Life changes

Retiring from medicine: Knowing when it’s time to get out

My colleagues often ask me how to tell if it’s really time to retire. The answer is surprisingly simple.

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In 2019, I retired from a rather high-stress surgical practice after 30 years. I walked away for a very specific reason – I had to. But as I look back, the medical problem that forced my hands (literally) was also a serendipitous tap on the shoulder telling me it was OK to leave. It was time. And after I’d been out for a few months I realized something else – I had gotten out before I was permanently injured.

Ask me today why I quit and I might mention the physical limitation of the disability. But more likely I will quote one of the great American philosophers of the 20th Century – Popeye the Sailor Man – who memorably said:

“That’s all I can stands ‘cause I can’t stands no more!”

If you’re not familiar with the beloved cartoon character, you’re probably too young to be contemplating retirement right now. If a smile crossed your face, you’re either there or on final approach.

How do you know when to retire?

Since I started writing this column and pretty much ever since I retired, actually, I’ve fielded lots of questions that all come down to one thing – how do you really know when it’s time? They’re asked as if I’ve traveled to some terra incognita beyond the horizon and everyone wants to know what it looks like and how the weather is.

And when I talk to colleagues who have retired and drop my Popeye line – they almost all instantly nod in agreement. It seems like none of us were dragged kicking and screaming from our toil. We all went pretty gently, not to mention willingly, into that good night.

So it occurs to me that the answer to the question, barring extenuating circumstances, is pretty simple – it’s time when the job starts hurting us.

And it can hurt us. Badly and sometimes permanently. And we may not even be aware.

Nagging injuries

For all the wonderful experiences that come with caring for patients, working with trusted colleagues and just plain making a difference, there are a host of nagging injuries, the result of the sometimes brutal emotional collisions and concussions that we rarely talk about or refuse to acknowledge.

Perfect outcomes are always out of our reach and treatment failures, missed diagnoses and complications, not to mention the litigation that can ensue, are omnipresent threats. Some physicians are shielded by their arrogance, their avarice or their ignorance – but I believe this is a very small group. The rest of us suffer the slings and arrows with barely a whimper and just keep moving ahead.

But these days, there are way more slings and much sharper arrows. And the fortress that used to be our office or the hospital has been breached by ruthless C-suite executives, more of which we seem to see every year. And places to find shelter or protection are rapidly disappearing. It started with pagers, progressed to portable phones and then to cell phones and iPhones. The IT monster that is the EHR and 24/7/365 online access to every nook and cranny of the medical-industrial complex has stripped away the once-sacrosanct comforts of home and travel.

“They can always hurt you more,” a character in the book “The House of God” says. Now it’s more like, “They can always track you down.” We can work – work! – any hour of the day or night from almost any corner of the world where there’s a Wi-Fi hotspot or a cellular tower. And, more and more it seems, that’s exactly what we’re expected to do. What was once the unthinkable has somehow become the norm.

To paraphrase the inimitable John Mellencamp, work goes on, long after the thrill of working is gone. Sure, there are certainly plenty of pragmatic reasons to keep plugging along. Health care benefits for yourself or a loved one, enhanced financial security or maybe just a genuine love of the profession and the patients.

But I’m not talking about when to stay – I’m talking about when to go.

Hanging in vs. hanging on

There is, in my mind, a fundamental difference between hanging in and hanging on. And that difference is, well, different, for each of us. For me, it was the escalating daily battle with clueless and sometimes malevolent administrators, meddling middle managers, bumbling bureaucrats and some of my physician colleagues who were more than willing to do their bidding that did me in.

I freely admit it: These people wore me down. If I were a football QB I’d say I was getting sacked on every other play and targeting was definitely not a personal foul. And I loved what I did. I loved playing the game. But in hindsight, I realize first I was sent to the medical tent, and then to the locker room, and then into the stands – and just in time, I’m convinced now.

We all, regardless of our specialty, take our share of hits over the course of our careers. Sometimes we are, as the TV announcers like to say, slow to get up. But get up we do and shake it off, maybe rub a little dirt on it. So take a hard look at why you’re still in the game. More importantly, take a hard look at the toll the game is taking on you – on your family, your health, your happiness and your mental well-being.

Finding your end point

Medicine is a life of service, of sacrifice and of putting the needs of others before the needs of yourself and those you love. But as is the case for any good scientific study, there needs to be an end point. And as the study’s principal author, you need to be the one who establishes that end point.

Hopefully, you’ll be able to decide before you get to Malcolm Gladwell’s “Tipping Point” or have your Popeye epiphany. But if the Sailor Man’s words start to echo in your head, at least consider charting a course for home port. My other favorite quote of his is “I yam what I yam and that’s all that I yam.” As physicians approaching the end of our careers, I’d tweak that to, “We were what we were, but that’s not all that we are.”

Have a good year, no matter which side of retirement you happen to be on. And may you be “strong to the finich” – with or without your spinach.

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:

The pros and cons of staying involved in medicine after retiring

Pack your retirement go-bag now

91 comments

  1. John Swicegood MD FIPP DABIPP

    Awesome article Dr.Waters!
    After 35 years I am “transitioning” into to full retirement. I think two realities became unbearable to me. Managed care became managed neglect, and the hospital/insurance/MC/MD/big Pharma industrial complex became a cartel. Despite all my achievements, certifications, and endless hours – I was relegated a lowly provider, a healthcare comrade subject to the state, held to the letter of a distorted and dishonest system, driven by puppeteers guiding and exploiting all who enter.

