I read or write about early retirement on a more or less continual basis. Most of the news is positive, although it’s not uncommon for people, particularly physicians, to fail their first go at retirement.
After reading the thread he started on the WCI Forum and the article he sent, I still had more questions. He answers them in the brief interview that follows.
I’ll close out today’s intriguing collection with a little more information from the DocNextDoor, including his recommendations for someone else with a primary care income who may eventually want to check out of medicine before reaching a typical retirement age.
Be careful if you do. The reaction to your good news may not be what you expect. The following is from the anonymous primary care physician DocNextDoor.
Physician Retires Early and is Met With Scorn
We have all had to deliver some form of bad news to patients and I am no exception. Whether it be informing parents they have lost their unborn child, discussing end-stage kidney, heart or lung disease and needing to determine end-of-life care or notifying a patient of their diagnosis of a terminal condition such as metastatic pancreatic cancer or an incurable neurologic disease.
It is a conversation I have had many times throughout my career and I have been as caring as possible to my patients. It is always emotional and I am there for them in their time of need as tears are sometimes shed.
The news I have been delivering to my patients over the past year, however, has sparked their emotions most of all.
“I am retiring.”
That statement has resulted in an outpouring of tears from men, women, young and old. I have been on the receiving end of a full emotional spectrum before my last steps out the door. Together, we have experienced stages of grief over this event.
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You’re Too Young to Retire!
There have been those in denial, with of course, the ubiquitous “You are too young to retire!” as at 51, I am years away from the typical retirement age for doctors, especially primary care. Some are insisting I will be back at work in a few months or that I am about to show up at another office down the street and they will be calling for an appointment when they see the announcement in the paper (that is not happening).
Amongst the emotions, what has surprised me the most has been the anger. Statements that sting are those such as: “I hate you,” or “Does everyone hate you as much as me?” “You don’t care about me,” “You’re mean,” “You’re selfish,” and “The nerve of you!”
Patients have spoken these words directly to me with no hesitation and with force.
Many patients have bargained with me “You only see me once every 6 months, so you only have to work 2 days a year.” “If they pay you more will you stay?” “Can you do house calls?” Or “Could you see me out of your garage?”
Some patients emphasized the financial aspect with statements such as “Well you must be a millionaire.” “Have you really thought this through?” Or “You must be paid too much.”
There have been depressive comments including “That is awful,” “You are just going to let me die,” “What will I do without you?” “Worse than me being sick,” “Horrible news,” and “I’m going to stop all my medications!”
One of my favorites was a husband and wife who came in for physicals in different rooms, after seeing the wife and her being very understanding of my retirement, I entered the husband’s exam room. Upon telling him the news he states “It would have been better if my wife told me she was leaving me.”
Burnout and Grieving
I guess I have gone through some grieving as well due to my admitted burnout and planned exit from my practice.
I announced my intention to retire and submitted paperwork about a year ago. Initially, in some denial, I did not want to tell some of the patients, acting as if everything were the status quo.
Anger would sometimes set in during some days, I would catch myself speaking out, mad at the healthcare system, mad at the insurance companies, mad about another form to fill out and document.
The anger would sometimes fade into melancholy, another 13 hour work day with no lunch and no time to exercise or to spend time with family. Work/sleep/work/sleep and repeat, spinning on the hamster wheel; it seemed like old times in residency.
I had cut back my clinic hours to try to reduce the stress and burnout, but it continued. I bargained to myself if only my organization would have let me stop taking additional new patients, unassigned hospital discharge patients and emergency room follow-up patients without primary care physicians, maybe I would have stayed (maybe not).
I am now to the point of acceptance. I have enough and I’ve had enough. With my final days winding down I no longer worry about the comments. I will get through to the end by working days off and weekends to provide the best care possible, if that is what is needed.
I no longer try to explain my situation or attempt to go into details about how I will spend all of my available time. My patients also have started to come around with congratulations and cards. It may have been the worst news ever for some but many patients now comment on how happy they are for me and well wishes for whatever I may do in the future.
