A viewpoint on “Retire Before You Tire”

This viewpoint addresses the complex issue of when physicians should step back from active clinical practice – balancing patient safety, professional integrity, and personal well-being in an era of rising healthcare demands. There is a common belief that doctors should never retire. In India and many other countries, no governmental or other agencies have put in place any process to monitor if aging doctors and surgeons are able to perform intelligently and with due diligence. In fact, the Medical Council of India had recommended raising the retirement age for medical teachers to 70 years. With a growing need for trained physicians and surgeons, it is very tempting to keep these senior medical professionals working as we need them. Every time practicing doctors retire from clinical practice, their several decades of experience are lost forever. The question then arises, why do doctors ultimately retire? Most doctors retire to ensure patient safety due to potential age-related decline in physical and cognitive skills, thereby maintaining a dynamic professional work force by making space for new physicians. Some also retire for personal reasons like burnout, health issues, but almost never with a desire for a more balanced life. There is no mandated age of retirement from clinical practice in some countries such as India and the US. Retirement for doctors is a complex issue influenced by evolving medical knowledge, healthcare worker shortages, and the personal and professional circumstances of individual physicians. One very important question that every practicing doctor needs to consider is: Is one still happy practicing medicine? When should doctors retire? The answer to this question may be one of the biggest motivators for someone’s decision. In the American Medical Association (AMA) Insurance Research that was conducted prior to the coronavirus disease 2019 pandemic, two common themes emerged about the timing of retirement: (1) do not retire from practice too early, especially if you still love being in practice; (2) but do not wait too long to retire because of poor health (yours or your spouse’s) that may prevent you from enjoying your retirement years. The medical profession is unique as there are many covert and overt sources of stress in the lives of doctors. After almost 25–28 years of intensive study in school and a professional college, doctors are often required to work long shifts at nights, weekends, and even holidays, limiting their personal and family time. Facing difficult patient outcomes, breaking bad news, and managing grief can be emotionally exhausting and does impact their mental health. Doctors are required to make critical decisions quickly and under pressure, which is also a significant source of stress [Figure 1]. The demanding nature of the profession makes it difficult for doctors to maintain a healthy balance between their professional and personal lives. Some degree of sympathy and empathy always comes into play in this profession as a result of which the mind–body connections exert their effects in the body. In addition, medicine as a profession is constantly evolving, and doctors must dedicate time to ongoing education to stay updated on new research and techniques.Figure 1: Burn out among those using the StethoscopeMyself being a neurologist and my wife a gynecologist, we were taken aback on receiving the following short poem written by our daughter when she went to college at the University of Maryland University College at Schwabisch Gmund (Germany) in July 2000. Dr. Mrs. Mother Who gave her the right to just call up and say, She would come after dinner, and never come. How could she live on the hope that Sangeeta cooked it well, and I liked it. Those emergency calls did not give her The right to bunk my emergencies, Without even a leave application or a feigned apology. Stitching women’s wombs She could leave my tattered hopes un-sutured. For what was I but another ritual, Just a little footnote. Her claim to the legitimacy, The completeness of her ambitious womanhood. But she could at least have succeeded in What she seemed to do best. She could at least have cured the Contagious germ of selfishness As I set out to be another titled mother. I did not have the courage to show this poem to my wife, who was then working as an active gynecologist in a busy government hospital. She got to read it after some time and immediately decided to stop practicing obstetrics and gynecology and switch to family medicine. Even I had made up my mind to leave the stressful job at AIIMS and lead a life with limited clinical work and more family time. Why doctors should retire? The book, “Life Beyond Medicine – The Joys and Challenges of Physician Retirement” by Sharon Romm, is a guide on how to think about your retirement if you work in the medical profession. The book is split into several sections: Introduction, Burn Out, Is It Time To Move On?, Emotional Challenges, More problems, Substance Abuse and Other Addictions, Couples and Retirement, The Importance of Friends, Finding Romance, Staying Connected with Medicine, Finding Activities Outside of Medicine, Retiring Young, Second Thoughts, and Summing Up. Excluding the introduction and summing up, I like to call these “The Dirty Dozen” of our professional lives. At some stage in our professional life, we need to stop and look back on these issues and give them a serious thought!! Like almost all doctors, I have also saved lives and alleviated suffering to the best of my ability. I know that every day I have worked in this profession has been an honor and privilege, but it has come with a huge cost!! As doctors, 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 ourself. But as is the case of any good scientific study, there needs to be an endpoint. We must be the one who choose that endpoint! One of the big fears that people have is loss of identity. We spend our lives building up our professional identity. It can be difficult for many to walk away from it. 