Viewpoint
ajog.org
Considerations about retirement from clinical practice by obstetrician-gynecologists William F. Rayburn, MD, MBA; Albert L. Strunk, JD, MD; Stephen M. Petterson, PhD
A
n analysis by the American Congress of Obstetricians and Gynecologists (ACOG) in 2011 showed that growth in the number of actively practicing Fellows over the past 30 years was outpaced by the expanding US population of adult women.1 This finding coincides with a more or less fixed output of resident graduates and an anticipated growth in demand for women’s health care services with passage of the Patient Protection and Affordable Care Act.1,2 Retirement of senior obstetrician-gynecologists therefore is a matter of concern for the delivery of high-quality women’s health care. Despite its importance to the overall provider supply, physician retirement patterns have received little attention. Expansion of medical school enrollment and residency programs in the 1960s through the 1980s has led a larger cohort of “baby boomer” physicians (born between 1946 and 1964) to now reach retirement age.3 In this Viewpoint, we attempt to determine what constitutes an age range for most obstetrician-gynecologists to retire from clinical practice, how this range compares with practitioners in other specialties, and what considerations are important to obstetrician-gynecologists before retirement.
Methods of determining retirement Determining the usual age range of retirement is not easy. The most common method is by surveying physicians about when they either retired or planned to retire. Defining retirement, projecting when someone plans to retire, and not receiving feedback from an adequate proportion of respondents are major limitations that bias interpretation. The American Medical Association (AMA) Physician Masterfile is the best available resource of current and historic data on all physicians (MDs and DOs), whether AMA members or not, and foreign medical graduates who reside in the United States who meet the educational and credentialing requirement to be recognized here as physicians.4 A method of defining retirement from clinical practice would be to From the Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM (Dr Rayburn); American College of Obstetricians and Gynecologists (Drs Strunk and Rayburn); and Robert Graham Center, American Academy of Family Physicians Center for Policy Studies, Washington, DC (Dr Petterson). The authors report no conflict of interest. Presented at the 81st annual meeting of the Central Association of Obstetricians and Gynecologists, Albuquerque, NM, Oct. 9-11, 2014. Corresponding author: William F. Rayburn, MD, MBA. wrayburn@salud. unm.edu 0002-9378/$36.00 ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2015.03.027
determine the age at which a physician did not renew his/her national provider identifier (NPI) number, which is essential for Medicare, Medicaid, and most other insurance billing. Determination of retirement age, according to the Masterfile, involves a combination of licensure status, maintenance of certification, and results from an annual survey of all physicians.4 Although the proportion of survey respondents is low, the raw number who respond is high. NPI data from the wellvalidated National Plan and Provider Enumeration System can be used to reduce the magnitude of error vs using the AMA Physician Masterfile data alone.5 When combined, these 2 large national datasets will minimize bias in reporting ages at retirement and will increase sample sizes to obtain more precise estimates of physicians’ retirement ages. Data between 2008 (onset of NPI number required for electronic billing) and 2013 (the most recent year of reporting) were obtained was obtained to create a large sample size for an even more precise estimate of retirement age ranges.
Ranges of retirement ages In the December 2013 annual AMA report, the percentage of active physicians who were 55 years old was comparable between physicians in obstetrics and gynecology, obstetrics only or gynecology only, and in all specialties combined (41.3% vs 42.6%).6 Combining the 2013 AMA Physician Masterfile Survey and NPI datasets revealed the median retirement age from clinical practice for obstetrician-gynecologists to be 64 years. Although obstetrician-gynecologists at or near retirement were predominantly men, women retired earlier by 5 years. Male doctors retired between 60 and 71 years old. The practice location and region of the United States did not influence the median age of retirement. Nor did the median age vary from year to year. We defined a customary age range of retirement to be the interquartile of ages in which retirement began. The customary age range for obstetrician-gynecologists was 60-68 years. The Figure displays box plots of interquartile retirement ages (upper limits of first quartile, second quartile or median year, and third quartile) across all core specialties. Obstetrician-gynecologists retired earlier than their counterparts in all of the listed medical and surgical disciplines, especially family physicians, general internists, and general surgeons. We estimate this retirement age range (59-69 years old) to represent obstetrician-gynecologists in practice. In every specialty, especially obstetrician-gynecologists, women retired earlier than male doctors, with an average difference of 1-3 years among and between specialties. These findings from the combined 2 national datasets are supported by a survey that was conducted and reported in 2008 by Anderson et al.7 Results from their 38-question SEPTEMBER 2015 American Journal of Obstetrics & Gynecology
335
Viewpoint
ajog.org
FIGURE
Interquartile range of retirement ages
Range between female and male physicians, by specialty, from 2008-2014. Rayburn. Retirement age. Am J Obstet Gynecol 2015.