  2. Jack Hotchkiss

    “it was’t fun anymore.”I loved what I did as an anesthesiologist. I retired from full time practice as it wasn’t fun to take night call and to do stressful cases. I worked six months in an overseas position, and then returned to a part time no call position for 7 more years. That was fun until multiple rapid changes to the practice made is not. Our hospital built a new hospital that was sterile and had many changes that I didn’t like. They had indicated that our department was consulted on the plans, but I was not. Actually there was also a large turnover in the OR nursing staff, and not only did I no longer work with nurses who had become my friends, I needed to instruct them in exactly what I wanted/expected from them. Ths ended my 23 full-time years, and 7 part time years of practice. I hit the ground running and was not “lost” from the loss of what had consumed and controlled so much of my life.Haven’t missed it overly, actually after 7 1/2 years.

  3. Brooks Conforti DO

    Good for you, Dr. Waters! I agree wholeheartedly and without reservation. It took me a year to admit it to myself, but you need to go before rust starts to settle on the ‘shiny bits’. As you said, we are SO much more than our professions. It’s a definite part of us, without a doubt, but it does NOT define me. I love your articles, BTW. Great insights!
    Happy New Year to you.

  4. Dr. Thom

    So true; with compassion burn out, bureaucratic headaches, insurance co. hoops to delay care and picking up the mess left by lower level providers who do not know their limitations there is a point to bail before ptsd sets in. When the fun is done it is time to leave the park!

  5. C.S. Bonney M.D.

    Beautifully written with with much insight, sentiment, and humor. Great philosophers, like Popeye, are too few and far between in the field of medicine.

  6. Michael P O'Leary, MD

    Enjoyed Dr Waters piece on retiring and the Popeye quotes in particular. Another colorful adage, and what I have told people who asked me why I was retiring comes from Mae West who famously said “Leave ’em while you’re still looking good.” Nobody should ever stick around long enough to be told they need to go.

  7. John Fornace

    One side effect that occurs after stopping practice is that you have more time to read articles about retirement. Your article definitely was the highest quality one I have read.
    I appreciated your allegorical use of the Popeye, slings with much sharper arrows, and “House of God” references. You lucidly describe the developments of our generation’s position. I know of
    going out willingly into the good night and physicians of the previous generation being dragged kicking and screaming.

  8. James Clinton DO, FACP

    Excellent article and perspective! I’ve been out of practice for a year now and the thing I miss the most during those thirty five years is the personal interaction that I had with my patients. I have so many great memories. When the scale tips to the negative because of the bureaucratic hassles of business and providing quality care, it is time to get out. You need to leave while you still have something left. Spending more time with family, especially my six grandchildren, makes up for the loss. Trying to be the best Popeye that I can be for my Olive is now my full time job.

  9. Matthew D. Kay, MD

    Well articulated. I just retired after 31 years of Orthopedic Surgery for what I suspect are similar reasons. My clinical acumen is at its peak, but my body has told me “time’s up”. Do not mourn the changes that life brings, the circle of life is inevitable. Rather, relish in the accomplishments that you have achieved, the many lives you have touched, and the positive impact that you have made for so many! I appreciate the “House of God” references – we have buffed too many charts, treated too many GOMERS, and genuinely done the best to do our part for our fellow humans.

  10. Mike

    31.5 years and I’m done. Watched it descend into organized crime masquerading as insurance. Patient’s became more and more behaviorally challenged and treated staff like it was no different than a fast food operation. Hope they like the next iteration of what these changes will bring, but not my problem anymore.

  11. Caroline Taylor

    I agree with you. Its not just what you can offer with efficiency, wisdom and expertise, but that must be balanced against one’s own stress and health issues. When its time to walk away your inner voice will tell you if you just listen!

  12. Dipak D. Nadkarni, DO

    Well written.
    My wife and I served on active duty in the US Navy.
    She died on active duty and was buried with full honors in Arlington National Cemetery in 2014.
    As a DO by medical school, an MD/DO by military medical residency
    In Family Medicine and I completed a near 30 year career retiring in 2021 to Florida I can honestly say that working in the civilian environment I found no mission like I did in the military.
    I worked very little in medicine in 2022 and may work more in 2023 but the excitement is gone.
    I would rather use the machine at the golf club where I take lessons to pick up balls at the driving range.
    No kidding and I might get the job.
    Like Forrest Gump mowing the lawn for free.
    I pray for all of my fellow physicians and wish them the best in their careers.

    1. Gottagit

      Thank you both for your service to this country….couldn’t agree more….after 34 years in practice, it was time…..time to wake up to the sun and birds, not making the daily mad dash to the hospital at 5:30 in the morning…..life is beautiful on the other side…..

  13. Ronald Ward, M.D.

    Too much in-house surveillance, lack of real administrative concern and support for physician for physician wellness, and little to no gratitude (except from appreciative patients). Always thought Popeye got it right.

  14. Kimberly

    I don’t look forward to it anymore. I enjoy running the business and working on the business instead of in it. Being a doctor seems to get in the way of what I really want to do.

    A part of me believes this is a mindset shift though. My plan is to give myself 2023 to figure this out and in the meantime try to continually tell myself how wonderful it is to have the privilege to be able to be a good physician of service. Let’s see how convincing I am. ‍♀️

    Thank you for this article.

  15. H M Armaiz

    After 40 yrs. In Otolaryngology, I stopped all surgery and quitted my hospital privileges.
    I only work 4 hours daily with spare time to do my things and to enjoy the time I have left. This article was exceptionally good. Everyone MUST read it

  16. Robert Pollack, MD

    I retired in April off 2022 after 49 years of practice. For the first time I did not have to tug my phone with me wherever I went nor did I have to respond to calls within minutes . While I loved my contact with patients, the healthcare industry became a battle. When all I wanted to do was care for the sick I found myself locked in combat with arbitrary overlords who would dictate how I should care for the sick, when and where. After several months I found ways of helping others and sought out the assistance of others docs who have combined to spread information to those still practicing and to patients who need information given to them in simple and direct terms.No money is involved and I am once again caring for others outside of the box that Popeye dreaded so much. Yes there is life after retirement

  17. ROBERT ZUCKERMAN

    Thanks for the focus. Unfortunately I am solo practitioner providing care to a community that does not have alternative resources and my responsibility is to keep going despite diminishing reimbursement and satisfaction.

