Editor’s note: This is a condensed version of an address Dr. Vincent gave to the Ontario Medical Association Scientific Session May 12, 1977. The issues addressed are as pertinent today as then. Dr. Vincent, a long time member of CMDA Canada, has had a life long interest in issues of physician well-being which has very recently been discovered as an issue by the profession at large. – W James Fenton MD FRCPC
I would like to define retirement not as resigning from life, but as that period of life when you are free to do things you want to do. This may even be practicing medicine with greater freedom.
If a number of current trends persist, I believe that we shall see an increase in the number of physicians retiring. Some of these trends are:
Malpractice insurance is becoming more expensive. This may make slowing down a practice less affordable.
More physicians are in salaried positions or group practices. These positions often produce pressure to retire as well as providing pensions that make it practical.
It is increasingly difficult to keep up with the technical advances of medicine.
Peer review is here. Added to this is the need to document learning.
Perhaps physicians have always grumbled, but it is my impression that I hear physicians increasingly express their disenchantment with medical practice, saying that they are getting tired of red-tape, filling out forms, seeing their autonomy disappearing, all while the risk of being sued increases.
The Physician’s Fear of Retirement
People do not look forward to retirement, and physicians share this view. Most of us are prepared to admit that we do not like the idea of getting older. We accept growing older because there is only one alternative! In not wanting to grow older, we often avoid sensible planning for it. Physicians tend to share the public’s negative view of retirement that sees retirement as a very stressful transition, often followed by serious maladjustment, physical and emotional deterioration, decreased life satisfaction and expectancy.
However, studies in recent years point in a more positive direction. Poor health is much more commonly a cause of retirement than as a consequence of retirement. Studies suggest that retirement improves physical health and do not confirm that retirement brings about a decrease in “general life satisfaction”.
The most important variable in adjustment to retirement is not retirement itself, but rather the individual personality and life-patterns of the individual. Further, these are cultivated early in life and are not subject to change suddenly at the moment of retirement.
A recently retired physician considering reasons offered for not retiring, wrote: “the really important reason that doctors are loath to admit, is that they know little and can do little outside of their own little worlds. Doctors as a class are very poorly educated except in medicine.”
Dr. A. D Kelly (General Secretary of the CMA from 1954 to 1966) said: “We have been accustomed to hard, responsible work for long hours and most of us have been so immersed in professional activities, that avocations have been neglected”.
The Basis of a Satisfying Retirement
A philosophy of life or belief-system is needed that permits you to see yourself as valuable, gives you self-esteem and a sense of identity which is not based solely on your work output or production. If our self-esteem is based solely on our productivity both are likely to decline with the years. To be useful, our philosophy and faith must help us live with the inevitable losses of advancing years.
Good physical health certainly adds satisfaction at all ages. Much ill-health results from “diseases of choice” and should I add “procrastination”? Tomorrow I start my diet/exercise/quit smoking, etc.
A positive attitude towards retirement is also vital. A healthy attitude views retirement, not as a crisis event, but rather as one of life’s expected transitions. Retirement is best looked upon as the beginning of a new career.
Dr. Wilder Penfield advises: “When a man reaches his 60s, he should be released from heavy harness […] given the opportunity of starting a new or modified career. The nature of that career must depend on interest and ability. It should provide greater latitude of living, allowing a variable or decreasing amount of physical labour. To most men there should come a time of shifting harness, for lightening the load one way and adjusting it for greater effort in another […] time for the old dog to perform new tricks. The new career may bring little or no money; it may be concerned only with good works, it may, on the other hand bring in support that is much needed. It can be a delight to a man, who comes at last to a well earned job instead of a well earned rest. It can be too, what society needs most from him.”
I am suggesting we should all plan for the possibility of retirement. The sooner we begin to plan the better – like today. Life is unpredictable and full of the unexpected. If you plan, you must be prepared to modify your plans.
Assuming a satisfying philosophy of life, reasonable health, finances, and a positive attitude, what next?
Start now to notice things having to do with retirement. How do you wish to spend your time in retirement? What are the activities you enjoy? Make a list of interests and activities that you would like to develop, but don’t have time for now. Try out some of these ideas. Seek to develop or maintain non-medical interest throughout your life.
As the years go by, try to make time to develop these interests, hobbies, avocations or skills.
If possible, ease into your second career by progressively arranging more leisure time to try out the things you think you are interested in.
Don’t forget to cultivate your marriage relationship. It grows best if looked after. Include your spouse in your retirement planning. If you are married, satisfaction in retirement is closely related to marital satisfaction.
Consider where you wish to live. A word of caution: before a radical move, try it on a temporary basis – don’t burn your bridges prematurely.
Most physicians need some challenge to use their talents through out their life whether that be in formally paid work or in a variety of forms of unpaid service.. Many forms of volunteer work are available that can make use of a physician’s knowledge and experience. Adult education can also challenge and interest the retired physician.
What are your plans doctor?