survey of ACOG Fellows >50 years old who were either in practice (n ¼ 875) or retired (n ¼ 289) revealed that the average age contemplated to stop providing patient care was 65.5 years (SD 5). On average, female doctors retired 4 years earlier. Reasons given in that survey for retiring earlier included high professional liability premiums, insufficient reimbursement, reluctance to maintain certification, and deteriorating health. Those who retired later than expected did so because of high career satisfaction or inability to afford to retire. Data required to discriminate between the type of practice (eg, comprehensive obstetrician-gynecologists, ambulatory practice, hospitalist, gynecology only) practice settings (private practice, salaried position, academic medicine), and part-time vs full-time clinical effort before retirement was unavailable from past reports. This information would be useful in the future, especially to physicians who 336 American Journal of Obstetrics & Gynecology SEPTEMBER 2015
wish to extend their careers or consider retirement at earlier ages.
Moving forward In the absence of mandatory retirement, guidance is needed to individualize the transition into eventual retirement. A first step would be self-recognition, with time for reflection, and informed and guided self-monitoring to enhance insight into adaptive aging.8 Self-monitoring would include not only an assessment of cognitive abilities but also mental and physical wellness. Occasionally, independent professional treatment might be useful or necessary. Little has been done systematically to guide and support physicians, although a close professional friend and/or spouse can be invaluable in listening and advising. The obstetrician-gynecologist must consider how a transition to retirement from medical practice can be accomplished
Viewpoint
ajog.org to ensure satisfaction and happiness. Physicians, particularly those approaching retirement age, desire quality-of-life accommodations such as less full-time work, less weekend work, and fewer on-call requirements.9 Many plan to reduce practice workload ahead of actual retirement, which usually requires special conciliations and adjustments in group practices and professional liability insurance coverage. Extending the period of clinical practice does not appeal to all senior obstetrician-gynecologists. Practice can be physically and cognitively demanding, with reliance on a range of memory and processing capabilities, reasoning, and fine motor, sensory, and visual-spatial skills. These skills decline with age, although there is great interindividual variation, particularly in cognitive performance. Some hospitals and institutions have rules that require competency testing and limitations or prohibitions on surgery for patient safety and quality assurance purposes.10,11 Most physicians understand that they cannot “just retire.” Some intellectual activity is needed to support their sense of self-esteem and worth. Such activities may relate to either what the retiree did previously or something entirely new and different. Alternatives to full-time retirement from practice include part-time work, employment in nonclinical health settings, interim work for another physician (locum tenens), and volunteer work here or in an emerging country.7,8,12 Volunteer medical service, teaching, or administrative functions are effective ways of maintaining strong mental function. Two excellent personal perspectives from leaders in our field have highlighted the rewards of volunteering in primary care clinics in underserved areas and in medical student or resident teaching.13,14 Providing primary health care to patients of limited financial means maintains fundamental medical knowledge and, circumstances permitting, working alongside a younger colleague who can monitor the volunteer’s work provides an additional level of support and safety. Another form of activity that does not involve the distractions that plague contemporary medical practice would be teaching. A contribution of 3-5 hours a week with a local medical school would increase the basic fundamental knowledge and skills of residents and students. Although financial compensation would not be expected for these activities, the volunteer would be able to access information technology systems and national library search capabilities to maintain his/her base of fundamental medical knowledge. In summary, this Viewpoint attempts to provide a better understanding of what constitutes a customary retirement age range for most obstetrician-gynecologists and what reasons precipitate retirement. Compared with other medical