    1. Alan Weinberg

      Until you die and they then find a replacement. If you think you are important, check your schedule the day after you die. Take care of yourself. Every extra day of work is one less day of retirement.

    2. Matt Freitas, FNP-C, PA-C

      I was in the same situation. After working what seemed like 24 seven for a year during the Covid pandemic Rather than keep going on I was motivated to try to find someone to replace me. It was surprisingly easy and I gave my practice away so that my patients would continue to get the care they needed. After two years I still believe I did the best thing for me and my wife. Actually I don’t believe you’re ready to retire yet. sure you’re tired, sure you’re resentful of the way medicine has changed but that moment you have in the exam room with your patient has probably never changed because you care for them. And when you retire you’ll miss that feeling I know I do.

    3. Gottagit

      Don’t sacrifice what is left of your life thinking you are irreplaceable…my husband was in the same position as you and when the day came when he HAD to retire-a replacement appeared….

  18. Marwan Balaa

    Very nice article Dr. Waters. It has been 2 years since I retired from my private Gastroenterology practice. I did a lot of research before reaching the decision. I read books and searched the internet, but was very dissatisfied with my findings. Most of the writings were focused on financial survivability.
    In my view there is more to that question than what Dr Waters mentioned. He elegantly tells us about the role “of what is pushing us” in fixing the timing of our retirement. I believe there are 3 other factors in addition to “being pushed away”, to facilitate the retirement process:
    1. Finding things that would “pull you towards them” in the retired life. These things are best cultivated in the years leading up to retirement, to be tried as sustainable vocations that are enjoyable and that would put structure into the new life. In my case it was reading and traveling. Working around the house and fixing things is also satisfying and earned me brownie points.
    2. Cultivate an acceptance of adaptability and change. That includes trying to be politely disinterested in the comments of previous patients about how much we are missed etc… when we meet them in grocery store aisles. Be ready to cancel medical journal subscriptions.
    3. Cultivate and grow “curiosity”. That has been a great help in making my retired life very enjoyable. A curious mind can be infinitely entertained by education and learning new stuff.
    I hope this is of help.

  19. Byron Haney MD

    3 years ago, age 63, as a self employed rural FFS FP I came to “That’s all I can stands ‘cause I can’t stands no more!” I looked at what I couldn’t stand (broken system abuse), what I loved (my medical ministry) and my options. I could retire, join hospital group, or transition to Direct Primary Care (eliminate all insurance contracts). I did the later, returned the Joy to medicine and have no regrets. I downsized in all ways (employed providers, employees (Office administrator, all secretaries and billing staff, As well as nursing staff), Complex EHR and large FFS office). Offered for consideration if you find yourself as Popeye.

    1. Elizabeth Steinhaus, MD

      hello Dr. Haney,
      I am on the brink of starting a Direct Specialty practice. Are there any recommendations you can make about your routine to handle patient concerns…mundane as well as clinical problems without being on call 24/7?
      Elizabeth Steinhaus, MD
      epsteinhaus@outlook.com
      ps. my grandmother was Pearl Haney from Nebraska area :)

  20. Jeffrey S Miller MD

    Article superb and accurate!
    Also the comments! But of course you can’t make a mistake siding with Popeye!!!

    1. M K

      Very well written article!
      I changed to a employed job after 30 years of private practice-giving employment to 10 people, and still be financially viable.

      This was a decision I took to be close to my family and grandson.

      My staff was literally horrified when I announced that I am leaving private semi-rural hospital/office practice of Internal Medicine for an urban corporate employed position.

      It was like “from frying pan to-Fire”.

      In this corporation controlled practice- I found myself completely alone and being watched every second by corporate bosses.

      All the work of support staff, right down from receptionist, MA to billing and coding and to even stapling a after visit summary or taking patient to exit door, is now thurst upon me as my Responsibility.

      The worst of the experience is a daily shalacking by “the immediate Boss” who has much less medical education or experience.

      99% of the time, there is nobody in office except patient who has checked in himself digitally and me, and the omnipresent digital surveillance cameras, pings, messages, pop-ups.

      This is all in the name of efficiency.

      All the system of protocol driven care here is designed to get rid of the support staff.
      I am encouraged to appease to the understaff or they squeal to the corporate bosses.
      It does not make sense that MAs have a separate cabin and office in a different part of the building than the patient care area. The patient never sees a MA after BP and weight taken.
      Should I still stand?

  21. Susan Newsome

    I was amazed to come upon this article today of all days. You see, I just sent an email to my employer yesterday evening, telling them of my intention to retire later this year. I have been in practice for almost 36 years and have loved my profession. I love the people I work with and I will miss them greatly. But with the passage of time, there have been so many changes brought on by the ever increasing number of administrators who have no idea what our work as physicians entails. I have had wonderful relationships with my patients, staff, and fellow physicians, but I feel disrespected and undervalued by those who sign my paycheck. I’m looking forward to a new future.

  22. Jan Jurnecka

    You’ve summed up exactly the way I felt when I retired (some would say early) at age 62. I haven’t looked back.

  23. Gary j. Nitti, MD, FACA

    I think that if your life has many facets (ie. parent, spouse, teacher, athlete etc.) it is easier to quit since your identity is not wrapped up in being called “Doctor”. Every student I meet who wants to be a physician, I tell them, “never give up on your outside interests”; I now realize after after 35+ years of private practise my sense of self makes it much easier to walk away.

