By Dr. Anthony Ellis, WCI Columnist
In the research for this column, where I would continue to discuss my journey of early retirement from full-time work, I came across comments like these discussing the issue of Medicare subsidization of physician training:
- “The enormous cost to the government to educate each resident ($100,000+ per year) is the reason we cannot have part-time MDs and physicians on the “‘mommy or daddy track.'”
- “Residencies go on for much longer than the minimum three years, such as plastic surgery at seven years. Anyone gifted and fortunate enough to become a physician should be working a minimum of 60 or 70 hours a week to serve humankind. Instead, we have 43% of female MDs and 27% of male MDs working part-time or 32 hours a week or less, according to articles in the NYT, Wall Street Journal, and Bloomberg.”
- “No wonder so much of the population is underserved and patients cannot get a timely appointment. Part-time work is also afforded by excessive fees as per widespread coverage by the NYT.”
I found these lines of reasoning both amusing and irritating as they implied that becoming a physician is a type of indentured servitude and, further, that we should all work most waking hours and eschew having children or at least neglect their care. We are not regular humans. We are fortunate government-funded machines of empathy and altruism whose only purpose is to serve humankind in a masochistic grind until we die on our feet in service.
I think not.
What Is Early Retirement?
Having written a summary of the journey from a negative net worth of ~ $250,000 to retirement from full-time work in the span of 28 years, I wanted to tackle the idea that I do not deserve to retire because I am a doctor. Worse, I am a psychiatrist at a time when there is a shortage of psychiatrists. I am sure you have seen these arguments and the forms they take, implying that since Medicare subsidizes resident training, a physician owes a debt to society that should preclude early retirement or part-time work.
Of course, it is entirely unclear what constitutes early retirement. One must resort to incomplete and outdated statistics to get an estimate of what this means for people in general and for physicians specifically. In addition, many people work part-time in the first few years after they stop full-time work. In a recent practice survey, about half of physicians said they wanted to transition to retirement by stepping down to part-time work. Retirement is defined by Merriam-Webster as “withdrawal from one's position or occupation or from active working life.” I suppose this means that if I take occasional night call and work a long weekend each quarter, I am not “retired.”
But I'm not sure I care.
If Dr. Jim Dahle stops working as an emergency physician; sells the WCI business; outsources all retirement account management to an outside entity; and in no way ever, trades time for money again . . . then he is fully retired. Clearly, “fully retired” is in the eye of the beholder.
The average U.S. retirement age is variably reported. U.S. Census Bureau data shows that the retirement age in the United States averages 65 for men and 63 for women. Are all people counted by the census fully retired? Does this account for people who work part-time or go back to work if their financial planning fails or if there is a recession or unexpected financial issues?
Gallup’s 2021 survey reported that the average retirement age was 62. It varies by state and by year, and by . . . pandemics. The reported age of 62 (in 2021) was the highest retirement age reported in that survey in 20 years of data. The actual average can only be estimated, but one can surmise a consensus of about age 64. This may be partly due to the ability to collect “early” Social Security at age 62, although the benefit reduction is 30%. In addition, there is about a two-year gap between respondents' “anticipated retirement age” and “actual retirement age,” and this holds true for physicians also. At a point in the future, there may be a hard line on data before the pandemic and data after the pandemic for all types of workers.
More information here:
Are Doctors Retiring Early?
The average age of retirement for physicians varies widely by specialty just as the general population retirement age varies widely based on the duties of the job, workforce issues, personal and macroeconomic issues, and health issues. In the most recent salary survey called “Medscape Physician Compensation Report 2022,” specialists averaged pay of $368,000 vs. a primary care average of $260,000.
One can surmise that physicians in highly paid specialties can afford to retire earlier or that some specialties prone to burnout might have an earlier average retirement age. Retirement is a highly individual decision, and most conjecture of this sort will prove to be wrong.
In looking for the hard-to-pin-down “average physician retirement age,” I found all sorts of conflicting and dated information. Again, trying to get an accurate number is a challenge. The American Academy of Family Physicians compiles a survey, and it has years of data. In this data, the average age of retirement for surveyed physicians was 70 in 1980, 65 in 1995, and ~65 in 2016. In similar surveys, about 80% of physicians say they plan to retire between 60-70. That is quite a range.