specialists, obstetrician-gynecologists are inclined to retire slightly earlier. Given earlier retirement by women, this finding is of particular concern because women now represent one-half all of obstetrician-gynecologists in practice, and this proportion will continue to increase over time. Planning ahead for replacement activities can help avoid emotional, physical, and financial turmoil. Strategies to extend practice longevity, particularly for those considering early retirement or desiring part-time employment, would be worth further exploration. Many physicians are interested in learning about volunteer medical work, which includes teaching and delivering primary patient care to the underserved. Last, the large cohort of approximately 13,000 obstetriciangynecologists within a reasonable retirement age (59-69 years) requires tracking while they are exploring alternative, integrated models of women’s health care delivery. REFERENCES 1. Rayburn WF. The obstetrician-gynecologist workforce in the United States facts, figures, and implications, 2001. Washington, DC: ACOG Press; 2011. 2. Dall TM, Chakrabarti R, Storm MV, Elwell EC, Rayburn WF. Estimated demand for women’s health services by 2020. J Womens Health 2013;22:643-8. 3. Salsberg E, Dill M. The complexities of physician supply and demand: projections through 2025. Washington, DC: Association of American Medical Colleges; 2008. 4. American Medical Association. AMA Physician Masterfile. 2015. Available at: http://www.ama-assn.org/ama/pub/about-ama/physicandata-resources/physician-mataerfile.page/ Accessed Jan. 20, 2015. 5. Bindman AB. Using the National Provider Identifier for health care workforce evaluation. Medicare Medicaid Res Rev 2013;3:E1-10. 6. Center for Workforce Studies. 2014 Physician specialty data book. Washington, DC: Association of American Medical Colleges; 2014. 7. Anderson BL, Hale RW, Salsberg E, Schulkin J. Outlook for the future of obstetrician-gynecologist workforce. Am J Obstet Gynecol 2008;199: 88.e1-8. 8. Purdon TF, Cefalo RC, Stenchever MA. Career transitions: planning for alternative futures. Obstet Gynecol 2002;99:828-31. 9. Keeton K, Fenner D, Johnson T, Hayward R. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol 2007;109:949-55. 10. Drag LL, Bieliauskas LA, Langenecker SA, Greengield LJ. Cognitive functioning, retirement status, and age: results from the cognitive changes and retirement among senior surgeons study. J Am Coll Surg 2010;211:303-7. 11. Porreco RP. The senior obstetrician requesting obstetric privileges. Am J Obstet Gynecol 2012;206:183-6. 12. Meritt, Hawkins & Associates. 2007 Survey of physicians 50 to 65 years old. Available at: http://www.merritthawkins.com/pdf/mha2007older docsurvey. pdf. Accessed Jan. 15, 2015. 13. Weinstein L. Is it time to take a “rest”? Obstet Gynecol 2004;104: 623-5. 14. Pitkin RM. Retirement musings. Obstet Gynecol 2012;119:1048-9.
SEPTEMBER 2015 American Journal of Obstetrics & Gynecology
337
Viewpoint
ajog.org
Supplemental Materials
ABSTRACT
Considerations about retirement from clinical practice by obstetrician-gynecologists Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement. Although the proportion of obstetrician-gynecologists 55 years old is similar to other specialists, obstetrician-gynecologists retire at younger ages than male or female physicians in other specialties. A customary age range of retirement from obstetrician-gynecologist practice would be 59-69 years (median, 64 years). Women, who constitute a growing proportion of obstetrician-gynecologists in practice, retire earlier than men.
