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?
Robert Marion is chief, genetics and developmental medicine, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.