The email from the International Skeletal Society (ISS) invited me to be on the faculty for the Refresher Course at their annual meeting. I responded that I was flattered to be asked and added that I had been retired (at that time) for five years. The return email insisted that I participate and speak on the imaging of suspected spine trauma. After all, the chairperson reminded me, I was still considered an expert in that area, having written what was considered the definitive textbook on the subject as well as the recommendations for imaging on that topic for the American College of Radiology in their Appropriateness Criteria®. And so, as Michael Corleone said in “Godfather III:” “Just when you think you’re out, they pull you back in.”
I have been asked by many colleagues and friends who were nearing retirement age if I had any advice and words of wisdom on the subject. In short, here are six areas for potential retirees to consider: 1). Know when the time is right; 2). Understand that retirement is not just stopping working; 3). Have a plan; 4). Fill your time; 5). Financial considerations; and, perhaps most importantly 6). Be aware of how your retirement will affect your spouse/partner. Let’s consider each of these areas.
Knowing when the time is right
Years before I thought of retiring, older colleagues, whom I met at professional meetings, often asked me when I was going to retire. My answer was always the same, “Either when I have a serious health issue or if the job stops being fun.” In 2007, I underwent a total hip replacement and was off work for two months. As I sat rehabbing at home, I thought that if retirement was going to be like this, I wasn’t ready for it.
Two years later, I had the other hip replaced. This time, however, I began thinking that this wasn’t so bad. I got up later, had a leisurely breakfast, read the newspapers, did the New York Times crossword puzzle, and could take a nap whenever I felt like it.
I still wasn’t ready. I enjoyed my work – the daily consultations with various clinicians, as well as teaching my residents and the medical students. But things were changing. Our group was one of the last independent practices in the then West Penn-Allegheny system that had recently been taken over by Highmark. Pressure was being put on our chairman to have the group become Highmark employees, like the other physicians in the system. At the time, there were five members of the group who were over age 65, and I felt that subtle pressure was being placed on us to retire. For me, the fun stopped when I learned that my weekend call was being increased by 25%. At the same time, I received a phone call from my tax advisor asking if I had taken my minimum required deduction (MRD) from my IRA, since I had turned 70 and a half. Some quick mathematical calculations of my MRD from not only my IRA, but also from my TIAA/CREF accounts from my days working at Duke, showed that I would be pushed into a higher tax bracket. So, the prospect of working harder and paying more in taxes convinced me that the time was right to retire.
Another, perhaps more common, scenario is the situation where the physician loses his/her ability to continue practicing. This may be the result of illness, including (early) dementia. In some instances, the physician recognizes his/her shortcomings and voluntarily retires. In others, his/her partners may notice a drop in clinical acumen, lower productivity, or an increased error rate and recommend that their colleague retire. In these situations, the hospital Medical Staff Committee may recommend retirement and loss of privileges.
Understanding what retirement is
Many people think retirement is simply stopping work. And, for many, that is exactly what they do. They stop working, sit at home, watch television, eat snacks, gain weight and often die at an early age. During their working lives, they never developed outside interests or hobbies. For them, their occupations were their lives. For others, however, and I include myself in that group, retirement meant leaving one chapter of their lives, and moving on to one or more new chapters. That may involve an entirely new occupation, particularly for those who have the financial need (see below). Or, pursuing and/or developing other interests. Often, the retiree becomes (more) involved in (additional) volunteer activities or seeks to broaden their knowledge bases by participating in one or more adult education programs, such as Osher at CMU or at the University of Pittsburgh.
When I announced that I was going to retire to my chairman, he asked me if I would consider continuing giving lectures to our residents and students. He pointed out that I gave more didactic conferences to our residents than any other faculty member. Furthermore, he reminded me that many of my topics covered areas that the other staff either had no interest in or that they felt were not in their areas of expertise. As a musculoskeletal (MSK) radiologist, I concentrated on interpreting (old fashioned) X-ray images as well as CT applications to bone abnormalities. My younger MSK colleagues preferred doing MRI and invasive procedures (arthrograms, biopsies and CT-guided screw placements). And so, I agreed to continue lecturing for two years, but with the stipulation that I now be paid the going rate for visiting professors. The reason I set a time limit was because I felt that without exposure to current clinical cases, my material would become outdated. Fortunately, my former partners were more than generous in providing me with new material whenever I requested it.