335.e1 American Journal of Obstetrics & Gynecology SEPTEMBER 2015
The large cohort of “baby boomer” physicians who are approaching retirement (approximately 15,000 obstetrician-gynecologists) deserves tracking while an investigation of integrated women’s health care delivery models is conducted. Relevant considerations would include strategies to extend the work longevity of those who are considering early retirement or desiring part-time employment. Likewise volunteer work in underserved community clinics or teaching medical students and residents offers continuing personal satisfaction for many retirees and preservation of self-esteem and medical knowledge. Key words: age, obstetrician-gynecologist, retirement
ajog.org
Considerations about retirement from clinical practice by obstetrician-gynecologists William F. Rayburn, MD, MBA; Albert L. Strunk, JD, MD; Stephen M. Petterson, PhD
A
n analysis by the American Congress of Obstetricians and Gynecologists (ACOG) in 2011 showed that growth in the number of actively practicing Fellows over the past 30 years was outpaced by the expanding US population of adult women.1 This finding coincides with a more or less fixed output of resident graduates and an anticipated growth in demand for women’s health care services with passage of the Patient Protection and Affordable Care Act.1,2 Retirement of senior obstetrician-gynecologists therefore is a matter of concern for the delivery of high-quality women’s health care. Despite its importance to the overall provider supply, physician retirement patterns have received little attention. Expansion of medical school enrollment and residency programs in the 1960s through the 1980s has led a larger cohort of “baby boomer” physicians (born between 1946 and 1964) to now reach retirement age.3 In this Viewpoint, we attempt to determine what constitutes an age range for most obstetrician-gynecologists to retire from clinical practice, how this range compares with practitioners in other specialties, and what considerations are important to obstetrician-gynecologists before retirement.
Methods of determining retirement Determining the usual age range of retirement is not easy. The most common method is by surveying physicians about when they either retired or planned to retire. Defining retirement, projecting when someone plans to retire, and not receiving feedback from an adequate proportion of respondents are major limitations that bias interpretation. The American Medical Association (AMA) Physician Masterfile is the best available resource of current and historic data on all physicians (MDs and DOs), whether AMA members or not, and foreign medical graduates who reside in the United States who meet the educational and credentialing requirement to be recognized here as physicians.4 A method of defining retirement from clinical practice would be to From the Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM (Dr Rayburn); American College of Obstetricians and Gynecologists (Drs Strunk and Rayburn); and Robert Graham Center, American Academy of Family Physicians Center for Policy Studies, Washington, DC (Dr Petterson). The authors report no conflict of interest. Presented at the 81st annual meeting of the Central Association of Obstetricians and Gynecologists, Albuquerque, NM, Oct. 9-11, 2014. Corresponding author: William F. Rayburn, MD, MBA. wrayburn@salud. unm.edu 0002-9378/$36.00 ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2015.03.027
determine the age at which a physician did not renew his/her national provider identifier (NPI) number, which is essential for Medicare, Medicaid, and most other insurance billing. Determination of retirement age, according to the Masterfile, involves a combination of licensure status, maintenance of certification, and results from an annual survey of all physicians.4 Although the proportion of survey respondents is low, the raw number who respond is high. NPI data from the wellvalidated National Plan and Provider Enumeration System can be used to reduce the magnitude of error vs using the AMA Physician Masterfile data alone.5 When combined, these 2 large national datasets will minimize bias in reporting ages at retirement and will increase sample sizes to obtain more precise estimates of physicians’ retirement ages. Data between 2008 (onset of NPI number required for electronic billing) and 2013 (the most recent year of reporting) were obtained was obtained to create a large sample size for an even more precise estimate of retirement age ranges.
Ranges of retirement ages In the December 2013 annual AMA report, the percentage of active physicians who were 55 years old was comparable between physicians in obstetrics and gynecology, obstetrics only or gynecology only, and in all specialties combined (41.3% vs 42.6%).6 Combining the 2013 AMA Physician Masterfile Survey and NPI datasets revealed the median retirement age from clinical practice for obstetrician-gynecologists to be 64 years. Although obstetrician-gynecologists at or near retirement were predominantly men, women retired earlier by 5 years. Male doctors retired between 60 and 71 years old. The practice location and region of the United States did not influence the median age of retirement. Nor did the median age vary from year to year. We defined a customary age range of retirement to be the interquartile of ages in which retirement began. The customary age range for obstetrician-gynecologists was 60-68 years. The Figure displays box plots of interquartile retirement ages (upper limits of first quartile, second quartile or median year, and third quartile) across all core specialties. Obstetrician-gynecologists retired earlier than their counterparts in all of the listed medical and surgical disciplines, especially family physicians, general internists, and general surgeons. We estimate this retirement age range (59-69 years old) to represent obstetrician-gynecologists in practice. In every specialty, especially obstetrician-gynecologists, women retired earlier than male doctors, with an average difference of 1-3 years among and between specialties. These findings from the combined 2 national datasets are supported by a survey that was conducted and reported in 2008 by Anderson et al.7 Results from their 38-question SEPTEMBER 2015 American Journal of Obstetrics & Gynecology
335
Viewpoint
ajog.org
FIGURE
Interquartile range of retirement ages
Range between female and male physicians, by specialty, from 2008-2014. Rayburn. Retirement age. Am J Obstet Gynecol 2015.