  24. james elbaor md

    Thank you for great article.
    Yes you are quite correct the whole medical system is really broken down as far as the healthcare delivery system. However, the medical advances in medicine are stunning and sensational.. It is quite tragic that the healthcare delivery system slipped from physicians into the hands of the accountants and CEOs who are paid multi-millions a year at these big center centers which is absolutely insane.

  25. Phil Dean

    Thank you for so elegantly putting into words what my psyche has been struggling to understand for the last year. I still love treating and caring for patients after 30+ years of surgery but realized over the last year that I no longer enjoy the practice of medicine as it has evolved to be as an employed physician. What you have written has allowed me to separate the two, and I am now beginning that transition process to retiring from medicine in the next few years. Strange that I needed your words to give me “permission” to do that, but it worked.

  26. Mark Johnson

    Not a Physician, but retired from my busy private Physical Therapy practice after 35 years, last year at the age of 64. I sorely miss the patient interaction but not the ‘business’ of medicine. It had indeed ceased to be fun. The system is corrupt and corrupted by large center admins, monopoly dominating providers and the entire insurance industry. The percentage of medical care provided that is unnecessary, wrong or ineffectual seems to grow exponentially every decade. We are all staring into the abyss where WE are now becoming the patients and you won’t like what you see when YOU need care. I feel for our young medical providers of all stripes who in these times will grow jaded and disenchanted with their chosen career choice decades before they should. The level of burnout is high right now in all fields. My advice? Have a few hobbies, have FUN doing things you like. Socialize more, and this time for the right reasons with people you enjoy, not those forced dinners with the admins where you constantly had to kiss behinds to get your full funding or have to justify the hiring of one more employee…..and lastly, enjoy that glass of wine a little longer. The first year has been a blast for me, but it has passed awfully fast, too. None of us knows how many of them we have left.

  27. Robert F. Kepley, MD

    Very Nice article, Dr. Waters! I appreciate your perspective as do many who have commented here. Mine however is different and may offer a sliver of hope for those who are contemplating retirement but still love their profession and have not experienced the pain and difficulties that you and others describe.
    I retired last year after 41 years as an Orthopaedic surgeon sub-specializing in joint replacement surgery. It was a thrilling and rewarding experiance right up until the end! My reasons for retiring had to do with a desire to leave on top and not hang on until hearing the whispers of “when is he going to retire?” While there certainly have been many challenges in medicine that weren’t there when I started, the advances that have occurred in Medicine since I started have outweighed the administrative hassles we now face.
    One reason for this was my good fortune to land in a group of docs who were able to control our own environment and remain independent from “big medicine.” We never became “employed physicians” and built one of the few physician run and physician owned sub-specialty hospitals in the country. I was able to step
    back from my practise to help my group and advance the developing practice of my younger partners.
    There were still the challenges of managed care and large system competition in our area but having the ability to run a hospital like it should be run, and used to be run, made the practice of medicine rewarding right up until the end!

  28. Poms

    We committed so much time, energy, and monies to create a
    career that would serve others and take care of us as well.
    In order to get out, we have to get over the guilt of walking away, and the misplaced guilt that–somehow–we could have figured out how to make a better, more satisfying life in medicine—for not just our patients, whom we honored–and administrators–whom we tolerated—but for ourselves as well. I believe as physicians,the practice of medicine has deteriorated to such a place that tidbits of satisfaction or security from the career, is like a mere table scrap. My hope is that those of us that have to keep eating Popeye’s spinach and tolerating it—will find ways to transition to different careers that offer some hint of joy and satisfaction and worth. I don’t think it comes as a surprise or is an overestimation that so many of us physicians would easily walk away if we had these other options. For clarity, it is not walking away from our patients, but what a life in medicine has done to us.

  29. Michael Perline, MD

    The profession has been so damaged that there were only two questions to consider. “Do you have enough?” And, “Have you had enough?” For me the answers were yes and yes after 28 years in the ER.

  30. Heather Cook

    This won’t be a popular answer but…as a pediatrician, I honestly do not think I will retire. My job gives me a reason to get up in the morning. My patients make me laugh and warm my heart. Every . Single. Day. Yes, its difficult. Yes, the notes are a pain. But I have a reason to smile and a mission to accomplish. I just don’t feel I will ever feel my heart sing on a golf course. It might be a beautiful, challenging, outstanding golf course/ vacation/ cruise/ garden/ movie/ novel/ cooking class. But all that, all that …. will never compare to seeing my diabetic 2 year old speech delayed patient give me his first heartfelt smile and ” Hi doctor!”. I am sorry. But NOTHING compares. Good luck everyone with figuring out your missions in life after retirement. I’ll be heading to work to see some patients!!!!

    1. Richard P. Stankus, Ph.D,MD

      Glad to see there are other physicians who value the privilege to practice medicine and continue to enjoy caring for others. Unfortunately we seem to be in the minority. Godspeed!

    2. Mark Pascuzzi, M.D.

      Agreed. This is the other side of the retirement issue. Make sure that you can keep your mind, body, and spirit active in retirement. Have a plan. After 40 years of Ob/Gyn (29 of them solo) I am down to 20 hours a week- no deliveries, no surgery, but I get to visit and care for all of the wonderful women that I’ve come to know after all these years.

  31. Larry Cohen, DO, MBA. FACOS

    Dan,
    As one of your former trainers I appreciate your article. I just retired after 43 years of practice. I guess there are things that you can learn from your residents.

  32. Kathleen Rovall MD

    A beautifully written article! My sentiments, exactly. After 30 years as a pediatrician in an extremely busy large group practice with 8 wonderful partners and 2 offices, I realized I had nothing left to give. To my patients, their families, and my practice. I was physically, mentally, and emotionally drained. I made the difficult decision to retire this past December and I’m not looking back! My practice will go on, and I look forward to reinventing myself with a second career and learning to put my family and myself first again after over 30 years of delayed gratification and self sacrifice. Well said, Dr. Waters, thank you for putting my thoughts into words!