Having a plan
Most new retirees have some sort of plan for what they will be doing with all their free time: getting up later in the morning; spending more time with their children and/or grandchildren; taking longer vacations, for example. For many, they will now be able to spend more time on hobbies, projects, or in volunteer activities to which they already belong. In many instances, however, most of those activities already take place in evenings, after the normal working day. I already played in a community concert band and belonged to a flute choir. I joined a second band that played primarily during summer months when most other community bands took time off.
I have been a Boy Scout leader for 43 years, devoting one evening a week to troop meetings and two weeks for summer camp. I immediately signed up to be on the staff of two additional weeks of an Advancement Camp, where I taught several different merit badges. In addition, I signed up to be on the medical staff for Mountainfest, a Council-wide event at Heritage Reservation, our main scout camp. In addition, as a member of the Laurel Highlands Council Enterprise Risk Management Committee, I agreed to be the Council Medical Supervisor, overseeing the medical policies and procedures at our many resident and weekend camps.
Finally, I increased my vacation time. In addition to my two weeks at scout camp, I increased my week at a summer cabin owned by my cousin at lake Luzerne, in the Adirondacks. And my wife and I also extended our annual visit to Grand Cayman to an additional week.
Filling your time
Filling your time once you retire is a must. Think about other interests that you have and make your participation in them a reality. Again, this may involve taking on additional responsibilities in organizations to which you already belong. I have been a Trustee of the Albany College of Pharmacy and Health Sciences (ACPHS), my alma mater, on and off for many years. The year I retired, the president of ACPHS announced his retirement after the current academic year. The chairman of the Board asked me to chair the Search Committee, since he knew “I had the time.” That job required frequent trips to Albany from July through December, when we selected our new president. I didn’t realize how many trips I made until the Southwest Airlines gate agent in Albany started greeting me by name!
I joined other organizations, volunteering at South Hills Interfaith Movement (SHIM), building shelves and storage areas for their food pantries; Rotary Club; Mt. Lebanon Reader’s Theater, where we read one-act plays at retirement and nursing homes; and Global Links, where I rebuild wheelchairs that are sent to Central and South America.1
One of my most rewarding activities is the participation in the Osher Lifelong Learning Institute programs. Here one can take a variety of courses covering a list of topics in arts and humanities, business and commerce, science, social sciences, as well as a diverse list of topics called “learning by doing.” We are fortunate here in Pittsburgh, in that we have two Osher programs – one at CMU and the other at the University of Pittsburgh. The CMU program has a fixed number of memberships due to space limitations; the Pitt program is under the auspices of their Graduate Education Department and has open membership. In addition to taking courses, I am also a study leader for both programs. The thing I appreciate most about the Osher program is that all participants, both learners and study leaders, are mature adults, who are motivated to learn. This is in sharp contrast to my experience teaching medical students and residents.
And, of course, I have been able to contribute to the Bulletin first as an author of Perspective pieces, and now as an assistant editor. Filling my time has led me to often observe that I’m busier now than when I had gainful employment.
Maintaining your lifestyle and determining what you do in retirement is, of course, dependent on how financially secure you are. Some people, unfortunately, can’t retire because they have not done the requisite financial planning to assure a comfortable retirement. Sadly, Social Security is not enough to live on. Furthermore, serious or prolonged illness can rapidly deplete one’s retirement “nest egg.” Financial planning for retirement should begin immediately when one joins the workforce after residency or fellowship. Unfortunately, many young physicians don’t think of this as they start practicing. An important but simple tool is to make a table of one’s yearly income and expenses from existing savings and checking accounts. This will change over time, as children enter college, graduate and move on with their lives. The result, under each set of family circumstances, will give you a monetary number of what you need to maintain your current lifestyle. There may be a need for sacrifices – perhaps one less vacation, or eating out less frequently. Or, if you have planned properly, you can be assured by your financial advisor that you have enough money to maintain your lifestyle until age 110.
Don’t forget your spouse or domestic partner when considering retirement. In most instances, while we are busy tending to the ills of humanity, they also have developed a lifestyle of their own. Retirement often is a cause of divorce among older couples. Physicians, because of their busy professional schedules, don’t often spend a lot of time at home. Once they retire, they’re home much more, especially if they don’t fill their time.
It’s often been said that retirement leads couples to either become much closer, or, get on each other’s nerves. Right after I retired, my wife of 48 years explained the “rules of the house” (for example, “Last one up makes the bed”). There are activities we do together as well as those we do individually.
Retirement represents entering a new stage in one’s life. The retiree will have opportunities to participate more frequently in activities which they enjoy, or to try new ones. Approaching retirement requires planning, not only to fill your time fruitfully, but also to assure that you will have the financial wherewithal to maintain your current lifestyle.