[PoF: Those are some strong reactions. No, not strong. Vile! I imagine the reactions speak to the relationships you had built over time with your patients. It’s as though you’re breaking up with them out of the blue and they didn’t even see it coming.
As an anesthesiologist, I won’t have to worry about any of this negativity being cast in my direction. My last patient won’t have a clue that I’m minutes away from leaving medicine, and I prefer it that way.
Thank you for sharing your experience. It gives our primary care doctors and specialists who have longstanding relationships with patients something to ponder as they contemplate exiting the workforce on their own terms.]
Question and Answer Time
When was your last day?
I finished at the end of the third quarter 2018, that’s September 28th. The downside of my particular timing is that I was not eligible for any end of the year quality and patient satisfaction bonuses. I could have worked another 3 months but it’s only money.
Have any of your physician colleagues had similar reactions as your patients?
My physician colleagues have all been positive including the specialists that are aware that I am retiring. Some saying they wish they could do the same. I do feel for my coworkers who will need to take on the burden of additional patient load and hope that I am not the impetus for anyone else’s departure if they are not yet ready.
What are your short-term and long-term plans after retiring?
My short-term plans after retiring will initially be to take a breather from the hectic workday. I think I will enjoy dispensing of the frequent logging on to the EMR whittling down the inbox only to see it erupt with additional messages. Maybe I’ll learn about these things called Facebook and Instagram that I hear people talk about.
Fitness and health will be important, I hope to be able to lower my golf score and running pace. Maybe I will get to see my name posted at the gym for the most visits in a month.
I plan on spending some time traveling, we have some great sites to see in this country as well as locations overseas. I have always felt the obligation to plan travel a minimum of 6-9 months ahead of time as to not disrupt my already scheduled patients. Spontaneity will hopefully become my friend.
Of course, I will not be able to step away from medicine completely. I will look into volunteering at the local free clinic and I’m sure I would be a good standardized patient at the nearby medical school (DRE’s no longer recommended).
I have already agreed to do some very part-time work that does not involve direct patient care and I have been offered multiple other positions both within and outside my organization. My mantra has been not to commit to any significant obligation.
Would you do it all again?
Of course I would do it all again. Unless someone is so dissatisfied in their career, I am not sure how anyone could say otherwise. There is no way I could know how my life would have gone either in a different specialty in medicine or another career path altogether. I feel fortunate to have helped so many and all in all it has worked out very well.
I have two great kids, I have not pushed them in any direction as to their career choice. Both of them have studied science without an intention of pursuing medicine as their calling. My hope is that they find passion in whatever career they choose and enjoy life.
DocNextDoor’s Financial and Life Advice
You may want to listen to someone who is retiring with a withdrawal rate of under 2% after a 23-year career in primary care. I pulled some pearls that he shared in the WCI forum.
What does he recommend?
1. Go to a low cost school and get out of debt as quickly as possible. Admittedly, it helps to have parents who had planned and helped pay for their children’s education.
2. Marry someone with similar financial goals and if they can work even part-time, their retirement savings can be substantial.
3. Maximize all of your retirement vehicles as soon as possible and then add even more into an after-tax account. You will need that if you retire young.
4. Start saving for your kids’ education when they are born. 529 plans did not exist for mine but a $500 monthly investment for each covered their education and satisfies #1 for their future.
5. To succeed with #3 and #4: Live like a resident, and do not buy an expensive house, high-end cars, or join a country club. The house will be paid off before kids go off to college, expenses will stay controlled, and the now enormous pile of marshmallows can be eaten slowly for the rest of your life.
[PoF: Enjoy those marshmallows! I hope you’re enjoying your life without the dreaded inbox, fights with insurance companies, and are finding life after medicine to be all that you hoped for.
I was certainly surprised by your patients’ reactions, but I think their resentment is a testament to the good work you did for them and the prominent role you had in their well-being. Take their furor as a compliment.]
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Have you had negative reactions to your desire to retire? Are his patients out of line to feel this way and express it to him in the manner that they have?