  33. Thomas Hubbell, M.D.

    I think I understand what you are saying but you’re attributing the misery to the wrong variable. Administrators and insurers are just as clueless as they were 40 years ago, you (all) just now realize it. As an FP, patient care is just as rewarding now as it was decades ago, if you stay focused on the patient. Compliance with “rules” and employer executive directives and productivity targets are just as absurd as they were decades ago, and can be passively disregarded as we did back then. Only the words have changed. Just do your medical work to your best ability for the patient; you’ll be happy and so will they. What’s the penalty for missing targets? Make a little less. OK. No problem. Or move on. The time to retire is a)when you’re tired (beyond recovery) of the weight of patient responsibility – you just can’t continue to carry the emotional load of patient suffering and needs any longer and b) before your colleagues tell you it’s time to stop. Incidentally, I got the biggest rejuvenation from the occasional patient who would genuinely ask how was I doing? And then a word of empathy, sympathy, or encouragement – that’ll make your day. Meanwhile, don’t let the bastards (not patients) grind you down. (I’m out after 40 years in practice but still love teaching residents, mostly D.O.s. And I really miss seeing my patients.)

  34. Joseph Arpaia

    I loved your article Dr. Waters. Thank you for your wise words.

    I was struck by the words you used for those continuing to practice despite the toll: “hanging in” or “hanging on”.

    I think the operative word there is hanging. And hanging is unsustainable and can become lethal.

    If we feel like we are hanging in or on to our position that is a huge red flag. Something is going to change, and hopefully we can make a positive change instead of change being done to us.

  35. Timothy J. O'Leary

    Retirement is scary – it feels like you are walking off a cliff. if you are prepared, however, there is no hard landing, and the freedom of flight is truly wonderful. Having said that, I do not believe anyone should ever retire in order to get away from their life – you should retire to go towards what you want to be doing for the rest of your life.

  36. Eugene R Ross MD

    Superb article. Not a comprehensive analysis, but it accesses the spiritual impoverishment generated by corporate dominated, computer screen suffocated medical practice, in a depersonalized society, made so much worse by Covid. And doctors are no longer the masters of their domain, which we were when I graduated 46 years ago. Now, after a 28 month Covid spawned hiatus, I do a part-time, out-patient, New York City ENT practice, as an unpaid (I refused monetary compensation) attending, and I enjoy the stimulation, learning and giving of myself to a needy, disadvantaged patient population.

  37. ScottB

    “For me, it was the escalating daily battle with clueless and sometimes malevolent administrators, meddling middle managers, bumbling bureaucrats and some of my physician colleagues who were more than willing to do their bidding that did me in.”
    That is exactly what happened to me. Thank you for sharing – it helps to know you are not alone.

  38. James K. Weber, MD, FACS

    A thoughtfully and excellently written piece, Dr. Waters. Thank you.
    In my case, I transitioned from a general surgical practice, specializing in bariatric surgery, to teaching yoga. I just couldn’t contemplate giving up teaching or serving others. I made the switch fourteen years ago after a thirty-year career.
    I am convinced that I wouldn’t be alive today had I not made the decision to move on. I was the only male in my yoga teacher training course—also the only one over age fifty-five.
    I wrote about this rather radical about face in a book called “Cutting Out: The Making and Unmaking of a Surgeon,” with a nod to William Nolan, who only got as far as “The Making of a Surgeon” in his book.
    The book will be available by the last week in January. I hope it helps confirm the points that Dr. Waters makes, in his case, more succinctly.

  39. Gary S Rinzler, MD-MPH

    Every time I consider retiring, something drops into my life that results in a totally new path within medicine. Disgusted with the penalties of “caring for patients” rather than “doing things to them”, the biggest reward came from teaching senior residents the alien tools, the most important tools, that have all but disappeared due to the ‘time is money’ infection that spoils the privilege of what we do. That, as the residents about to see a new patient, run to review the MRI, run through the labs, tally the medications and read the problem list from every “ologist” in the city, I invoke the endless pleasure of grabbing their wrist gently to say, “Go ask the patient what’s the story?” The panic, lost, sr or chief resident “Child” looks at me in heresy, “You’ve got to be kidding, how am I supposed to know what I’m walking into?” “Ask the patient to tell you their story, then shut up for 3 minutes, other than nodding, an occasional “hmmm”, let them know you are listening, not formulating your questions paradigm, triage, that lousy breakfast, or your day-trading hobby.” The best professor I was gifted to study under (and in 1984, I was his last resident before an MI took him) drilled into my head, “By the time you’ve watched the patient walk into the exam room, greeted you, shook hands, and climbed onto the exam table, 90% of your differential should be clear. The 3 minute monologue and careful exam, amazing how that art is gone.

    1. DAVID A SPIRO

      “By the time you’ve watched the patient walk into the exam room, greeted you, shook hands, and climbed onto the exam table, 90% of your differential should be clear. The 3 minute monologue and careful exam, amazing how that art is gone.
      This is so true. The “new physician” would rather see their patients at home via a virtual visit. Triage, order some tests and make a presumptive diagnosis.

  40. Gregg D Nulton, MD

    Excellent, thanks for writing. I retired at 68 from full time Family Medicine after 33 years. I had some great staff and colleagues, a wonderful medical assistant for that 33 years and some truly beloved 3 and 4 generation patient families. On retirement I still cared for >100 patients that I delivered (out of ~400) and some of their children.
    So why leave the calling that I loved so much? As you quoted Popeye, “That’s all I can stands ‘cause I can’t stands no more!” I realized that I was being hurt by the “Medical-Industrial Complex” and I didn’t want there to be permanent damage.
    I had always wanted to finish well, to run my race, to finish my course, faithful to the end, and I suppose I did. But my beloved assistant and even some of my patients could see that I was no longer practicing with joy. So it was time to go.
    Since retirement I have had several former patients tell me that I look 10 years younger. I have most of my sense of humor back, complete with bad Dad jokes. I am now a “Certified California Naturalist” and have started volunteering – completely unrelated to medicine.
    I am also still licensed and “make rounds” at church and when one of the neighborhood kids hurts something or has a rash: (“Doc, do you mind looking at this?”) So I again have some of the joy of my former days.
    Thanks again.

