; and the 4%rule can be affected adversely by substantial market downturns, and by longevity greater than 30 years. There also are factors that influence early retirement among physicians. They include work dissatisfaction, inflexibility, bureaucracy, electronic medical records, burnout, and desire for personal time. Gender is not a major factor. Other issues that figure into retirement timing include cognitive decline, physical decline, dexterity, frailty, and increased error rate. Experience can be an asset or a deterrent. If physicians remain thorough, diligent, and energetic, then experience should be beneficial. However, when physicians start relying on impressions at the expense of comprehensive evaluation, then problems arise.

It is also helpful for organizations to offer retirement education and guidance, including access to financial advice. Organizations also are served well by creation of post retirement opportunities including peer support, teaching, mentoring, administration, and other nonclinical activities. This approach maintains access for younger physicians, patients, and administrators to the experience and wisdom of older physicians. Organizations should avoid mandatory retirement ages. They are responsible for many challenges associated with retirement including patient care continuity, maintenance of deserved reputations for expertise, and succession of physicians in the institution/hospital.

One of the big fears that people have is loss of identity. We spend our lives building up our professional identity. To a greater or lesser extent, it defines who we are and it can be difficult to walk away from. Many of us also have the feeling that we are the best and the world will stop if we stop, or that “my patients need me.” The sad fact is that the vast majority of us are average and the number of people who are matchless and exceptional are very few. Even those few are not irreplaceable.

Whatever stated principles, most private institutions are coldly pragmatic about issue of retirement. The whole idea of mandatory retirement is simply a way of easing some older physician out while retaining others who still have value to the institution. Why retire the aged goose who is still laying golden eggs? Assessment of competence is flexible, after all. We are not regular humans. We are fortunate government/Pvt funded machines of empathy and altruism whose only purpose is to serve humankind in a masochistic grind until we die on our feet in service.

Like almost all doctors, I saved lives and alleviated suffering to the best of my ability. I knew every day I went to work has been an honour and privilege, but it has some expense. We are “only little human beings” doing our best. We have been tutored that medicine is a life of service, of sacrifice and of putting the needs of others before the needs of our self. But as is the case for any good scientific study, there needs to be an end point.  We must be the one who choose that end point.

I want to live by the adage that it is better to be asked why you retired rather than being asked when you are going to retire.

Dr. A.K. Dewan

Director – Surgical Oncology