The 3 S’s: What you must have in your possession when you retire

Remember the Three A’s of a successful practice? Be Able, Affable and Available.

That bit of advice served many of us well although some, no doubt, did OK with Meat Loaf’s musical axiom, “Two out of three ain’t bad.” But if your practice days are winding down, there are a few things you should have in your possession if you intend to retire contentedly.

Notice I did not say happily. Notice I did not say comfortably. Being content in retirement relies not a whit on wealth or possessions. Contentment in retirement is knowing you survived a perilous tour of duty, all the while keeping the promise you made the day they handed you your medical school diploma.

 So I hereby declare (Nobel Committee, are you paying attention?) “The Three S’s of a content retirement”:

 #1: Sanity

Modern medical practice can drive you crazy, literally and figuratively. Call it what you will—moral injury, burnout, empathy exhaustion, PTSD, stark raving lunacy, terminal cynicism, reaching your Popeye Point or your Howard Beal “Network” moment. Holding on to your sanity until the end is not just first, it’s foremost.

For decades, administrators and payers have introduced ever more ingenious ways to assault your psyche—RVUs, HMOs, exponentially increasing numbers of hospital administrators, prior authorization, practitioner ratings and EMRs—the last being the most nefarious, which is to say, the most effective. Staying sane for an entire medical career is not luck—it takes dogged persistence and constant self-reminding that you are not locked in a bank vault in Stockholm. A medical career was always demanding but I think it’s only recently that, for a fair share of our colleagues, it’s become downright demoralizing.

The reason you need to carry your sanity with you into retirement is that only through an unfractured lens can you focus and thus make sense of your life’s work. Without it, it’s a funhouse mirror where what you see is wildly out of proportion to what actually occurred. There are a few things you can do as your farewell party approaches. Make new friends outside of medicine. Find a challenging new pursuit or hobby. Start writing your memoirs. In short, start The Long Goodbye sooner rather than later (apologies to Raymond Chandler). Think of it like tapering a steroid or an opiate dose—you want to be clear-headed and unimpaired when you walk out the door for the last time.

#2: Sense of humor

Hopefully, you’ve had one all along—it’s Sanity’s best friend, or maybe its “plus one.”  If you don’t, you can skip ahead to #3—you won’t find anything amusing.

Possessing a sense of humor is like having a reliable and endlessly renewable source of fresh water while hiking in the desert. Some aspects of medicine just lend themselves to laughter—never at a patient’s expense, but at those situations that come under the broad umbrella of “Well, you certainly don’t see THAT every day.”

I also found it vital for dealing with certain colleagues, most administrators and many middle managers. It’s a healthy way to channel cynicism, end-stage exasperation and even righteous anger without becoming a complete curmudgeon. It won’t transform tragedy (and much of what we have or had to deal with is tragic), but if your practice experience was truly devoid of lighthearted or absurd moments, you may have picked the wrong specialty and, possibly, the wrong profession.

A lifetime in medicine is a chapter book—page upon page of pathos, conflict, drama, joy, absurdity and humor. When the story of your practice gets to the page that says THE END, there will have been tears, triumphs and more than enough nail-biting moments and jump-scares. But when you finally decide to close the cover and put the book of your career on the shelf, you’ll want to have a smile on your face.

#3: Self-respect

This is a tricky one, obviously, and one that can easily be confused with self-satisfaction.

Most of us carry a moral compass that guides us during our professional lives. Hopefully, it’s a gimbaled one, resistant to the rocking, pitching, rolling and yawing of the little ship that ferries us along—our practice. An absent, faulty or, more commonly, artificially influenced compass can take us wildly off course. Money, status, unchecked ambition and unblinkered avarice are powerful external magnets, able to distort not only the direction of a medical career but also its purpose. Such a compass might indicate that North is monetary wealth, a stable of trophy possessions or the square footage of parchment on an office wall. But what one accumulates or achieves is different than what one has accomplished. Three A’s again—slightly adjusted.

Most physicians leave a mark—on their community, their hospital, their specialty, their colleagues and their trainees. Some, however, leave a stain. One hopes physicians who exploited their healer’s status and privilege strictly for financial gain will be appropriately judged in the afterlife. Such colleagues will have all the appearances of a successful exit. And enough cash and possessions are certainly capable of inducing a convenient and chronic amnesia as to how, exactly, they were accrued. These physicians are often remembered more for the cars they drove than for the care they provided.

That’s not exactly a legacy.

The boneyards are already brimming with irreplaceable doctors. When you shuffle off to Buffalo (or wherever your final destination may take you), what remains of your medical life is your reputation and your contributions. All well and good to be envied for what you amassed. Better, I think, to be respected and admired for the things you did and the way you did them.

Unlike our dust-fated selves, that never gets old.

Related reading:

What I learned about being a patient after finding my own cancer in ultrasound class

20 reasons to love and hate retirement