If you are a solo orthopedic surgeon or practice in a small group and are 55 years or older, this article is for you. The answer to the question “When is the right time to begin planning for the transition out of practice?” is now. And planning is the most important word in that sentence.
Joining your peers who’ve quit, often rather quickly, because of Obamacare, electronic health records (EHRs), or the implementation of ICD-10 (International Classification of Diseases, Tenth Revision) may prove unsatisfying. As the saying goes, “act in haste, repent at leisure.” And as a gerontologist friend of mine liked to say, “Retiring from medicine without retiring to something is risky.” He often quipped that golf didn’t count.
Recent survey results help support his point. In the 2014 Medscape Orthopedist Compensation Report,1 respondents were asked:
What is the most rewarding part of your job?
- Gratitude/relationships with patients 43%
- Being very good at what I do/Finding answers, diagnoses 31%
- Making good money at a job that I like 10%
- Knowing that I’m making the world a better place 7%
- Being proud of being a doctor 4%
- Nothing 1%
- Let’s hope you are not part of the 1%!
In the often-quoted Deloitte 2013 Survey of U.S. Physicians,2 6 in 10 respondents predicted that many physicians will retire earlier than planned in the next 1 to 3 years. Yet even in that survey, 41% of surgical specialists said that patient relationships were the most satisfying factor about practicing medicine. Protecting and promoting individual health was second (33%), and intellectual stimulation was third (16%).2
As Steve Marsh, managing partner at The Medicus Firm, Dallas, was quoted as saying about this data, “For older doctors, being a physician is much more of a lifestyle than a job.”3 In my 40 years of working with physicians, I agree. And that’s why you, dear readers, must begin the transition planning process now, if you are 55 years or older, or soon, if you are approaching this age. Unraveling yourself from the patient relationships and the profession you have enjoyed for so long will feel like a big loss for the majority of you. There will be a grieving process. You’re not just leaving a “job,” you’re leaving your “life’s work,” and the sooner you begin planning for this shift, the less uncomfortable it will be.
Transition Planning Timeline
As the Chinese saying goes, “the longest journey begins with a single step.” The first, most challenging step in transition planning is deciding to address the issue head on—whether you see yourself practicing well into your late 60s or stepping aside 3 years from now.
Here are 7 questions to get you started. Discuss them with your spouse and a trusted advisor or mentor.
1. Have you done everything that you wanted to accomplish professionally? What’s left on your “to-do” list?
2. Are you satisfied with the legacy you are leaving to your community, partners, or employees?
3. What does your spouse think? His or her age and stage may dictate some choices. One wife said she believed in Henny Youngman’s advice: “Promise to take your wife for better or worse, but not for lunch.” Younger spouses in satisfying careers may not be ready to quit or slow down.
4. What could fill the void of, as the Medscape survey indicated, the “gratitude/patient relationships” and “being good at what you do” that you would be leaving behind? Could going on medical missions satisfy your need to keep your hands in? Or volunteering for the community clinic?
5. If you were to retire within the next 6 months, what would your routine look like? Because the first year is often filled with travel and long-postponed fun, think beyond that and describe year 3. (Assume good health and adequate finances.)
6. Are there options for part-time practice? Could you ease out instead of going basically full throttle until your retirement date?
7. Are challenges such as stress, fatigue, cognitive decline, or a feeling of burnout a reality for you? Be honest with yourself. These are real issues that not only impact your decision about when to transition, but also patient safety and care.
If you’ve reached 60 years of age and haven’t thought about questions like these, you aren’t alone. Many orthopedic surgeons delay this planning exercise for the same reasons other business owners do:
You are too busy spending all of your time putting out fires. Who has time to plan? Learning the new ICD-10 codes for local coverage determinations (LCDs), hiring a new physician assistant, firing the receptionist, and, oh by the way, taking care of a full schedule of patients, takes time and reduces the time to plan.