Is there life after medicine?

My group of nephrologists is trying to convince our 75-year-old colleague to retire from full-time clinical practice.  I think he truly believes that the day he retires, his essence, soul, chi — whatever you want to call it — will be forcibly removed from his body, and he will cease to exist. He has told me, more than once, that he will be dead in less than a year if he is forced to stop being a physician. I envisioned this type of machismo was very old-school thinking, but maybe not. Modern doctors strive for a better balance of work and life, but do you ever really stop being a physician?

We all have many different titles in life. What happens when the title remains, but the interactions cease? As a nephrologist, I often deal with patients on the worst day of their life.  I strive to add quality and not just quantity to the lives of my patients with kidney disease who need to start dialysis. I personally have had Type 1 diabetes for 25 years and realize that their reality may someday be my own. Time is something you can’t replace, and you can’t save up. We are at every moment, moving closer to the precipice. I hope to retire young enough that I can still enjoy all life has to offer.

As it turns out, “old age” is actually quite new in the history of humanity. From about 1500 to 1800, the average life expectancy in Europe was between 30 and 40 years. Nowadays, the older population is the fasting growing population in the world.  By 2047 there will be more people over the age of 60 than children under 15. In the specialty of nephrology, where we have not been filling fellowship training spots, we are failing to replace ourselves in the workforce. Therefore, there will likely be a need for me to prolong my work-life. When I think about stopping my medical practice, I think about the one million ways to not do medicine. Volunteering, teaching, reading, writing, relaxing. They say you never work a day in your life if you love what you do, and I do love interacting and helping patients. I do not, however, always enjoy the structure, administrative, and financial barriers imposed by day to day practice.  This has been my point to my senior partner; why not take the best parts of medicine and only do those things that add meaning and pleasure to your life?

But is my partner correct? Do we lose something when we retire? There is some evidence that waiting to retire may have some health benefits.  In a 2019 Swedish study, it was suggested that working past 65 years of age was associated with better overall health, but one can certainly argue cause and effect in this type of observation. One thing that is not debatable is that the average age of American physicians is increasing. A 2016 U.S. census noted that 30 percent of physicians are 60 or older. A 2017 Survey by CompHealth responding doctors reported an average retirement age of 68 years old (versus 63 for all Americans). In that same survey, only 32 percent said they looked forward to no longer working in medicine. Losing social interactions at work, feeling a loss of purpose, boredom, loneliness, and depression may provoke an identity crisis at the end of a physician’s career.

The ideal retirement means something different for every physician, depending on circumstances, desires, health, finances, and other factors. However, it is clear the valuable skills we acquire afford the opportunity to contribute long into our golden years. I hope that when I am 75 years old, I have the choice to contribute (or not) as I see fit. There is purpose in being a doctor. The trap is when you assume all that you are is a doctor.

Brian Rifkin is a nephrologist.

Image credit: Shutterstock.com

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