Preparing Others for YOUR Retirement: Challenges You Never Anticipated

Anesthesiologists work in an environment in which every member is a cog in the wheel. A missing spoke could cause the entire cart to collapse. Hence, when we retire, or even step into a new role, it behooves us to prepare ourselves and others for our new phase in life. One could argue that this is impossible. It requires much effort to prepare for your own retirement, and to consider preparing others may be asking too much. Each of us is a unique individual with differing skills, temperaments, and histories that brought us to this moment in time. As we contemplate retiring, each of us should ideally analyze our personal situation by assessing:

1. Tangible resources – financial and physical
2. Mental resources – emotional health, motivation, cognition
3. Social resources – social support and quantity and quality of interaction.

“Even for those in longstanding relationships, retirement may represent the longest period of time spent with one another on a daily basis. Developing mutual goals and plans for the future, determining who will have the responsibility for routine tasks (i.e., paying bills, grocery shopping, arranging social meetings), and maintaining daily routines are topics that must be broached.”

Maintaining or increasing resources in any domain can lead to increased satisfaction with retirement, whereas a decrease in any domain might decrease satisfaction and even cause us to reconsider our decision (J Vocat Behav 2012;81:171-82).

Everything starts at home

We live in a dynamic world with dynamic relationships. These relationships and circumstances change with retirement, sometimes dramatically. It is wise to consider the effect of retiring and to facilitate meaningful conversations before retiring. This is most important for the individuals who may be in your household – companions, adult children, and especially spouses (asamonitor.pub/3YYKpp4). Each partner in the marriage may have been focused on different individual priorities during the working years, e.g., occupation or children. Even for those in longstanding relationships, retirement may represent the longest period of time spent with one another on a daily basis. Developing mutual goals and plans for the future, determining who will have the responsibility for routine tasks (i.e., paying bills, grocery shopping, arranging social meetings), and maintaining daily routines are topics that must be broached. This may alleviate some of the tension that occurs in retirement, which can lead to unhappiness and ultimately a breakdown of the relationship. “Gray divorce” has surged in recent years. As per U.S. Census statistics from 2021, 34% of women and 33% of men aged greater than 20 who ever married underwent divorce. However, the number is a startling 43% for both sexes in the 55-64 year age range (census.gov/).

The social network

Outside of the home, social connections at work are vitally important. The longest-running study in the world, the Harvard study of adult development, searched for answers to the most important question facing mankind: “What makes us happy?” In this landmark 85-year-old still-running study, 724 people, ranging from those living in Boston’s poorest areas to Harvard undergrads, were followed through their middle and late years to see what motivates them and keeps them happy (asamonitor.pub/4hIJdxu). They were questioned every two years, and even their family members were questioned. Some of the participants are now in their 90s. The surprising answer to the above question was not health, exercise, job, or even social status: it was personal and social connections. Participatants emphasized the desire to increase positive social interactions and decrease negative interactions. In the words of one of the investigators, Dr. Waldinger: “Personal connection creates mental and emotional stimulation, which are automatic mood boosters, while isolation is a mood buster.” Hence, preparing your family and friends for retirement and making social and leisure plans are key ingredients to happiness. To facilitate this, sometimes legal and financial tools allow the retiree to be confident that hard-earned money is used for their benefit and shared according to their wishes. Discussions surrounding the creation and use of wills, advanced medical directives, and financial power of attorney are supremely relevant.

The workforce balance

ASA membership data from 2023 indicate that late-career anesthesiologists practice mainly in urban/suburban settings (92%). Fifty-six percent of respondents are in private practice, with 39% employed by a health system (including those in an academic/university setting) or the Veterans Administration. Seventy-seven percent practice in multispecialty hospitals, while another 12% practice in freestanding ambulatory surgicenters (ASA 2023 Retired Member Survey, Final Report; 2023). Regardless of practice location, retirement does leave a lacuna in the system that needs to be filled. In the current market, there is a shortage of experienced anesthesiologists, which may make the void difficult to fill (Anesthesiology 2024;141:238-49).

