588823
research-article2015
CPJXXX10.1177/0009922815588823Clinical PediatricsSteele
Commentary
Why Do Pediatricians Retire?
Clinical Pediatrics 2015, Vol. 54(14) 1309–1310 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922815588823 cpj.sagepub.com
Russell W. Steele, MD1,2,3
It has been my impression that pediatricians retire from medicine much later than other specialists, both those in private practice and in academic medicine, perhaps with the exceptions of those who subspecialized in neonatology or intensive care medicine. There are no published data to support this observation, but if relatively late retirement is the impression of others, why would this be the case? It is tempting to conclude that pediatrics is simply a happier and more rewarding vocation, encouraging pediatricians to continue well into their senior years. I think I see more smiles and get more greetings from pediatricians and attendees at pediatric meetings than other medical events I attend. There are many other explanations. It may be that a long and close relationship with children with their unrelenting smiles and trusting approach to life, simply keeps us young. On the somewhat negative side, pediatrics does not pay as well as other specialties, so maybe we have to work longer to pay off our school debts, educate our children, and accumulate adequate retirement income. It may also be that those skills required to practice pediatrics at a high level of quality care remain longer in life than those required to practice surgery or procedureoriented aspects of medicine, where skills rely on excellent vision, dexterity, and in many cases physical endurance. As a matter of fact, because pediatrics is almost entirely a cognitive specialty based primarily on experience, it stands to reason that these specialists, as long as they keep up with advances in medicine, will just get better and better as they continue in their practices. One documented variable that may explain a delay in retirement is longevity. In the United States, overall life expectancy is 78.74 years,1 whereas the life expectancy of all doctors is 73.0 years.2 However, the life expectancy for pediatricians is substantially higher than those for other physicians, at 81.2 years.3 It is also tempting to speculate on this difference among physicians. Genetic factors are unlikely to play a role, although having a parent as a pediatrician might influence medical specialty choices. However, I do not think that anyone has identified a pediatrician/longevity gene; if so I am sure it is on the X-chromosome and dominant. More likely are lifestyle issues such as smoking, alcohol use, exercise,
driving habits, attention to and control of chronic medical diseases such as diabetes, and perhaps reduced stress, all of which influence overall health. These would be interesting issues to explore because early illness is a major reason why many people retire, regardless of their professions. In discussing decisions for retirement with senior pediatricians who have retired or have made a decision to retire soon, I have come up with their top 10 reasons (Table 1). Leading the list is health issues. Physicians certainly better understand the limitations of their profession when their health is not optimal and, therefore, retire because they cannot practice perfect medicine, something imprinted during our educations. There may also be health issues of their spouses and occasionally their parents, children, and even grandchildren that require a major portion of their time. After all, who is a better caregiver than a physician, and who cares more than a family member? Poor health of the pediatrician may also be related to the second most common reason for retirement—that is, pursuit of other activities such as travel; visiting family more frequently, particularly grandchildren; writing; reading; pursuing a treasured hobby; sailing; playing golf (this one I do not understand), and so on. Once anyone realizes that his or her time is limited, the need to complete life by spending more time with other special interests can become a major focus. One shortcoming of this thought process for retirement is that pediatricians have, for many years, felt greatly needed by their patients and their families, have been highly productive, and have contributed significantly to society. It is just hard to give this up completely. Number 3 on our list is administrative and personality issues. In most jobs you work to make your boss 1
Ochsner Children’s Health Center, New Orleans, LA, USA University of Queensland School of Medicine, Brisbane, QLD, Australia 3 Tulane University School of Medicine, New Orleans, LA, USA 2
Corresponding Author: Russell W. Steele, Ochsner Children’s Health Center, 1315 Jefferson Highway, New Orleans, LA 70121, USA. Email: [email protected]
Downloaded from cpj.sagepub.com at UNIV NEBRASKA LIBRARIES on November 26, 2015
1310
Clinical Pediatrics 54(14)
Table 1. Reasons Why Pediatricians Retire. 1. Health 2. Pursue other activities 3. Administrative/Personality issues 4. Lost skills 5. Family issues 6. More desirable location 7. Increased paperwork and changes in medical reimbursement 8. Frustration with law suits 9. Burnout 10. Advance to other aspects of medicine
happy, and academic medicine and large group practices are certainly no exceptions. Also an enjoyable medical practice is very much like a marriage, relying on very close personal relationships with people who will be spending the largest portion of their time together. You must love and trust everyone you work with, or quality of life will suffer greatly, leading to dissatisfaction and a desire to go somewhere else and perhaps do something else. The boss is usually the major factor in this setting. If a pediatrician has no control over administrative issues, the work environment may change to something considered untenable to her or him. Next on our list is lost skills, discussed above as a reason that physicians who are in subspecialties that require special skills might retire early. In pediatrics, these specialties are ones that include surgical procedures, intensive care, endoscopy, dialysis, and cannulation of blood vessels. Other than illness among family members, there are other family issues that may lead to retirement: the death or displacement of a relative that requires extended family support for surviving members; family businesses that need new management, with the preference for a family member taking over this responsibility, and that family member may be a physician; maintenance of family property; and issues related to family divorce. There are always those physicians who desire a better location to live after their children have grown based on a better climate (Florida here we come), more rural or urban environment (Arkansas vs New York City), lower crime (not East St Louis), or a location closer to family members. If a reasonable medical position is not available in the new location, physicians just opt for retirement, even though it may be relatively early. There are, unfortunately, some negative aspects to the modern practice of medicine that were not there when current senior pediatricians began their practices.