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 mostly average, and the number of people who are “matchless and exceptional” are very few. Even those few are not irreplaceable!! “How to stop Worrying and start Living:” In this interesting book, Dale Carnegie says that time has a way of moving quickly and catching you unaware of the passing years. Your kids are becoming you..and your grandchildren may not be perfect, playful ones anymore! Try to remember-When was the last time you did something for the first time? Today is the oldest you’ve ever been, and the youngest you’ll ever be. Old is gold: Old Songs, Old Movies, and best of all, OLD FRIENDS!! “The Top Five Regrets of the Dying” is another book by Bronnie Ware, who is an Australian author, songwriter and motivational speaker best known for her writings about the top death-bed regrets she learnt from patients under her care during the time she spent as a palliative carer. She has described the top five regrets of the dying: 1) I wish I’d had the courage to live a life true to myself, not the life others expected of me, 2) I wish I hadn’t worked so hard, 3) I wish I’d had the courage to express my feelings, 4) I wish I had stayed in touch with my friends, and 5) I wish that I had let myself be happier. “Die with Zero” is another famous book by American hedge fund manager and poker player Bill Perkins, in which he has presented a concept that is now very popular in the Western world. Besides managing one’s finances, it describes the 3 truths that are very true even with the medical profession. Most Doctors delay retirement for too long, or indefinitely. They put off what else they want to do until it’s too late, so that they never have time to enjoy other aspects of life. Most of us continue in our profession for too long as if we had all the time in the world. When the end is near, we start wondering-Why did I wait this long? We all get one ride on this roller coaster of life. Let’s start thinking about how to make it the most exciting, interesting, and satisfying ride it can be. The question then one must consider is when must a Doctor retire? The obvious answer is, when the physical and mental faculties are still intact. Many Physicians continue to practice into their 80s and 90s, and Surgeons who continue to operate well into old age. Why wait for cognitive decline, physical decline, dexterity, frailty, and increased error rate? In a very simple type of Case Study, while celebrating the Golden Jubilee of passing out of my school batch and the joining year of our MBBS batch, I looked at the current status of all those who had started together in our school in 1964 and the medical college in 1972. All these were almost of the same age. As of now, 6 of the 59 from our school batch (10.3%) and 16 of the 150 from our MBBS batch (10.6%) have passed away. Sadly, this percentage will only continue to increase in the next 10–15 years!! So, while planning the retirement as Doctors we must start thinking about retirement from our profession (the office) at the appropriate time and before it gets too late. We need to be fair to the patients, but fair to ourselves also. This may be more important in surgical disciplines. We need to find time to get engaged more with the implicit self, following its directives and spending quality time the way one feels like. Our longevity figures looked at above suggest that when nearing 70 years age, it should be a good time to start working on the retirement. This should be true and can be applied to most professionals [Figure 2].Figure 2: Think of hanging the StethoscopeThe four stages of life in Hinduism are known as Ashramas, each with its own purpose and responsibilities. Brahmacharya (student): Focusing on learning and chastity, Grihastha (householder): Marked by marriage, family, and worldly duties, Vanaprastha (hermit): Involving withdrawal from “Office” to engage more with the implicit self, pursue spiritual growth and do whatever you enjoy, and Sannyasa (renunciant): For those who reach this stage of detachment to achieve union with the Divine. Following the basic concept of the stages of life in Hinduism, we should try and follow the 30 + 30 + 30 Rule. We should plan and distribute our life span of approximately 90 years into three stages of 30 + 30 + 30 to make a good balance sheet of life. During the first 30 years, we should focus on Education and Learning. In the second 30 years, we should focus on Work, Societal duties and Family responsibilities. As suggested by Warren Buffet, the great American investor and philanthropist, we should aim to spend the last 30 years on 3Fs (Family, Friends, and Faith), 3Hs (Health, Hygiene, and Hobby), and 3Ss (Soul, Service, and Smile)!!! So, we should plan to retire to enjoy life beyond our profession. I would like 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? After a long and dedicated career, Doctors have earned the right to retire and enjoy other aspects of life outside of medicine. We must plan it well in advance and “Retire before you are Tired!! We should aim to be a proudly retired Doctor, just like a regular Doctor, but a lot happier!! The author with his wife – both retired and a lot happier doctors!! [Figure 3].Figure 3: The author with his wife – both retired and a lot happier doctors!!Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.