survey of ACOG Fellows >50 years old who were either in practice (n ¼ 875) or retired (n ¼ 289) revealed that the average age contemplated to stop providing patient care was 65.5 years (SD 5). On average, female doctors retired 4 years earlier. Reasons given in that survey for retiring earlier included high professional liability premiums, insufficient reimbursement, reluctance to maintain certification, and deteriorating health. Those who retired later than expected did so because of high career satisfaction or inability to afford to retire. Data required to discriminate between the type of practice (eg, comprehensive obstetrician-gynecologists, ambulatory practice, hospitalist, gynecology only) practice settings (private practice, salaried position, academic medicine), and part-time vs full-time clinical effort before retirement was unavailable from past reports. This information would be useful in the future, especially to physicians who 336 American Journal of Obstetrics & Gynecology SEPTEMBER 2015
wish to extend their careers or consider retirement at earlier ages.
Moving forward In the absence of mandatory retirement, guidance is needed to individualize the transition into eventual retirement. A first step would be self-recognition, with time for reflection, and informed and guided self-monitoring to enhance insight into adaptive aging.8 Self-monitoring would include not only an assessment of cognitive abilities but also mental and physical wellness. Occasionally, independent professional treatment might be useful or necessary. Little has been done systematically to guide and support physicians, although a close professional friend and/or spouse can be invaluable in listening and advising. The obstetrician-gynecologist must consider how a transition to retirement from medical practice can be accomplished
Viewpoint
ajog.org to ensure satisfaction and happiness. Physicians, particularly those approaching retirement age, desire quality-of-life accommodations such as less full-time work, less weekend work, and fewer on-call requirements.9 Many plan to reduce practice workload ahead of actual retirement, which usually requires special conciliations and adjustments in group practices and professional liability insurance coverage. Extending the period of clinical practice does not appeal to all senior obstetrician-gynecologists. Practice can be physically and cognitively demanding, with reliance on a range of memory and processing capabilities, reasoning, and fine motor, sensory, and visual-spatial skills. These skills decline with age, although there is great interindividual variation, particularly in cognitive performance. Some hospitals and institutions have rules that require competency testing and limitations or prohibitions on surgery for patient safety and quality assurance purposes.10,11 Most physicians understand that they cannot “just retire.” Some intellectual activity is needed to support their sense of self-esteem and worth. Such activities may relate to either what the retiree did previously or something entirely new and different. Alternatives to full-time retirement from practice include part-time work, employment in nonclinical health settings, interim work for another physician (locum tenens), and volunteer work here or in an emerging country.7,8,12 Volunteer medical service, teaching, or administrative functions are effective ways of maintaining strong mental function. Two excellent personal perspectives from leaders in our field have highlighted the rewards of volunteering in primary care clinics in underserved areas and in medical student or resident teaching.13,14 Providing primary health care to patients of limited financial means maintains fundamental medical knowledge and, circumstances permitting, working alongside a younger colleague who can monitor the volunteer’s work provides an additional level of support and safety. Another form of activity that does not involve the distractions that plague contemporary medical practice would be teaching. A contribution of 3-5 hours a week with a local medical school would increase the basic fundamental knowledge and skills of residents and students. Although financial compensation would not be expected for these activities, the volunteer would be able to access information technology systems and national library search capabilities to maintain his/her base of fundamental medical knowledge. In summary, this Viewpoint attempts to provide a better understanding of what constitutes a customary retirement age range for most obstetrician-gynecologists and what reasons precipitate retirement. Compared with other medical