Some are the greatly increased paperwork required by insurance companies, Medicaid, and Medicare; changes in reimbursement to levels that make it difficult for practices to be profitable; and a substantial increase in the number of trivial law suits. These simply make the practice of medicine less enjoyable. Physicians are trained as clinicians and scientists, not businessmen; but with the greater overhead and lower reimbursement, all physicians must spend increased time in addressing business issues. Perhaps the worst change is the increase in malpractice litigation, unique to our country. The average physician is sued every 10 years with considerably more than 90% of these suits having absolutely no merit. However, medicine is a very personal business, and not only are these lawsuits time-consuming for physicians, but more important, they are stressful to our basic vocational principles. As with every profession, there may be the “burnout” phenomenon, as defined by George Babbitt, the realtor in Sinclair Lewis’s novel and as part of the midlife crisis syndrome, if indeed it really exists. I think it is a rare reason for retirement because all aspects of medicine offer new and stimulating challenges almost daily, and there is always something new to learn. There is certainly no monotony in medicine. Finally, some pediatricians retire from practice to assume administrative roles in hospitals, medical schools, public health, insurance companies, or other areas within the health care industry. These individuals are not truly retired, but they no longer work as pediatricians. In summary, pediatricians live longer and retire later. We are all happy to be doing what we are doing. The logo for pediatrics should simply be “Life is Good.” Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. National Vital Statistics Reports. 2013; 61:12. 2. Frank E, Biola H, Burnett CA. Mortality rates and causes among U.S. physicians. Am J Prev Med. 2000;19:155-159. 3. In memoriam. Monthly AAP News. 2000-2014;16-36.
Downloaded from cpj.sagepub.com at UNIV NEBRASKA LIBRARIES on November 26, 2015
research-article2015
CPJXXX10.1177/0009922815588823Clinical PediatricsSteele
Commentary
Why Do Pediatricians Retire?
Clinical Pediatrics 2015, Vol. 54(14) 1309–1310 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922815588823 cpj.sagepub.com
Russell W. Steele, MD1,2,3
It has been my impression that pediatricians retire from medicine much later than other specialists, both those in private practice and in academic medicine, perhaps with the exceptions of those who subspecialized in neonatology or intensive care medicine. There are no published data to support this observation, but if relatively late retirement is the impression of others, why would this be the case? It is tempting to conclude that pediatrics is simply a happier and more rewarding vocation, encouraging pediatricians to continue well into their senior years. I think I see more smiles and get more greetings from pediatricians and attendees at pediatric meetings than other medical events I attend. There are many other explanations. It may be that a long and close relationship with children with their unrelenting smiles and trusting approach to life, simply keeps us young. On the somewhat negative side, pediatrics does not pay as well as other specialties, so maybe we have to work longer to pay off our school debts, educate our children, and accumulate adequate retirement income. It may also be that those skills required to practice pediatrics at a high level of quality care remain longer in life than those required to practice surgery or procedureoriented aspects of medicine, where skills rely on excellent vision, dexterity, and in many cases physical endurance. As a matter of fact, because pediatrics is almost entirely a cognitive specialty based primarily on experience, it stands to reason that these specialists, as long as they keep up with advances in medicine, will just get better and better as they continue in their practices. One documented variable that may explain a delay in retirement is longevity. In the United States, overall life expectancy is 78.74 years,1 whereas the life expectancy of all doctors is 73.0 years.2 However, the life expectancy for pediatricians is substantially higher than those for other physicians, at 81.2 years.3 It is also tempting to speculate on this difference among physicians. Genetic factors are unlikely to play a role, although having a parent as a pediatrician might influence medical specialty choices. However, I do not think that anyone has identified a pediatrician/longevity gene; if so I am sure it is on the X-chromosome and dominant. More likely are lifestyle issues such as smoking, alcohol use, exercise,
driving habits, attention to and control of chronic medical diseases such as diabetes, and perhaps reduced stress, all of which influence overall health. These would be interesting issues to explore because early illness is a major reason why many people retire, regardless of their professions. In discussing decisions for retirement with senior pediatricians who have retired or have made a decision to retire soon, I have come up with their top 10 reasons (Table 1). Leading the list is health issues. Physicians certainly better understand the limitations of their profession when their health is not optimal and, therefore, retire because they cannot practice perfect medicine, something imprinted during our educations. There may also be health issues of their spouses and occasionally their parents, children, and even grandchildren that require a major portion of their time. After all, who is a better caregiver than a physician, and who cares more