RETIREMENT FROM SURGERY

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RETIREMENT FROM PRACTICE WHEN SHOULD THAT
HAPPEN P.G.Alley SEPTEMBER 2009
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BARRIERS TO RETIREMENT

• Vocational vs job
• Owing the community
• Interesting work why to stop doing it?
• If work stops no money.

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RACS Active Fellows Ages
Australia NZ
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• Doctors can reasonably expect to live into their
  early eighties
• AT LEAST

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THE BIG QUESTION

• What do you want to do when you retire?
• What are you going to do for those ten or
• fifteen years from your mid sixties?

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See the world?
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Go to sea?
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Catch crayfish?
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Play Golf?
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MAJOR HAZARD AHEAD

• Do not envisage your leisure pursuits as the
  principal occupation in retirement. All reputable
  authorities say, with graphic examples, that
  intense and deep boredom is the likely
  consequence of such a move.

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• I keep six honest serving men.
• They taught me all I knew.
• Their names are What and Why and When
• And How and Where and Who.
• Rudyard Kipling The Elephants Child1902

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ANOMALIES ABOUT DOCTORS

• They are well used to long preparation for the
  undergraduate, post graduate and specialist
  training part of their life BUT
• They do not prepare in such depth for retirement
  arguably an equally important part of their
  lives.

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ANOMALIES ABOUT SURGEONS

• They readily appreciate the preference for
  elective surgery compared to acute surgery for
  any given condition
• BUT they often retire acutely

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TIMING IS NOT THE ONLY THING

• Retirement compared to Surgery
• The timing of elective surgery is patient
  dependent (in part)
• The timing of acute surgery is disease dependent
  (in part)
• The When is only part of the story
• Elective surgery is better and usually safer than
  acute surgery

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ACUTE RETIREMENT HAPPENS!

• Sudden mental or physical illness
• Sudden change in personal circumstances
• Sudden deterioration in cognitive function
• Sudden change of heart

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• THE CHALLENGE IS TO AVOID ACUTE RETIREMENT!!!

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ELECTIVE RETIREMENT MYTH 1.

• Ill retire when my colleagues say I am past it
• These are often translations of the statement
• Ill retire when and how I want to

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ELECTIVE RETIREMENT MYTH 1.

• No one else will make those decisions
• Especially colleagues or patients.
• Generally they have too much respect for you to
  make such suggestions

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ELECTIVE RETIREMENT MYTH 2.

• Ill retire when I am unable to cope with the
  call duties
• Ill retire when I am too slow

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• If the situation has got to the point
• when YOU notice a decline in function then
• it is possibly/probably late in the
• development of that decline in ability.

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WHY DO SURGEONS RETIRE 1984 -1985

• Leisure 20
• Non-surgical Activity 9
• Health 26
• Lost interest 9
• Pension/Annuity 6
• Unfavourable Sector Changes 29
• FACS data

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WHY DO SURGEONS RETIRE 1994 -1995

• Leisure 20
• Non-surgical Activity 2
• Health 14
• Lost interest 2
• Pension/Annuity 6
• Unfavourable Sector Changes 56
• FACS data

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IS RETIREMENT MANDATORY

• Not in NZ (Human Rights Act 1994)
• Not in Australia (Age Discrimination Act 2004)
• Provided you are fit for the job there is no
  retirement age

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AN ETHICAL DILEMMA

• If the general population is not bound to retire
  at a given age why should surgeons do so?
• Because their principal activities affect the
  lives of others, therefore-
• There should be objective appraisal of surgical
  capability after a certain age.

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HOW TO ASSESS COMPETENCE

• Peer review
• Cognitive Assessment
• (Micro Cog or CANTAB)
• AUDIT

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OTHER ISSUES TO CONSIDER

• Loss of purpose
• Loss of Status
• Loss of Busyness
• Loss of Health and Vitality
• Loss of Companionship

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ISSUES FOR THE LIFE PARTNER

• Retirement is twice the husband and half the
  money!!
• Wife of recently retired surgeon 2005

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ISSUES FOR THE LIFE PARTNER

• Loss of space
• Loss of Freedom
• Loss of Leisure
• Loss of Job Satisfaction

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SHOULD I DO LESS OF THE SAME?

• PRO
• Offer a much needed service
• Source of sage advice/mentoring/teaching
• Retain surgical skills
• Avoids on call
• Maintains income

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SHOULD I DO LESS OF THE SAME?

• CON
• There is no minor surgery only minor surgeons
• Collegial resentment
• Denying positions for younger possibly better
  surgeons

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GOING ON PAST RETIREMENT AGE

• Are you happy doing that?
• Are you competent as determined by peer review
  and
• OBJECTIVE ASSESSMENT of cognitive function

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• NOT When should I retire
• BUT I SHOULD RETIRE WHEN..

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THE PLANNING IS DONE

• 20 Years
• 10 Years
• 0-2 Years
• Life partner considerations
• Professional Partners
• Records

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I SHOULD RETIRE WHEN

• Ive given it a lot of thought
• Its a fork in the road NOT the end of the road
• Made the preparation for it
• Discussed it with the relevant people who are
  going to be involved

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PREPARATION SOME IDEAS

• Retain contact with your hospital
• Either formally or informally
• Stay fit
• Become e- savvy
• Read not only non medical but medical
• Write and learn to touch type
• Consider political support
• Identify charitable interests and voluntary work

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SOME Rs

• Retire the word Retirement
• Retain the competencies you need
• Restructure your priorities
• Renew your zest for education

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MORE Rs

• Respond to new opportunity
• Recharge your body by getting and keeping
  physically fit
• Revisit your childhood dreams
• Be Responsible for Winding down your practice
• Remember your wisdom stays with you.

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This is a SUNRISE Not a SUNSET