  41. Maurice Schneider

    As Bob Dylan says “The times they are a changing”
    Full time interventional cardiology for 40 years and retirement finally gave me the insight to volunteer at the local community clinic outpatient only
    No insurance , billing DRG’s Meaningful use,or pre cert etc reminded me the focus IS the patient and how easy the medical record becomes ( and yes Sovereign Immunity)
    Medicine as it should be free from hindrance and constant supervision and the gratitude of the patients is exemplary.

  42. Gina Carter,DO,MS-HM,COL-(R)

    Dr. Waters, I thank you for sharing your story and to confirm to those of us, who continue to toy with the idea of retirement… that it’s OK. I am on my fourth attempt to “call it good!”. I think that I was one of the last to be able to put out my shingle out-36 yrs ago and do what I had gleefully been called to do-Take care of patients. My career spans-27 years with the National Guard and a couple of “sandbox” deployments-thus forcing me to find FT employment,upon my return and ultimately retired from the VA-seven yrs ago-(another hidden “healing” gem). I did locums tenums, for a couple of yrs.-allowing me to be reminded of how little control we had as physicians-despite a MS degree in Healthcare Management, and then helped a colleague-in a short venture part-time, the last 3 yrs. Bottom line, in my opinion, is that it takes a while to determine how “valuable your time is”. I’m now finding that despite missing my patients and doing what I loved to do-taking care of them/families, etc.-is that I now really appreciate MY time w/o guilt. Always planning new adventures-even if it is next years’ garden, enjoying my family and learning to let go of chapters written in the book of life, to make room for more. Again, my thanks to you for your wisdom, wit and insight. Seize the day! (on your own terms)

  43. Owen B. Pickus D.O. Esq.

    As much as I agree with many of the comments of both the article and my colleagues that followed, I have a different take on the corruptness and dishonesty of the medical system. Rather than “let the bastards grind you down” I elected to confront them each and everyday. After nearly 50 years of practicing oncology/hematology, I retired and continued my career as an attorney and have taken on the banner to not turn a blind or tired eye towards the healthcare system but rather to change it, one case at a time. As Dylan Thomas wrote so eloquently,
    “Do not go gentle into that good night
    Old age should burn and rave at close of day.
    Rage, rage against the dying of the light.

    Though wise men at their end know dark is right,
    Because their words had forked no lightning they
    Do not go gentle into that good night.

    Good men, the last wave by, crying how bright
    Their frail deeds might have danced in a green bay,
    Rage, rage against the dying of the light.

    Wild men who caught and sang the sun in flight,
    And learn, too late, they grieved it on its way,
    Do not go gentle into that good night.

    Grave men, near death, who see with blinding sight
    Blind eyes could blaze like meteors and be gay,
    Rage, rage against the dying of the light.

    And you, my father, there on the sad height,
    Curse, bless, me now with your fierce tears, I pray.
    Do not go gentle into that good night.
    Rage, rage against the dying of the light.

    And so it goes……

    1. Kathleen Hands

      Yes yes!! Love this… at 43 years in, I’ve seen that pendulum swing so far left that it’s motivated me to help change the system back the way it was when we weren’t ruled by insurance companies and the bureaucracy at hand I stay to fight for my patients who are exposed to nothing but big Pharma ads on television hypnotizing them into thinking drugs are the answer I fight for my patience to teach them how to ask the right questions of their providers and to not fall pray. I want out but feel I have been called to stay in the game to keep them safe. God knows what will happen to them with this new WOKE education about equity and diversity. It’s disgusting how they have mutated our profession. We see everyone the same!! At least .. we did.. now only to be coerced into thinking that we are racist and discriminatory when in fact they are the ones propagating this agenda.

  44. Joe Testa, MD

    A perfectly insightful article. It helps clear some of the self doubt that comes with the decision to retire. I made the leap one year ago at 59. My statement was always “work to live don’t live to work”. That said medicine is an amazingly fulfilling career. But having practiced for 31 years we entered medicine at a different time. All the rules changed during my practice lifetime and not for the better. It comes down to “physician heal thy self” and realize when it is time for you and your family knowing you did well by your profession but it is now time to go.

  45. Jeff Polekoff

    Your article is in-line with my experience. As a former highly functioning internist with a background in hospital care, ER, and pathology, it became clear that our commitment to patients was increasingly compromised by the Peter Principal incompetents that control medicine. However, like the Phoenix that rose from the ashes, and Popeye who overcame his adversaries, there are ways to use our skill set that are not Sisyphean. Unfortunately, our change in direction will leave deserving patients with fewer worthy resources.

  46. James Arnold, MD

    Kudos to Dr. Zuckerman! Agree this is a pertinent and fun, well written article. I recall a comment from a colleague about an older physician who was still working: “Boy, he used to be really good”! Don’t be that person. My important decisions are now about family and community involvement.

  47. Dr. Luke Burchard

    Love the article and the commentary. I’m in my fifth version of the practice, hospital or company being “acquired” by the expert and endless parade of management companies or private equity. Every PE company in the world wants a piece of us personally and corporately. Fortunately, I just work PRN now in urgent care, so I’m free to walk away anytime. My advice to anyone over 45 years old is to diversify long before you are forced to make a change out of desperation. I’ve been fortunate to be able to alter my career multiple times from private practice to a large clinic to faculty to private industry, and now back to urgent care. Use all of your talents; the world is craving your leadership skills.