specialists, obstetrician-gynecologists are inclined to retire slightly earlier. Given earlier retirement by women, this finding is of particular concern because women now represent one-half all of obstetrician-gynecologists in practice, and this proportion will continue to increase over time. Planning ahead for replacement activities can help avoid emotional, physical, and financial turmoil. Strategies to extend practice longevity, particularly for those considering early retirement or desiring part-time employment, would be worth further exploration. Many physicians are interested in learning about volunteer medical work, which includes teaching and delivering primary patient care to the underserved. Last, the large cohort of approximately 13,000 obstetriciangynecologists within a reasonable retirement age (59-69 years) requires tracking while they are exploring alternative, integrated models of women’s health care delivery. REFERENCES 1. Rayburn WF. The obstetrician-gynecologist workforce in the United States facts, figures, and implications, 2001. Washington, DC: ACOG Press; 2011. 2. Dall TM, Chakrabarti R, Storm MV, Elwell EC, Rayburn WF. Estimated demand for women’s health services by 2020. J Womens Health 2013;22:643-8. 3. Salsberg E, Dill M. The complexities of physician supply and demand: projections through 2025. Washington, DC: Association of American Medical Colleges; 2008. 4. American Medical Association. AMA Physician Masterfile. 2015. Available at: http://www.ama-assn.org/ama/pub/about-ama/physicandata-resources/physician-mataerfile.page/ Accessed Jan. 20, 2015. 5. Bindman AB. Using the National Provider Identifier for health care workforce evaluation. Medicare Medicaid Res Rev 2013;3:E1-10. 6. Center for Workforce Studies. 2014 Physician specialty data book. Washington, DC: Association of American Medical Colleges; 2014. 7. Anderson BL, Hale RW, Salsberg E, Schulkin J. Outlook for the future of obstetrician-gynecologist workforce. Am J Obstet Gynecol 2008;199: 88.e1-8. 8. Purdon TF, Cefalo RC, Stenchever MA. Career transitions: planning for alternative futures. Obstet Gynecol 2002;99:828-31. 9. Keeton K, Fenner D, Johnson T, Hayward R. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol 2007;109:949-55. 10. Drag LL, Bieliauskas LA, Langenecker SA, Greengield LJ. Cognitive functioning, retirement status, and age: results from the cognitive changes and retirement among senior surgeons study. J Am Coll Surg 2010;211:303-7. 11. Porreco RP. The senior obstetrician requesting obstetric privileges. Am J Obstet Gynecol 2012;206:183-6. 12. Meritt, Hawkins & Associates. 2007 Survey of physicians 50 to 65 years old. Available at: http://www.merritthawkins.com/pdf/mha2007older docsurvey. pdf. Accessed Jan. 15, 2015. 13. Weinstein L. Is it time to take a “rest”? Obstet Gynecol 2004;104: 623-5. 14. Pitkin RM. Retirement musings. Obstet Gynecol 2012;119:1048-9.
SEPTEMBER 2015 American Journal of Obstetrics & Gynecology
337
Viewpoint
ajog.org
Supplemental Materials
ABSTRACT
Considerations about retirement from clinical practice by obstetrician-gynecologists Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement. Although the proportion of obstetrician-gynecologists 55 years old is similar to other specialists, obstetrician-gynecologists retire at younger ages than male or female physicians in other specialties. A customary age range of retirement from obstetrician-gynecologist practice would be 59-69 years (median, 64 years). Women, who constitute a growing proportion of obstetrician-gynecologists in practice, retire earlier than men.
335.e1 American Journal of Obstetrics & Gynecology SEPTEMBER 2015
The large cohort of “baby boomer” physicians who are approaching retirement (approximately 15,000 obstetrician-gynecologists) deserves tracking while an investigation of integrated women’s health care delivery models is conducted. Relevant considerations would include strategies to extend the work longevity of those who are considering early retirement or desiring part-time employment. Likewise volunteer work in underserved community clinics or teaching medical students and residents offers continuing personal satisfaction for many retirees and preservation of self-esteem and medical knowledge. Key words: age, obstetrician-gynecologist, retirement
