In early December 2012, I experienced two life-altering events. First, on December 5, Sadie, my first grandchild, was born. Second, on December 8, I suffered a myocardial infarction. All things considered, I was extremely fortunate. Because I received outstanding care almost immediately, I survived the heart attack. But that night, as I lay in bed in the coronary care unit after undergoing an angioplasty and the placement of a drug-eluting stent in my circumflex artery, I realized that if I wanted to see my granddaughter grow up, I was going to have to make major changes in my life. It was clear that one of those changes had to be finding a way to decrease stress.
And so, in August, after seven years, I will step down as the director of Einstein’s Children’s Evaluation and Rehabilitation Center. Although I will continue to work as a medical geneticist at The Children’s Hospital at Montefiore, while contemplating my future I spent some time thinking about retirement. I rejected that option for many reasons; one of them was that upon considering it, I realized that, incredibly, there are almost no role models for the academic physician who would like to make a graceful exit.
Think about it: through medical school and residency, the world of academic medicine is lousy with role models. Personally, during those years, I couldn’t take more than a few steps without running into someone who was ready to model for me exactly how I should act as a member of the academic subculture. There were Einstein faculty members who had themselves chosen careers in academic medicine, who wanted nothing more than to convince my classmates and me that the path they had chosen was the only one we should consider. When I went onto the wards as a third-year student, and through the rest of med school and residency, there were trainees who were one or two steps ahead of me, young physicians who had already begun their ascent up the academic mountain, from whom I learned everything I needed to know about what to do and how to act. From these role models, I learned how to present patients on rounds, how to speak “house-officer-ese,” the special language of interns and residents, how to “dress for success” as a resident, what to eat during on-call nights and where and how to sleep during those long nights (when getting to sleep was possible).
The modeling continued as I made my own way up the academic mountain. As a fellow, for instance, in addition to learning research methodology and becoming clinically adept in my specialty, I learned that while attending national meetings, it was mandatory to wear a navy blue or black blazer and tan trousers. For the successful academician, no other outfit was acceptable.
But now that I’ve climbed to the top of the mountain (or at least as high as I’m ever going to get) and have begun the journey down the other side, there seems to be no one to point the way. In academic medicine, few people ever retire, step down or go away gracefully. The model seems to be that once you’ve joined the faculty, you more or less work until you die.
I’m not kidding. I’ve been at Einstein since I started as a first-year student more than 38 years ago. Faculty members who taught me when I was a student are still here or are working at other medical schools in the New York metropolitan area.
In fact, I can count on the fingers of one hand the number of mentors who have willingly and electively given up their faculty appointments. For the most part, those faculty members who are not asked to give up their appointments leave only due to illness or death.
Why should this be? In other jobs, workers put in their 25 or 30 years, or they reach the magic age of 65 or 70, and they hang it up. Their employers identify other workers to replace them, retirement dinners are planned at which, in recognition of their many years of service to the firm, they’re presented with gold watches and mugs and/or T-shirts emblazoned with slogans such as “WORK? BEEN THERE, DONE THAT!” and they go off to Florida or Arizona or some other place that’s filled with retirees, to live out their “golden years.” But this almost never happens in medicine. Why should this be the case?
I’ve realized there are many explanations. For one thing, what with four years of college, four years of medical school, three or more years of residency and a few years of fellowship, it takes so damned long for us to train that if we don’t work until we die, we’ve essentially had no time even to have a career!
But it’s more than that. In speaking with people, I’ve found that many physicians view retirement as a kind of failure, a forced waste of the talents they’ve worked so hard to develop and perfect. By retiring, they are depriving society of the contribution they’re able to make. And no one wants to be accused of electively depriving society of his or her contributions.
Also, whether we like it or not, in our society, there’s a sense of power and respect that derives from being a physician. Retirement forces us to surrender that perk, which is not so easy to do. So, even as age and infirmity chip away at our skills and judgment, many physicians hang on, unable to let go.
In addition to these explanations, there are many more. Consider these:
- Being a physician is fun; who would elect to give that up?
- As a working physician, you instantaneously have a collegial relationship with all other physicians; after retirement, that relationship becomes more tenuous.
- As a member of a medical school’s faculty, you are surrounded by trainees, medical students, residents and fellows, young people who help you feel young even as your biological clock is ticking away.
- Regardless of the changing face of healthcare financing, it’s hard to beat the reimbursement.
Not surprisingly, after considering all of this, I’ve made the decision not to retire any time soon. Having made this decision, I realize I’m contributing to the problem rather than helping find a solution. The bottom line is that in academic medicine, there really shouldn’t be a stigma attached to making a graceful exit. We need role models to show the way, providing guidance that younger faculty members can follow. Anyone willing to volunteer?
