Monday, 25 Sep 2017

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The Retiring Rheumatologist

Deciding to become a rheumatologist was an easy, compelling choice.  Deciding when to get out of rheumatology is less clear and, possibly, more compelling for a growing number of U.S. rheumatologists.

A 2016 survey by the Physicians Foundation reported that 48% of U.S. physicians are planning to cut back on hours, change jobs, do concierge practice or retire. Moreover, nearly half admit to accelerating their retirement plans, largely because of healthcare changes. The reasons to retire are numerous, with most being related to age, practice burnout, changes in healthcare reimbursement, new regulations, medical or family concerns.

Last week I went to a doctor’s retirement party. It was festive, many came to honor and rib the lucky one, but there was an asterisk to his milestone. The lucky one had to retire for medical reasons.

His condition called for an abrupt end to practice, yet the gentleman is healthy enough to plan for a long retirement.  What I found curious was the juxtaposition of many who were envious of a retiring friend and physician, and the physician who wished he was still working at what he does best – medicine.

Physicians usually consider retiring between 60 and 69 years of age.  However, many of the physicians in this bracket, who would like to retire, do not have a long-established plan for retirement.

There are several forces in play that make retirement a major personal and public health issue:

  • The majority of U.S. rheumatologists are currently men of retirement age (60-70 years).
  • The ACR Rheumatology workforce studies are predicting a major rheumatologist shortage in the next 15 years.  A great quote by Dr. Chad Deal (Cleveland Clinic), who led these manpower studies, is that we are about to experience a “tsunami of retiring older white rheumatologists”.
  • The aging of baby-boomers while the prevalence of arthritis skyrockets from 56 million to over 70 million by 2020.

The ACR Workforce study presented at the 2016 Annual ACR meeting showed the rheumatology workforce will plummet in the next 15 years, from the 4,497 to 3,455 rheumatologists full-time rheumatologists.  Put another way, 50% of the current rheumatology workforce will retire over the next 15 years, and more than 80% of those planning to retire intend to reduce their patient load by more than 25% in the near term. (http://buff.ly/2riXrjh)

The annual supply of new rheumatologists (~215/Year) will yield a lower net workforce (~110). Many will be females or millennials who aspire to work half-time, and foreign trainees who will return to their home countries to practice. 

I was pleased to see that the ACR website has a section dedicated to “Career Development” (http://buff.ly/2rbm9hj). Yet, there are no articles on the topic of retirement. The website does address physician burnout, and even how to deal with physician burnout if you’re a rheumatology fellow. (My advice is that if you’re experiencing burnout as a fellow, you’ve either made a poor career choice or need counseling from your program director or primary care physician).

I personally don’t intend to join the “tsunami” any time soon.  I have always thought I would work until I’m unable to find the elbow or hear what the patient says.  Nevertheless, life’s events (vacations, job changes, surgery) have taught me that “time off” can be fun and rewarding.

But when does this translate to full-out retirement?

Retirement would be a major mistake if:

  1. You love your work;
  2. You feel undervalued or under-appreciated (change jobs and coworkers); or
  3. You’re just too busy (everyone's too busy; figure out why, take control of your schedule and focus on what drives or fulfills you).  

Yet there are situations where retirement is prudent.

Rules for Retirement 

I would suggest that retirement is appropriate or mandatory when:

  • You don’t like, enjoy, and look forward to your work.
  • When it’s time to reinvent yourself (I believe that in the course of a successful career, we should reinvent ourselves at least once twice, or even three times for the scattered thinker).
  • Career change is absolutely needed.
  • Someone else needs you more than you need to practice.
  • You know how long you’re going to live, if you don’t want to spend your days working as a rheumatologist.
  • You have a clear, financially and personally sound plan to retire.

The Plan to Retire

The retirement-minded rheumatologist must plan his/her exit and know the answers to several issues. This is partly addressed in an article in The Rheumatologist (http://buff.ly/2tdWsx3).  Concerns to be addressed:

  • Are you selling or closing your practice?  What are your legal obligations to patients, medical records, existing contracts, etc.?  
  • If you’re an employee, what does your contract stipulate about termination, notice, and compensation?
  • Are you aiming for semi-retirement?  What will your contractual obligations be and how will you be compensated and legally covered under this new employment status? Many rheumatologists intend to either “slow down” or semi-retire. However, the consequences of this move (financial, contractual, temporal) need to be well thought out and discussed with all relevant parties.
  • Are you financially able to retire?  Have you discussed retirement with a professional financial advisor?  Many physicians underestimate their financial needs during retirement. If you have been saving 20-30% of your income since starting practice, most physicians should be financially secure for retirement.
  • While when to retire is usually a discussion of finances, you need to equally consider the non-fiscal aspects of retirement that deal with mental, physical, social and spiritual fulfillment.
  • What’s your 10-year plan for retirement?  Those without a plan will likely experience a reactive future rather than a proactive future. No plans will end up doing nothing and despite the attraction, doing nothing will kill the person who spent most of their professional life doing everything and well.
  • Your retirement should focus on what you are good at, passionate about and plans for change. How exactly will you reinvent yourself?
  • Do you make a clean break from medicine?
  • Should you take up ______? (yoga, farming, the pan flute, a new language, numismatics, etc.)
  • Do you have to, or need to, make new friends and meet every day at the coffee shop?
  • How does your past life benefit your next life?  For example, in retirement, rheumatologists should utilize their teaching skills and learn to mentor.
  • Should you down-size, narrow or expand your focus, reinvent yourself?
  • Now is the time to decide; time to develop your retirement plan.  You need an articulated plan whether you’re a fellow or an academician changing posts or a 62-year-old private practice rheumatologist.

Just as we begin rheumatology, we should also begin our retirement as it is, sooner or later, an upcoming inevitability.  All need a retirement plan that can be modified or enacted based on either milestones or major life events. 

Retiring rheumatologists have great potential for newfound personal fulfillment. But, they also have the insight, skills and motivation to shape the future of rheumatology by committing to education, mentoring, research and adding their wisdom to the rheumatology knowledge bank that the medical world depends on.

What is your concern or advice for rheumatologists contemplating retirement?

 

Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He is the Executive Editor of RheumNow.com and Co-Editor of the online textbook RheumaKnowledgy.com. Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

Rheumatologists' Comments

How timely an article Jack. I will be leaving my job at Washington Hospital Center/Georgetown at the end of August. California here I come, mainly for personal reasons. I will still be involved in some academic activities which will satisfy my intellectual needs, but not patient care. I will of course miss the patients but not the bureaucracy. I hope I can do some volunteer teaching. I am older than the demographic group that this article applies to and have gradually eased my way to this position. I guess this is the correct decision for me since I have more positive feelings than misgivings. Wish me luck. Art
After 42 years of solo practice at age 74 I was fortunate enough to sell my practice in August of 2016.Retirement was not due to a medical condition although it has brought me a laminectomy ,a total hip and a lot of PT.I still read widely and intend to volunteer my services and travel when possible .I miss the patient care but not changes occurring with MACRA etc.Once again I enjoyed your timely article. Matt
Great article. After I "retired" I started doing in locums work when a colleague developed leukemia and needed coverage during chemotherapy. I subsequently have worked away from home in WI, IL, FL and have greatly enjoyed working with my younger colleagues, staying academically connected in a fast changing field and making good money instead of pulling weeds and missing my friends in the doctor's lounge. I would recommend that anyone interested register with a in locums recruitment company and define parameters for coverage. They are very willing to accommodate all requests and piece together coverage for their clients, I have not had any unpleasant experiences to date.