Retirement: Highlights of a new sunset
As the Department of Medicine prepares to launch a retirement toolkit to support late-career physicians, we are gathering stories and perspectives from faculty members who have retired from the DoM. University of Toronto Professor Emeritus George Fantus, now the Director Division of Endocrinology and Metabolism at McGill University Health Centre, shares stories of different approaches to retirement, from the physicians who never retired to those who did so enthusiastically, noting that there is no one rule for the approach to retirement.
When Dr. Non-Retirement was brought into my office, I realized it was time to think about the “retirement issue” myself. He was a family physician dedicated and responsive to his patients for many years. Now he was in his nineties with advanced congestive heart failure, reasonably controlled diabetes and moderate renal impairment. His daughter wheeled him into my office. She was actually bringing him from his office where he had just completed his morning clinic.
“You are still practising?” I asked with an obvious stare of incredulity.
“Yes,” he answered. “I have only a few older patients left who still want to see me.”
I looked at his wheelchair, at his daughter and noted his shortness of breath at rest.
“How do you get to work and manage?” I asked.
“I take him to and from work two to three half days per week and help him out,” his daughter answered smiling.
“Have you thought of retiring? Is there something you would rather do with your time?” He knew his prognosis was guarded. “Do you think it is wise to take responsibility for your patients’ health at this point?”
I asked these questions without waiting for answers, clearly building up to a recommendation.
“I have no hobbies and never did anything else but work,” he responded. “But I know it is time and I will stop.”
About six months later, shortly after he missed a follow-up appointment, he died.
Dr. Reluctant to Retire
A bit later I ran into a colleague, an academic surgeon who had been prominent and respected in his field for over 40 years. He looked upset and a little sad.
“How are you? What’s going on?” I asked.
“I have been told that it’s time to give up surgery. My OR time is being rapidly decreased and will be terminated. I can still perform the surgery,” he said looking at the ceiling. “My complication rates are the same...I have to make room for the younger generation. It’s disappointing.”
Dr. Reluctant to Retire was in his 70s and in reality, not as sharp a surgeon as before. He continued an office practice for another nine months, then entered full-time retirement spending his winters in the south. When I saw him three years later he still looked depressed.
“I’m bored. Only so many books I can read, so many movies to watch, no hobbies, but I manage to enjoy life as much as I can.”
Mr. Happily Retired
I have an acquaintance who is not a physician who retired at 65. He is comfortable with a small cottage on a lake and a low rise one-bedroom condo in Florida, splitting his time between the two. He likes to do his own home improvements and last summer he built a treehouse for his grandchildren. In Florida, he takes art classes and is painting again, something he did many years ago. He and his retired spouse spend time with friends and are both happy despite no longer “contributing to society” or being recognized by a title. Mr. Happily Retired tells me he loves the lifestyle and wants to continue this as long as his health permits.
Dr. Enthusiastic to Retire
A few of years before my own retirement, a colleague, a successful clinician scientist suddenly announced that she would close her lab and retire. I was quite surprised as she was relatively young (under 60), had peer-reviewed funding and was publishing.
“I’ve enjoyed my academic research career but there is more to life,” she told me. “I want to travel, read and spend time with my family who live away. Besides, Toronto is not where I want to spend the rest of my life. It is too congested and busy. I will be happier living in a smaller city.”
What could I say? I felt it took courage to make such a decision that would be unexpected by her community of academics, but Dr. Enthusiastic to Retire made sense and followed through with it.
Dr. Not Really Retired
I myself would be called Not Really Retired. My family influenced my retirement from the University of Toronto and our wonderful Department of Medicine. I motored east on the 401 to Montreal and McGill University to take on the task of DDD for Endocrinology and Metabolism at the McGill University Health Centre. After six months I can confidently state that “not really retired” fits. There is enough work to keep me occupied and challenged full-time for the next few years. At that point, it will be time to look in the mirror, have talks with family, friends and colleagues and plan for the real deal.
These caricatures of retirement raise many issues. Is there a rule for everyone? Clearly not!
Our rate of aging, emotional needs, demands of our specific fields of medicine, and external or unexpected events such as illness or family demands will all influence our retirement track. An added challenge for many physicians, whether community or academic, is that the practice of medicine is traditionally a calling rather than a 9-to-5 job. This is not just a lifestyle issue, but often it defines our place in the world and even provides the meaning of our lives. This psychological barrier to retirement must be addressed in order to arrive at a rational retirement decision.
A first principle would be to follow the old dictum: do no harm. As we age our skills and stamina falter. Thus, it is important to recognize when these diminish and risk suboptimal patient care, less effective teaching and/or decreased quality of research and administration. We must be honest with ourselves and, at the same time, we must be open to and require evaluation by our peers. The latter must be transparent and evidence-based.
Retirement need not, and probably should not, be an all-or-nothing transition. Skills and stamina being fluid require flexibility in job demands and thus in job descriptions. This is now the challenge for our leaders; those in the hospitals, the University and the government. As mandatory age-based retirement has disappeared, the individual variability and multiple factors influencing retirement outlined above have been brought to light. The time is ripe for us to create fair and robust policies combined with flexible retirement plans matched as closely as possible to the profile of each individual.
George Fantus, MD, FRCP(C)
Professor Emeritus, Department of Medicine, University of Toronto
Director Division of Endocrinology and Metabolism, McGill University Health Centre
Professor, Department of Medicine, McGill University
Senior Scientist, Research Institute-MUHC