Golden years

Physician retirement: A triad of loss and how to prevent it

Joseph M. Kaczmarczyk, DO, MPH, MBA, shares details about the identity crisis he experienced when he retired and how he resolved it.

Joseph M. Kaczmarczyk, DO, MPH, MBA

Dr. Kaczmarczyk is a DO physician, who retired as the vice dean of the osteopathic medicine program on the Philadelphia campus of the Philadelphia College of Osteopathic Medicine (PCOM) in July 2022.

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When I began to contemplate my retirement from osteopathic academic medicine, I became a student of physician retirement. I approached the subject of physician retirement with fervor and academic rigor. In this article, I am going to share the lessons I learned through my own physician retirement experience.

Physician retirement is unique in that a physician’s role can be all-encompassing and a major component of one’s identity. Retiring from medicine is associated with a triad of loss: loss of professional identity, loss of purpose and loss of meaning.

This triad is a cascade that is initiated by the loss of professional identity. My favorite definition of physician professional identity is “a representation of self, achieved in stages over time during which characteristics, values and norms of the medical profession are internalized, resulting in an individual thinking, acting and feeling like a physician.” When this thinking, acting and feeling like a physician is lost, an identity crisis ensues and opens the door to loss of purpose and subsequent loss of meaning. If these three losses remain unaddressed, a fulminant existential crisis can occur. I know because I experienced one—and I hope my disclosure and vulnerability will be comforting and helpful to those experiencing something similar.

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Despite my knowledge of the potential negative consequences of physician retirement and my proactive efforts to avoid them, I experienced, rather unexpectedly, a professional identity crisis, which worsened into an existential crisis. I felt worthless. I was lost and adrift in a sea of loss and grief, as I questioned my very existence. Knowledge was simply not enough. I needed more support as I began to build a new life.

The confusing mindset around identity

An existential crisis for a retiring physician is a period of profound self-reflection and great uncertainty about identity, purpose and legacy with few, if any, readily available answers. After dedicating decades to medicine, a physician may struggle with questions such as: Did I make a difference? Who am I now? Why am I here? What comes next? Accompanied by feelings of loss, regret or even guilt over past decisions, some physicians may feel disconnected from their sense of purpose, especially if their careers were deeply, inextricably intertwined with their identity.

When talking about the importance of physician professional identity, I invoke the image of a Jenga tower with the pieces arranged neatly and symmetrically, except for one protruding Jenga piece labeled “professional identity.” Imagine, if you will, attempting to extract that singular Jenga piece with all the surgical skill and precision of a world-renowned surgeon, only to have the entire Jenga tower collapse. This example illustrates the central role physician professional identity plays in the progression of this triad to the development of an existential crisis.

How can you identify a physician at risk for this triad of loss?

As physicians, we are taught to use screening questions. Theresa M. Amabile, PhD, from the Harvard School of Business, provided a guiding point to such a question: “Would you say work is what you do or who you are?” Those physicians who indicate that medicine is who they are should be considered at extreme risk for loss of professional identity, the triad of loss and existential crisis.

These physicians would benefit from skillful introduction to “Protirement.” In “The Three Stages of a Physician’s Career: Navigating from Training to Beyond Retirement,” the authors advocate for what they call “Protirement,” defined as “retiring from medicine to something else that gives your life meaning and gives you a sense of contribution to society.” In other words, to protire means you are not retiring “cold turkey.”

Instead, a physician needs to identify his or her core values—both personal and professional. Articulate them by writing them out, clarify them and rank-order them to help you make decisions that align with your core values. By doing so, you will discover (or perhaps rediscover) the person under the white coat—your authentic self.

A core values-based approach can bring purpose into focus. Purpose can provide meaning. Subsequently, a new identity can emerge. The GROW model (Goal, Reality, Options and Will), is a coaching framework that can help retiring physicians find new purpose, meaning and identity in a life after medicine.

  • Grow: Establish a clear end goal—Who is the person you aspire to become and how will you shape that future version of yourself?
  • Reality: Develop awareness of your current situation—are you on a helpful path? How will the steps you take now help you later to enhance your desired trajectory?
  • Options: Identify the various routes you could take to your goals—what decisions, strategies or resources could move you toward your goals?
  • Will: Decide on your plan of action and what you will do to strengthen your resolve to stay aligned with your ideal path.

I chose to make a change in trajectory and decided to train to become a physician coach, and along with engaging with a physician coach for myself, I completed a successful journey into retirement and beyond to the next chapter of my life. I now have a new identity and a renewed sense of professional fulfillment. This process changed my life. Consequently, I developed the Physician Retirement Emotional Preparedness Program, incorporating all that I have learned during my own journey to assist other physicians in embracing the next chapter in their lives with clarity, confidence and control. I plan to delve further into the specifics of PREPP in a future column.

If you are approaching retirement, I recommend sitting down to reflect on your core values and envision how they can guide you to find purpose and meaning beyond your physician identity. Having this vision laid out in front of you as you plan and embark on your retirement can provide you with active steps to take toward making those goals a reality.