than a family member? Poor health of the pediatrician may also be related to the second most common reason for retirement—that is, pursuit of other activities such as travel; visiting family more frequently, particularly grandchildren; writing; reading; pursuing a treasured hobby; sailing; playing golf (this one I do not understand), and so on. Once anyone realizes that his or her time is limited, the need to complete life by spending more time with other special interests can become a major focus. One shortcoming of this thought process for retirement is that pediatricians have, for many years, felt greatly needed by their patients and their families, have been highly productive, and have contributed significantly to society. It is just hard to give this up completely. Number 3 on our list is administrative and personality issues. In most jobs you work to make your boss 1
Ochsner Children’s Health Center, New Orleans, LA, USA University of Queensland School of Medicine, Brisbane, QLD, Australia 3 Tulane University School of Medicine, New Orleans, LA, USA 2
Corresponding Author: Russell W. Steele, Ochsner Children’s Health Center, 1315 Jefferson Highway, New Orleans, LA 70121, USA. Email: [email protected]
Downloaded from cpj.sagepub.com at UNIV NEBRASKA LIBRARIES on November 26, 2015
1310
Clinical Pediatrics 54(14)
Table 1. Reasons Why Pediatricians Retire. 1. Health 2. Pursue other activities 3. Administrative/Personality issues 4. Lost skills 5. Family issues 6. More desirable location 7. Increased paperwork and changes in medical reimbursement 8. Frustration with law suits 9. Burnout 10. Advance to other aspects of medicine
happy, and academic medicine and large group practices are certainly no exceptions. Also an enjoyable medical practice is very much like a marriage, relying on very close personal relationships with people who will be spending the largest portion of their time together. You must love and trust everyone you work with, or quality of life will suffer greatly, leading to dissatisfaction and a desire to go somewhere else and perhaps do something else. The boss is usually the major factor in this setting. If a pediatrician has no control over administrative issues, the work environment may change to something considered untenable to her or him. Next on our list is lost skills, discussed above as a reason that physicians who are in subspecialties that require special skills might retire early. In pediatrics, these specialties are ones that include surgical procedures, intensive care, endoscopy, dialysis, and cannulation of blood vessels. Other than illness among family members, there are other family issues that may lead to retirement: the death or displacement of a relative that requires extended family support for surviving members; family businesses that need new management, with the preference for a family member taking over this responsibility, and that family member may be a physician; maintenance of family property; and issues related to family divorce. There are always those physicians who desire a better location to live after their children have grown based on a better climate (Florida here we come), more rural or urban environment (Arkansas vs New York City), lower crime (not East St Louis), or a location closer to family members. If a reasonable medical position is not available in the new location, physicians just opt for retirement, even though it may be relatively early. There are, unfortunately, some negative aspects to the modern practice of medicine that were not there when current senior pediatricians began their practices.
Some are the greatly increased paperwork required by insurance companies, Medicaid, and Medicare; changes in reimbursement to levels that make it difficult for practices to be profitable; and a substantial increase in the number of trivial law suits. These simply make the practice of medicine less enjoyable. Physicians are trained as clinicians and scientists, not businessmen; but with the greater overhead and lower reimbursement, all physicians must spend increased time in addressing business issues. Perhaps the worst change is the increase in malpractice litigation, unique to our country. The average physician is sued every 10 years with considerably more than 90% of these suits having absolutely no merit. However, medicine is a very personal business, and not only are these lawsuits time-consuming for physicians, but more important, they are stressful to our basic vocational principles. As with every profession, there may be the “burnout” phenomenon, as defined by George Babbitt, the realtor in Sinclair Lewis’s novel and as part of the midlife crisis syndrome, if indeed it really exists. I think it is a rare reason for retirement because all aspects of medicine offer new and stimulating challenges almost daily, and there is always something new to learn. There is certainly no monotony in medicine. Finally, some pediatricians retire from practice to assume administrative roles in hospitals, medical schools, public health, insurance companies, or other areas within the health care industry. These individuals are not truly retired, but they no longer work as pediatricians. In summary, pediatricians live longer and retire later. We are all happy to be doing what we are doing. The logo for pediatrics should simply be “Life is Good.” Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. National Vital Statistics Reports. 2013; 61:12. 2. Frank E, Biola H, Burnett CA. Mortality rates and causes among U.S. physicians. Am J Prev Med. 2000;19:155-159. 3. In memoriam. Monthly AAP News. 2000-2014;16-36.
Downloaded from cpj.sagepub.com at UNIV NEBRASKA LIBRARIES on November 26, 2015
