My Retirement from Academic Medicine

By Rajam Ramamurthy, MD

The Academic ‘Bug’

While explaining the total and differential WBC (White blood cell count) to the student who was assigned to me when I was a senior houseman in the General Hospital pediatric ward in Chennai, India, I turned around to see that a group of students and nurses had gathered behind me. One commented, “Thank you, Ma’am. No one explains simple things to us; it is taken for granted that we know those things and we are too shy to ask, fearing we will be judged as stupid.” That statement has stuck with me all my teaching life.

During my pediatric residency at Cook County Hospital in Chicago, I was doing a newborn baby physical examination. It was customary for me to always request that the mom come and be with me so I could finish talking to her during my exam of the baby. The group of students who were assigned to neonatology would gravitate to where I was. Part of what I did and spoke was work, but part of what I did was showmanship, nicely said; role modeling. However, at some back corner of my conscience an image of myself was building, it was that of a teacher- ‘Guru’ in the Sanskrit language (Gu meaning darkness and Ru- light, literally a teacher who removes the darkness and shines the knowledge of light). A taste of this is intoxicating; it drives your career choice and is the most difficult one to withdraw from as one contemplates retirement from academic life. Bitten or smitten by the academic bug is no understatement.

Decisions to enter and exit academia:

The environment of one’s training greatly influences a physician’s career path towards clinical care, research or teaching. A person with an MD or DO degree who chooses an academic career balances on one leg of this so called ‘three-legged stool’. Teaching was the leg I stood on. One study shows that the primary reason women chose an academic career is an interest in teaching. The same study showed that women choosing academic medicine did so not as a planned decision but a serendipitous one realized almost at the end of fellowship. Silver et al, in a study involving 4,572 physicians, found that the average age at retirement for most physicians was 65 years, but women physicians tend to retire on the average 4.1 years earlier than men. Also, about 40% of the physicians reduced their activity by at least 10% for 3-4 years prior to retirement. This should enter the calculation when work force numbers are calculated based on the number of licensed physicians.

Although there are several papers regarding pre-retirement preparation, there are very few studies addressing the period surrounding retirement and post-retirement. Factors affecting male and female physicians’ retirement decisions include: general environment at work, decreasing income, employment of spouse, income after retirement (Social security income, pension or annuity other sources like rental property) current age, the existence of dependents in the family, years of service as a physician, the health status of self and spouse, stress/burnout, personal interests and the availability of part-time jobs. Once the decision is made to retire, there is almost no road map for that physician, particularly in the psycho-social aspect, which has prompted this article.

It was the last time I would give this lecture to medical students and residents which I did once a month. It was about skin conditions in the newborn baby. I had pictures of skin problems with a ‘wow factor’ of 10 on a scale of 1-10, as the students called it. I had mentioned that it was my last teaching session; I retired that week. At the end of the session the residents rushed to finish their work, the students rushed to the cafeteria to grab lunch. I sat down for what felt like a very long five minutes. Is that it? Forty-two years of a teaching career and no one in the institution cares? You just pack up, turn the projector off and walk away? It certainly seems like there could be something we do in recognition of a last teaching session, last surgery, last clinic patient, last day at work, to put closure to a lifetime of work for most physicians.

Life after retirement

Ideal retirement means something different for each physician. The most common statement I hear is that they are relieved that they do not have to follow any schedule. That was true for me. It was followed by using that unscheduled time in committing to unnecessary activities like listening to online webinars, attending lectures, book clubs and planning to have lunch with other retirees. Others plan vacations they should have taken at a much younger age when their stamina and agility would have allowed them to walk the long trek to Petra and back instead of staying back looking at the facade. Those who are grandparents among us overcommit to taking care of grandchildren, finding ourselves in the familiar place of playing the role of parents. However, this is among the things grandparents do that is probably the most pleasant engagement that infuses youthfulness and joy in one’s life.

My retirement planning started two years before actual retirement. I was in my office preparing a lecture, an activity I thoroughly enjoyed. It occurred to me that I can do this forever. I love to write! I should do that while I have the clarity of thought and physical wellness. It was at that point I decided I will set a retirement date. I felt that my work environment was ready for that as well. I have written a lot since then,

but my book is still only in my head.

After the honeymoon period, boredom sets in. Every physician friend who retired has expressed the desire to do some part-time work. Most academic retirees have not expressed financial reasons for wanting to work but just to be doing something to keep medicine in their life. Working as Locum Tenens, telemedicine, overseas volunteer work, volunteering in a clinic are among medical activities which attract physicians. Physicians who have a serious passion like gardening, golfing or mountain climbing have delved into these activities with gusto. This is a financial commitment as well and should be considered when planning finances. For me, it is teaching Indian classical dance. I spend twenty hours a week teaching, preparing lessons, organizing programs and other dance related activities. The financial perks are minimal but the physical and mental fitness aspects of it are great rewards.

The Forest Dweller

Some colleagues have delved into reading religious literature for an in-depth understanding their own religion and sometimes other world religions. In the Hindu way of thinking, humans go through four phases of life. The student (Bramacharya), Householder (Grihastha), Forest dweller (Vanaprastha) and Sanyasi (Renunciate). The first two stages are obvious, the third literally means retiring to the forest and trying to withdraw from a material world to spend more time on spiritual pursuits. In modern times, this is the stage of retirement when one gradually tends towards spiritual pursuits. Time spent in meditation or prayer gives a special kind of quietness as we get into the later stages of retired life. I have heard senior friends say that they achieve this while doing dishes, gardening, singing or listening to music. In English literature, life’s seven stages were eloquently described by Shakespeare in the play ‘As you like it’.

All the world’s a stage,

And all the men and women merely players;

They have their exits and their entrances;

And one man in his time plays many parts,

His acts being seven ages.

There are differences between male and female physicians in the manner they consider retirement.

Rajam Ramamurthy, MD is a member of the BCMS Publications Committee and is a past President of the Bexar County Medical Society.

References:

Key findings highlight perceived barriers to retirement planning at various career stages in addition to factors that can enhance physicians' retirement planning, including creating gradual and flexible retirement options, supporting ongoing discussions about financial planning and later career transitions, and fostering a culture that continues to honour and involve retirees. Medical institutions could foster innovative models for later-career transitions from medicine in ways that address physicians' needs at various career stages, support gradual transitions from practice and recognize the value of experienced, capable latercareer physicians and retirees.

Planning for retirement from medicine: a mixed-methods study

Michelle Pannor Silver 1, Laura K Easty 1

Affiliations expand • PMID: 28401128 • PMCID: PMC5378543 • DOI: 10.9778/cmajo.20160133

Free PMC article

Implications: Strong work identity and tensions between different generations may confound concerns about retirement in ways that complicate institutional succession planning and that demonstrate how traditional understandings of retirement are out of date. Findings support the need to creatively reconsider the ways we examine relations between work identity, age, and retirement in ways that account for the recent extensions in the working lives of professionals.

Gerontologist 2018 Mar 19;58(2):320-330. doi: 10.1093/geront/gnw142.