My Journey into Retirement: Before, T=-1 month

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An abbreviated version of this essay ( A Physician’s Impending Journey into Retirement ) was the winner of:

Doximity: The Best Op-Meds of 2023

Community Favorite Award

https://opmed.doximity.com/articles/the-best-op-meds-of-2023

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For those of us who have had a career that we enjoyed, “retirement” causes us pause.  

    • Am I ready to shed my professional identity as a physician?
    • Should I stop reading the medical literature? 
    • Do I want to be on vacation perennially?
    • How will I ensure I do not become bored?
    • Will retirement be as personally fulfilling as my career as a physician?
    • Must I cease contributing to society and now become a “consumer” of culture/society?
    • Is there a way I can “make the world a better place” in retirement?
    • How do I maintain and expand my circle of friends?
    • Am I financially able to retire?

I intend to explore these (excluding financial) and related retirement questions in an ongoing series of blog postings that discuss my perceptions of my retirement.

Why I Retired: Institutional Bureaucracy 

The vast majority of my career was spent running a solo private (endocrine/internal medicine) practice (DiabetesEndocrine.com) and a small software company (ComChart.com), both now shuttered, two synergistic endeavors which were personally fulfilling.

Over the last decade or so the US healthcare system had been taken over by corporate entities, (Consolidated Healthcare institutions, Insurance companies, Pharmaceutical companies, and Health Information Technology companies [The CHIPHIT complex]) which, along with the Federal Government, believed that they “knew” how medicine should be practiced. They use their political and economic influence to take control of the US healthcare system and began to treat physicians as vendors. For more, see “One Physician’s Frustrations of Practicing Amidst the CHIPHIT Complex and Implications for the Future of the U.S. Healthcare System ”

In 2017 it became apparent that my 2.5-decade-old solo private practice was not sustainable in the era of The CHIPHIT complex.  If I hoped to continue being a physician then I would need to become an “employed” physician.

Soon after doing so, it became clear my institutional bureaucrats would not allow me to configure the office in a manner that would enable me to deliver efficient, high-quality medical care. Thus, the bureaucrats degraded my ability to care for my patients and made an already stressful job significantly more stressful. (Note: Many of my retired patients have told me that the primary reason they too chose to retire is that their institutional bureaucracy made it too difficult for them to perform their jobs.)

Why I Retired: Deficient Medical Knowledge Base 

As the medical knowledge base doubles every several months, it is to be expected that  one’s depth of medical knowledge decreases with time. To compensate for this, about 1-2 decades after I finished my training, I began to restrict my practice to only those diseases for which I felt my clinical skills were up-to-date. Now, 3.5 decades into my career, the repertoire of diseases I treat has narrowed significantly.

Why I Retired: A Stressful Occupation

Being a physician is an inherently stressful occupation. I was the only endocrinologist in my medical community for more than 1.5 decades and was on-call 24/7/365, responsible for providing endocrine care to 2 or 3 community hospitals and for my endocrine patients. I would receive phone calls at any time of the day, night, and while on vacation. 

I do not regret my choice to be a physician. I loved being a physician and would choose to do so again. But it was a stressful career and it took a toll on me and my family.

Becoming a Part-Time Physician

In recognition that my clinical skills had diminished, corporate medicine had negatively impacted my ability to provide care, and the stress was untenable, I decided to wind down my beloved clinical career so as to allow for a more contemporarily trained endocrinologist who would be more adept at providing care within the constraints of the current healthcare system.

In the spring of 2022, my employer agreed to allow me to work part-time and reduce the number of patients I saw daily. As my schedule was fully booked months into the future, these changes would  not be implemented until October 2022. 

Concurrently, my employer began aggressively recruiting for an endocrinologists to replace me and two other endocrinologists who had recently resigned from the practice. 

In May 2022, I posted my article “Approaching Retirement.”

A Moment of Cognitive Clarity

In July 2022, I was hiking in the Wrangell-St. Elias National Park as a participant in an 8 day REI guided backpacking trip.  We hiked up a river valley to a mountain pass. At peak elevation, I turned around to see the river below, its banks’ speckled with verdant patches of grass and flowers in all the hues of the rainbow, with a vista of 30 miles of granite mountains covered with glaciers and snow fields, all under a crystal-clear blue sky. The scenic grandeur was overwhelming and there was a complete absence of the “stress” which had so degraded my soul every work day. 

In that instant, I had a moment of “cognitive clarity” during which it became obvious that I needed to retire from the career I loved. I turned to the person next to me and said “I am going to quit my job.” 

When I return to my one-man tent, I dictated a resignation letter.  

After we returned to civilization, I emailed the resignation letter to my wife. As she was acutely aware of my dissatisfaction with my work environment, she immediately agreed with my retirement plan. 