As we reflect on physician retirement, let us always remember that every stage of a physician’s career is an essential chapter in a much larger and compelling story. Physician retirement is not the end, but rather a transition to new beginnings.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

After retiring from medicine, keeping up (for the fun of it)

Denouement: How life evolves after you retire from medicine

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17 comments

  1. Charles Kaluza, DO

    I was an ENT surgeon until I turned 46 and developed Rheumatoid arthritis. For some reason they do not let you operate if you keep dropping surgical instruments and had trouble tying Knots.
    It was a major psychological crisis…if not a surgeon then who am I and what can I do now. I found some fulfillment in teaching and had wonderful family support but who was I.

    Reply

    2. Bill Xie

      After retirement, all physicians should totally forget about your professional identity! All of us should start our new life, i.e. taking on our hobbies! This triad loss shouldn’t exist at all! Otherwise, do not retire, period. Dr. Perry Dworkin is our model! (see his comment below). Thanks.

      Reply

  3. Tristan Kohut, DO

    Wow! Definitely relates to me! I can understand and use the advice. The lesson learned is that “physician” is how you expressed your personhood. You find alternative ways to express “who you are.”

    Reply

  4. Perry M. Dworkin,D.O.

    I did not have a problem. I enjoyed my professional life and was proud of my accomplishments and was ready to retire without any reservations or regrets. I thoroughly enjoyed my career and remember it well and satisfactory. I have no regrets about retiring and I do not miss working. Perry M. Dworkin, D.O., FAOCR.

    Reply

  6. Eric Katz, M.D.

    I had similar concerns prior to retirement from anesthesiology eight years ago. Prior to retirement I took up new endeavors like beekeeping, mango tree grafting, and martial arts. I was also able to work a few days a month PRN at my old surgery center for a few years. Now fully retired, I’m busy every day and usually feel like there aren’t enough hours in the day for me. My advice is to find things in which to channel your energy and you’ll never be bored.

    Reply

  7. Walter Lee Irving

    I keep busy every week with the things that matter to me. I have interests outside of my prior medical experience, but I also practice medical care for patients who are in the poverty level and have no insurance. South Carolina has a VIM clinic experience for all physicians. I don’t do deliveries or surgery except office procedures, but I still make a difference with all age patients that need primary Gynecologist care. You should keep that in mind when you are retired.

    Reply

  8. Sirona Pruna

    We do exist as human beings , we are very complex creatures so we have to acknowledge our complex life and potential. Being a doctor is ( it was-in my case since I am retired now) just a chapter in our life! Maybe the most significant one, but is so much to do and the most I like is having the freedom to discover and to enjoy everything that I missed! Even hiking almost every day day, watching birds coming in my backyard, traveling when I want and where I want gives me a fantastic feeling of freedom! So I am feeling happy and I think I completed my duties to society !

    Reply

  9. thomas barley MD

    It is possible to wean yourself from it. I cut down from 60 hours a week to 50 hours a week at age 40 and 40 hours a week at age 50 and 30 at age 60 and afterwards and retired at age 67. The gradual withdrawal was not painful whatsoever. The best point is when you become debt-free and therefore somewhat independent.

    Reply

  10. Martina Nicholson MD, FACOG

    My way of describing how it feels was to say it was like being a banana without a peel. In spite of many other things I am doing and love to do, my whole self felt vulnerable and without the ‘cover’. It took about 2 years to be able to reduce the vulnerability and loss to a bearable level, although I did keep busy and active. Writing poetry continued to help give me a focus. But some of the disorientation was with wide expanses of unstructured time, in comparison to trying to squeeze every minute out of every hour before!

    Reply

  11. Donna Cardoza

    The best approach to not having an identity crisis is to gradually retire if possible. Cut hours to part time as you start adding in hobbies. Stay close to friends and families. We spent so much time at work that work does become out lives.

    Reply

  12. Susan Reeder, M.D.

    Retirement is the time to start pursuing those other interests that one didn’t have time for while in practice. I picked up playing guitar and piano again. I’ve also added dulcimer, mandolin, and most recently, fiddle. I volunteer through the service organization that I am a member of, and I help staff the genealogy desk at my local library. I’ve served on the Alumni Board of my medical school. There is a whole world of things to learn and to do.

    Reply

  14. R Wingrove MD

    Related to your article. I was somewhat blindsided into an early retirement. And despite previously joking about retiring early, it was an adjustment. And I have plenty to keep me busy. Martina Nicholson, MD described it well. I think some people adjust well to retirement and some struggle. Not just physicians.

    Reply

  15. Frank Cebul, M.D., FAAFP

    When I retired from a busy Family Medicine practice 5 years ago the biggest issue that I had to work through was a sense of irrelevance. I missed the friendships and comradery with my former partners, nurses, and office staff. When I returned to the office to visit they really did not have time to socialize and it became obvious that was no longer part of the Team. Fortunately two of my former (retired) partners got me involved with Hospice and Kiwanis. I am now active in multiple volunteer teams and I feel that I am still making a difference in people‘s lives. I exercize regularly with cycling, swimming, and pickleball groups. And I am learning a foreign language. I don’t have time to work! Once you get past the initial feelings of irrelevance you‘ll Go as far as your imagination and dreams take you.

    Reply

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