Retiring physicians may want to assist their colleagues and practices because they recognize that their retirement may exacerbate the current workforce imbalance. In some departments, medical schools, and practices, there are established procedures for retiring physicians to follow. Advance notification of intent to retire may be specified in employment contracts, human resources policies, or departmental/academic procedures. Typically, this will allow time for the employer, if possible, to recruit or make alternate arrangements for the provision of clinical care and other work responsibilities. Gradual transition to retirement, rather than stopping work abruptly, is beneficial for the individual and allows time for the employer/practice and the employee to adjust. Many large academic centers have an established retirement pathway where clinical responsibilities are gradually eased off, while emphasizing adequate replacement training as well. However, if such a path is not available, specifically identifying and discussing modifications to work schedules and stresses to allow for gradual transition to retirement are useful for both the individual and the practice.

I’m retired, but can I still work?

As we move through the various stages of retirement, humorously known as Phase I – GO GO!, Phase II – SLOW GO!, and Phase III – NO GO!, there are times that work and colleagues left behind come to the foreground. For some, these are dismissed: “Hanging up the scrub cap” means exactly that, and the response is, “I’m retired. I’m happy. Enjoying life without it”! Some others choose to redirect their energy to related but nonclinical responsibilities such as political advocacy, administration, education, and research, either as a continued contribution to previously held roles or as part of a renewed emphasis on personal values. Still others may choose to maintain a time-, acuity-, or location-limited clinical presence through locums or casual work, or even international mission trips or teleconsultations. All of these commitments require a careful analysis of time and scheduling vis-a-vis health and social pressures.

The intricacies of communication at work, beyond the OR

Although there are systemic arrangements that can be made regarding scheduling and patient care, what about preparing others to take YOUR unique place? All of us are aware of the person we “go to” for difficult or complicated issues. We may even be that “go-to” person. What happens when the go-to person retires? This may require careful planning and replacement training.

For many who retire, routine, consistent communication with (and dissemination of information through daily work from) experienced clinicians may no longer be available, unless mechanisms to address this loss can be implemented. Fortunately, through technology like webinars, podcasts, blogs, and virtual meetings, there may be opportunities for retiring physicians to participate virtually. Those who have worked for years can share their experiences, which can offer valuable insight into situations like dealing with surgeons and professional colleagues and even addressing uncommon clinical situations or crisis events. Simply put, it is “what to do when you don’t know what to do!”

Many of us engage in meaningful individual activities or roles that we want to continue, albeit partially, after we retire. These are typically defined for businesses, hospitals, departments, and universities in the realms of education, research, and administration, e.g., residency program director, medical staff president, OR director, or primary investigator. There are many articles, workshops, and even templates describing approaches to succession planning for businesses. Many of these techniques can be applied to health care as well. These processes ensure that the right individuals are selected, developed, and prepared to take on defined roles. They are crucial to adequately replacing exiting talent so the vitality of the organization may continue.

Each of these areas has multiple facets and opportunities for involvement, particularly for those late in their careers or who are in the process of transitioning to retirement. It is particularly valuable to begin the process for someone to take your place while you are still working.

The scenario is different in private practice

The culture of a private practice and how it is communicated to its members is of fundamental importance. However, within that culture, the evolution into leadership roles is not rigidly formalized. Formal mentorship is often not a legacy in private practices, but the influence of excellent clinicians and active participants in the management of the practice is recognized and often emulated. In retirement, some physicians may remain as consultants to their practices, while others may, especially if there are workforce shortages, continue to work clinically in a part-time capacity. Other options depend on the needs and interests of the practice and those of late-term and recently retired members. There are some roles that do benefit from more direct mentorship within a practice, especially in the area of contract negotiations with hospital administration and third-party payers. Identifying members with these interests and skills is important in maintaining the practice’s strength. In addition, and not unique to private practice, competition within a practice or even a department of competitive people should ideally be transformed into a source of growth and improvement, reinforcing the mission and goals of the practice.

In precis, how can retired members contribute (Committee on Retired Member Engagement October 2021)?

Review items for others, such as presentations, research, resumes, and promotion portfolios.

Educate on clinical, professional, and administrative issues and serve on committees and councils as allowed. Participate with valuable insight on mortality and morbidity presentations in particular.

Take time to contribute to your own mental and social health.

Provide Insight regarding choices, career, and family life to those dealing with issues.

Research items that are important to you and make time for them.

Enjoy and celebrate successes – for life is short!

Do what makes you and others happy!