I then emailed the retirement letter to my employer, with a note which stated that I was willing to work for as long as was necessary for the institution to hire a replacement endocrinologist – I did not want to abandon my patients.

My retirement was set for late December 2022. 

In August 2022, I posted my “Retirement Letter to My Patients.”

Informing My Patients

Informing my patients of my decision to retire has been difficult for both my patients and me. Some of these people have been under my care for 3 decades, I’ve seen them through the death of a loved one, the addition of a family member, major educational milestones, and serious illnesses. It has been emotional for some, and me as well.

I wish I could have personally selected the endocrinologist who will replace me so I could reassure my patients that they will get good endocrine care in the future. But that is not the reality of today’s healthcare system.  And some of my patient will need receive medical care from a nurse practitioner, despite their wishes to be continued to cared for by a physician.

Stages of Retirement 

The Internet is awash with TED talks and articles discussing the “stages” of retirement, which are essentially:

    • Stage 0: Pre-retirement planning
    • Stage 1: Vacation
    • Stage 2: Boredom/stagnation
    • Stage 3: Exploration
    • Stage 4: Enlightenment/Fulfillment

Clearly, I am in Stage 0 of retirement. 

I hope to skip Stage 2 and simultaneously experience Stage 1 and Stage 3. Is this possible?

My Mantra for My Retirement: “It is now our time”

I have spent my entire life subjugating my personal needs to the needs of my family and patients. While I have some regrets, I have had a wonderful life.

Moving forward, I have decided that my initial retirement mantra will be “It is now our time” and by “our” I mean my wife, Gail and I.

After a high-stress career of her own, Gail now has a low-stress, part-time job which she enjoys immensely. The job can be done remotely and on her own schedule, thus her scheduling flexibility is nearly unlimited – a perfect retirement activity and a perfect retirement partner.

My kids have already said, “As you now have so much free time, can you do XYZ for me.” My response was “I have helped to set you up for life and you are doing amazingly well. Henceforth, I’m only going to do the things that I (we) want to do. You are welcome to ask me for help, but don’t expect that I will automatically do as you ask. It is now our time.”

As I now work part-time, I have already begun to attend more art events, theatrical productions, musical events, and lay scientific lectures. Fortunately, the Boston area has a surfeit of cultural and educational opportunities. 

My initial retirement plan is to do more of my current hobbies; recreational cycling, woodworking, blogging, and I have begun to read recreationally. While “recreational reading” may sound like an oxymoron, one needs to understand that I have spent my entire adult life reading technical articles, mostly medical. A year or two ago I began to read non-technical books and listen to audiobooks (while cycling) about politics, human nature, science, science fiction, classical literature, etc. I intend to do more recreational reading.

And there is so much to learn about our world.

I recently applied to the Harvard Institute for Learning in Retirement and am now on their waitlist. I am not unfamiliar with academic rejection. When I first applied to medical school, I was initially put on two waitlists and ultimately rejected, twice. Those rejections turn out to be the most advantageous event in my entire academic career as I met my wife, Gail when I was a graduate student at MIT. Thus I am sure I will be OK, even if I am ultimately rejected by HILR.

Having found great intellectual joy and personal satisfaction in the interface between medicine and technology, I now provide medical/technical advice for a start-up called Healthful Data. As I have a wealth of experience and my opinion is free, hopefully, additional opportunities like this will present themselves in the future.

And of course, I have created a “Retirement Activities To Do list” which I update frequently. Currently, the list includes:

Retiring with Apprehension and Anticipation

Like so many others who are considering or entering retirement, I too am worried that I will not find enough to keep me intellectually entertained and physically busy. Hopefully, some of my plans will prove these concerns were unfounded. And I will keep an open mind to opportunities that may unexpectedly present themselves. 

Numerous studies have demonstrated that the most important factor contributing to one’s happiness is having many meaningful friendships. I am uncertain how I will maintain a circle of friends as many of my friends were a direct result of my professional experiences. Maybe my attendance at the aforementioned activities will be a source of new friends, and maybe I will create a “retired men’s weekly brunch” club at a local coffee shop, but the “friendship” issue remains a concern of mine.

Gail and I intend to remain in Somerville for our retirement as the Boston area offers a nearly unlimited number of “retirement” activities.

So, I begin retirement with a plan and a mantra: It is now our time.

Hayward Zwerling

27 November 2022


11/39/2022 Editorial revisions

12/7/2022 An abbreviated version of this article appeared on Commonwealth Magazine.

5/24/2023: An abbreviate version of this article appeared on Doximity and is reproduced here: A Physician’s Impending Journey into Retirement

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