  48. marvin r leventhal md

    I could not agree more ! After 35 years in practice as an orthopedic surgeon , i reached my popeye moment in Jan of 22 and retired in april . Truth is i had to retire to save myself. So many factors played a role in this decision and you articulated most of them. Colleagues and friends ask me what i do all day… my response is SELF CARE! Our heathcare system is so brokenand it needs to be fixed. I gave most of my life to medicine… it took alot from me and the moral injury / ptsd has left scars that likely will not go away. I am way happier and i do not look back. Should have walked away sooner but i was afraid to quit. Never wanted to be carried out. Walked away while i still could.

  49. Walter Millar, M. D.

    Excellent article, Dr. Waters. I am reminded of one more aphorism from the comic pages, from Pogo: “We have met the enemy, and he is us.” In my 40 years of practice, I learned early on that we doctors are systematically abused by the government-hospital-insurance-pharma/device complex, but we are unwilling to band together and even willing to compromise one another.

    After I retired prematurely because of a surprise cancer diagnosis, several of my colleagues still in the trenches confided that they envied my release from the miseries of today’s practice environment!

  50. Adriana Maldonado-Brem MD

    Love the article! I consider myself in semi retirement. The administration battles where intense. I love patient care. After 34 years of practice, training physicians and APs , creating programs I left. Now I work locums which reduce hrs to 8 hr days when on the job , traveling, meeting people. I’m excited about my upcoming assignment . So, not ready for full retirement. We have to admit we are more than MDs. Sad about all this burn out talk. It’s really about being tired of administration abuse interfering with the physician patient relationships.

  51. Lonette Bebensee, D.O.

    Thank you for a thoughtful, affirming, and most accurate description of the stresses leading to tiredness. I started medicine late (med school age 43, then surgical residency), and after 20 years in practice felt it was time to retire. I am not sorry I did, nor that I did not even keep up my license. I am still enjoying being close to medicine (volunteering, doing missions) and am grateful for that part of my life. At nearly 80, I am still looking forward to another career, or just plain fun with my family.

  52. Dennis Hudson

    Nice article. I retired for the first time as a hospital based neurorehab specialist at age 75. I was good at my job and enjoyed my work. Fortuneatly I could keep interference to a minimum in that setting. My initial retirement only lasted 6 mos. I went back to work as a locum tenens (full time, but only 2 weeks/mo) since I clearly hadn’t been quite ready to retire. After my contract was up I was planning to work part time in the same capacity at a local hospital. This was march of 2020, just as covid-19 hit our area. Since everything was in disrray they asked me to wait 6 mos or so. Come summer they were ready, but I was not. Got too comfortable in retirement and have been happy ever since. My take aways are: (1) if I had been working in an office setting I probably would have retired 10 years earlier due to stress and interference (2) some times it pays to phase into full retirement after all medicine has been a big part of your life for I long time (in my case 30 years) (3) you do slow down physically as you get older withless tolerance of stress and some memory lapses (compensable in some respects with medication and cell phone apps) but it ultimately catches up with even the best of us.

  53. Sandra Bell,MD

    I believe the handwriting is on the wall for my retirement. I am sick of the buracracy of medicine. Everyone is telling you how and when to do stuff for little or no reimbursement. Patients parents are rude, impatient and mean. Not what l signed up for. Love my patients. Nothing makes me happier that guiding parents and helping them to become effective loving parents. I’m pacing myself for exit.

  54. Murray Zedeck DO

    Great article ! Personally, I never left Medicine …. It left me after 25 years of a wonderful life in family practice. It no longer matched what I “signed up for”. I no keep up my license because my Mother would have wanted me to but I have found a great many business opportunities and developed interests that keep me happily busy as my own person once again.

  55. Caryl Mussenden, MD, FACOG

    Thank you Dr. Waters for your thoughtful and well written article.
    *Having declared at the age of 6 that I wanted to deliver babies, I finished medical school at 24 with my 6 month old daughter in my arms.
    *My son was born during my internship. The 1980’s was the era of the rising tide of female OB/GYN who were sought after in the DMV and I was no exception.
    *I delivered 30 babies a month and was blessed to have a live-in nanny for my children. She was a great surrogate, but it wasn’t me and I missed a lot as my children grew up!
    *Now after 44 years, having stopped OB 18 years ago, stopped major surgery 10 years ago and working 2.5 days a week, I will retire this July!
    * The reason? I have a 5 y.o grand daughter, Isabela, that I can spend endless time with in Brazil where she lives and bring her home with me. No patient calls, no more Tele med video calls, no EMR records to complete. I can get any kind of tickets for any performance at any time of day and not have to rush. We can bake, go to the zoo, go to the park, do WHATEVER she wants. How exciting it will be to pour into my grand daughter unrushed, unhurried or distracted. Having lost 30 pounds in the last 3 years through stringent exercise and diet, I am physically healthier than in my entire life. It must be time to retire!!
    Best wishes to those who will choose this path this year.