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Our dear Bob Marion, premier pediatric geneticist, prolific author and recently retired Director of CERC, is concerned with the lack of mentors to guide the pathway to useful retirement for academic physicians. Fear not, Bob, we have them galore at Einstein. Let’s start with Dominick Purpura who retired after being Dean at Einstein for more than 25 years. Dom, a neuroscientist by training, now spends his time as Professor Emeritus of Neuroscience(the department he founded and once Chaired) advising graduate students, writing provocative scientific manuscripts and collaborating with faculty. This is his full time, unpaid job. Then there’s Milford Fulop. He was Chief of Medicine at Jacobi for decades then Acting Chair and Senior Vice Chair of the Department of Medicine who is now teaching residents and medical students 4 days a week at Jacobi. James Scheuer, former Chief of Cardiology then Chair of Medicine who, post retirement, teaches cardiology fellows and advises young researchers. And the list goes on of faculty who have become Emeritus but still spend anywhere between three and five days a week mentoring, teaching and collaborating. If you were good before retirement, you still have much to give post retirement. I think the successful formula for the retiree is to pick the one aspect of one’s job that ignited the most passion during the career years, be it clinical work, research or teaching, and devote oneself totally on a volunteer basis to that endeavor. You’ll never be bored or lonely while remaining in the environment you’ve always cherished. But Bob, may you be blessed with many healthy years of fruitful work ahead before you have to contemplate complete retirement.
Edward R. Burns, M.D.
Albert Einstein College of Medicine of Yeshiva University
I read your post with great interest…because I did decide to retire from clinical medicine (private practice). The tipping point for me was the birth of my granddaughter(who lives 2000 miles away) and whose life I wanted to be a big part of. It has been hard–giving up the relationships with long time patients, the self-esteem associated with being a doc, the structure of my life… I sought the advice of mentors-one from my residency, one who is 86 and still works, one who is a public health/academic physician…So, I spent the year volunteering my time.. teaching and mentoring med students, teaching undergrads, working with a non-profit that started a charitable pharmacy, participating in an childhood obesity collaborative, working with a group of physicians interested in the environment and health, volunteering with public tv, etc. Doctors do have skills that can translate to many other roles and these new challenges are invigorating…The best part is that I can contribute to my larger community and also be part of my granddaughter’s life…I made the right choice for me…and that is what it comes down to—making the right choice for yourself.
The problem in retirement for those physicians who have defined who they are by what they do is that one can’t retire; if you can no longer do that which defines your existence you can’t quit because it’s the equivalent of dying. The secret of a successful retirement is to view it as a change in occupation; you move from one job (practicing medicine) to another job which you have chosen and which you find satisfying but which entails little to no stress. Physicians who can’t make such a transition might benefit from seeing a therapist. Read my article at .
I’m reading Dr. Marion’s thoughtful musings sitting on the beach in Delaware having spent a few days with my two grandchildren. And I too am an Einstein grad (’83) who can’t seem to escape the lure of the Bronx, the borough of my birth. Primary care has been a wonderful and challenging mix of caring for patients and teaching students and residents. I guess I have two thoughts about this topic. My daughter is a second year student here–another “nontraditional” student like me. Last year I watched her wade thru the rigors of anatomy and listened to her wax lyrical about the beauties of the kidney. There was a goodly portion of grousing too. So when I gave her a print of Jan VerMeer’s Woman Holding a Balance, which hangs in her room today, no doubt I was sending my self a message as well.
My other thought has to do with basketball. I still manage to lace up my sneakers for hoops at the Falk Center–another attempt at balance I suppose. When my friend Dr. Sharp motions me to join the game I tell him, “OK Dave, I’m in but you will let me know when I start embarrassing myself.” I know my colleagues will do the same.
As I begin my retirement in December, I am looking for advice from fellow physicians. I was interested to read yours.So far my adult dermatology patients have weighed in either with “You’ll be bored” or “You’ll be busier than ever.” When I had breast cancer 5 years ago I was too ill to take advantage of the 4 months “off.” Restored to health, I am grateful for the opportunity to cook more, see patients at my pace (narrowed focus of now 12 hour a week practice to pediatric dermatology ONLY) and to leave the house in daylight, stop at a park, library or high school music department as I please, and return home- gasp- when it is still daylight!
Although I never met you in 1978-9, you were a medical student when I was an intern at Jacobi, and inspired by your writing I hope also to write about that experience. I hope you will write more and sit in traffic, boring lectures, and cardiology waiting rooms, less.