  56. Louis Bergeron M.D.

    Hanging in there. Have come to realize a couple of points. #1 Corporations Lack Heart. I remember Sister Seraphin the Dom inican Nun who ran St. Mary’s Hospital in Reno Nevada. When interviewed after the church decided to sell this facility on local television when asked what she thought of the move stated “I long for the days when it was more about caring than competing.” We as physicians have been roughed up. We are known as “providers” along with P.A.s and N.P.s which is interesting. I much prefer “Physician” as I earned this designation thru hard work,long hours in training, and competition. The Affordable Care Act gave a large amount of money to institutions to produce 300,000 Nurse Practitioners. I suspect yet cannot say for certain that a sizable sum of money went to hospice care. Why ? You do not hear much about the social security and Medicare crises. Is it because of earlier death rates? This has been documented. Also beware of the government temptation to get more people enrolled in Medicare. Why ? Control !As Bob Dylan says in one of his song “watch out kid you are going to get hit”. How many people read “The Affordable Care Act “ in its entirety? None is my guess.We have become too careless in terms of rules and regulations. They are not always for the common good. Meanwhile I’ll hang in there. I have some very ill patients of a variety of ages that I cannot simply abandon as it would rake my conscience to the end result of loss of quality of my life. Thank You

  57. Sue Hanson MS, CLS

    Thank you for the insight and supportive comments by the hive mind. As a clinical scientist turned practice manager I agree with much of what was said about the top heavy administrative pressure in health care delivery today. Always remember, you are the medical expert, they are not! Best wishes on your journey.

  58. Thomas Kelly, M.D.

    Insightful article. May I add: DOD computer to Matthew Broderick in the movie War Games:
    “The only way to win (this game) is not to play.”

  59. Jeffrey Rosen MD

    That’s weird because I felt insurance companies were well meaning brethren when they kept telling me that they would “gladly pay me some Tuesday” for lots of work and data (never mind a hamburger) today. Guess I was being Wimpy in trusting them. How can you have any dessert without no sand ? My generation preached “no pain, no gain”, “a quitter is never a winner” – so it’s easy to see how sado-masochistic forces slimed their way in with bad intentions. Our ritual was “wait till your father gets home”, get the belt (which you may or may not have deserved), watch Popeye if you were lucky and go to bed. Rinse & repeat daily. Times were simpler and there was less sleeze & cannibalism. The Popeye stuff started a stream of consciousness – apologies.

  60. Mark Iannettoni

    I had the good fortune of working with Dan in Iowa and he was a force and legend in Mason City. They will never see another person with the skills, dedication, and commitment to the community which is why it was so hard for him to leave- unlike the administration he felt responsible for those people and their health.

    I left Iowa because of the administration and it was the best thing I ever did in my life because now it is fun again and I am happy to say I really enjoy working with my hospital leaders and the medical school administration again which is the only reason I am still doing it.

    They get it! They recognize the we are in an underserved area and hard to recruit to so they involved us in decision making and treat the physicians with respect. Most importantly they listen and help us improve the care and our work environment. That makes all of the difference in the world. I am no longer a commodity to be used up and tossed side.

    People leave their jobs for usually 3 reasons, lack of respect, lack or enjoyment/appreciation and the last reason is money. I am fortunate to have an administration that understands and supports this. So I may never retire

    Dan you served a population that can never repay you but in the end you paid a high price when the appreciation and joy goes away the money makes no difference. Continue to write I enjoy reading these. but maybe I am just getting to old!

    Thanks for the great article

  61. Claude Lamar MD

    Great article. I reached a similar point at 63. It was 7 years short of when I planned to retire, but my body was protesting. For decades I had been part of a pediatric group of 6-7 pediatricians, including 4 partners that shared the duties of running the practice. When I reached 60, 2 of my partners were diagnosed with cancer and died shortly afterwards. My hours devoted to the practice increased and I found myself working 7 days a week for up to 100 hours and eating a lot of fast food. It was a really stupid plan. Predictably, by 63 my blood pressure and cholesterol were no longer in a healthy range. I couldn’t see a solution and felt trapped, so I decided to throw in the towel and moved to a mountain side in Montana before I was carted off on a gurney. Retired, I suddenly found plenty of time to be active, exercise and eat a much healthier diet, which resulted not surprisingly in my blood pressure and cholesterol dropping back to normal. After a year I started working part time for a group desperate for pediatricians. I agreed to work a couple of weekdays each week, which sometimes was up to 5, but I worked no weekends, took no call, had no hospital privileges and no responsibility for running the practice. It was really a fun, healthy way to practice medicine and ended up lasting 3 years rather than the 1 year to which I had initially agreed. Someone smarter than me, needs to come up with a plan that allows doctors live the lifestyle we tell our patients to live.

  62. Patrick Aufiero MD

    Great article
    I got out as the hospitals starting taking over all practices
    and controlled the flow of referrals
    I was independent ID and hospital was not interested in me as
    i can be outspoken and they want you to follow the party line
    I miss the patients, medical staff and friends i made
    during my 30 yrs private practice
    and glad I am out
    NO REGRETS!

  63. Mary Totten

    Thank you for sage wisdom and a well written article. At the age of 56-while grounded at home in a hard C-collar recovering from a second C-spine fusion-I decided to throw in the towel. I’m stubborn and it often takes a 2X4 to get my attention. I had cultivated a wonderful practice in Alaska and loved caring for patients-but my body made the decision for me to retire. Many of my family and friends have already figured out what I can do “next” with my medical degree. The truth of it hit me while glumly staring at my Christmas tree-I will walk away completely…because medicine has become toxic and all those little bites matter. They affect me whether I want to acknowledge that or not. So I will heal; learn to take care of myself for once; and figure out how to engage in a new life.
    Blessings to those who remain.

  64. George Scott

    Great article Dr Waters! Very relevant, well thought out and TRUE! Unfortunately I am of the age to get the Popeye reference.

  65. Lee K. Schwartz, MD

    Greatly appreciate and concur with the variety of personal experiences and decisions. Being a physician has been a great honor and adventure for me.
    I regret nothing. I learned to greatly appreciate the human condition. And hope I left it a bit more improved than before.

    A wise mentor passed
    on this bit of wisdom:
    If one thinks of retirement, do it slowly over a few years. Don’t just walk out abruptly. Gradually replace the Have To with Want To. So after a few years you are doing Only what you Want To (if that is a new way of doctoring, singing in a choir, traveling the world, or knitting- or a combination of Want To’s) -We have earned this… Best of luck to my wonderful colleagues.

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