For this discussion, though, I will use the AAFP 2016 data of ~ age 65.
More information here:
Physician on Fire: Early Retirement Chose Me
Why I Have No Moral Issues About Retiring
At the age of 58, I am retiring about seven years earlier than the average physician. I must be a laggard and seem to have no moral compunction about the debt I owe to society for subsidizing my training. Or, maybe after 32 years of treating patients, it is enough. My OB/GYN internship varied from 70 hours per week (for off-service rotations in the ER and NICU) to 130 hours per week on obstetrics. I may have delivered 500 babies that year. My psychiatry residency averaged about 50 hours per week until I started moonlighting and pushed it to perhaps 60-70 per week in my third and fourth years.
My first inpatient/outpatient job as an attending started out at about 50 hours per week, but at times, it was 70. Even with outpatient-only psychiatry since 2011, with my moonlighting weekends added in, the average hours have almost always been more than 50 hours per week. This is close to the average reported by most physicians, and psychiatry has better hours and lifestyle than many specialties. So, unfortunately (or fortunately, depending on how you look at it), for much of my career, I suppose I did “work 60 or 70 hours per week to serve humankind.”
Here is the way I look at this as to my retirement decision: with an average work week of 60 hours, I had a “job and a half” my entire career. It's as if I completed about 48 years' worth of work in my 32 years. Personally, I felt like that was enough. I want to spend more time on family, leisure, and my own wellness. There are myriad activities I enjoy, and I would like to spend more time doing these while I still can.
Another reason I decided to finish up with full-time work at 58 was related to longevity and function. My father lived to be 79. My father-in-law also lived to be 79. Neither of them had a great last couple of years, so their functional longevity only lasted to about age 74-75. That’s uncomfortably close. I think many people delude themselves into thinking they will easily live to 85-95 and remain intact. There are no 80-year-olds on the trails I walk. We saw no aged tourists on our recent Mexico excursions. Better “zip line when you can.” The last decade we are here can involve a lot of doctors, medication, and joint surgery.
Now, here are some more sobering stats.
Rough Dementia incidence by age:
- 60-69: ~ 5%
- 70-79: ~ 15-20%
- 80-89: ~ up to 30%
- 90-99: Possibly 50%.
It does not plateau. While one can quibble over the exact percentages, it’s clear that a lot of older folks are affected. My financial plan ends at age 85 . . . not 100. Based on data from Ancestry.com, if I live to age 86, I’d be the oldest living male in my lineage on either side going back about 100 years.
Like almost all doctors, I saved lives and alleviated suffering to the best of my ability. I knew every day I went to work that I would help someone. It has been an honor and a privilege, but it has come at some expense. Among all the several dozen psychiatrists I have known, I am the only one finishing full-time work under the age of 60 with my marriage intact and with no medical disability or serious medical conditions. That makes me a rare, fortunate, and grateful person. Many I have known who were retired by an MI; a stroke; other medical issues; mental health issues; or, tragically, even suicide. Doctors are not machines. We are “only little humans” doing our best.
It is true the government subsidized my training. The government has subsidized my education at all levels. Like many Americans, I also benefitted from Pell Grants when I started with a beat-up used Mazda and no money at a community college. I took out government-backed undergraduate student loans despite a partial scholarship. The government also lent me $67,000 to go to medical school. Of course, I paid all these loans back with interest, and I was incredibly grateful to have access to them. The government made tax-deferred accounts available to me (and everyone else) that I used to save for retirement. The government allows tax deductions for children. The government has had a large hand in my success, and that includes the subsidy of my training by Medicare.
For all I have been given, I am forever grateful, and I have always worked hard to help others.
I hope I did enough with the government's investment. I hope I relieved enough suffering and saved enough lives. I hope my family forgives me for working so many holidays and weekends and for missing occasional notable events in their lives. I can honestly say I did my best.
When is it enough? For me, it was August 2022 when I left my Michigan McMansion for the glorious views of western North Carolina (where I'll still work a couple of days per week).
Every individual can choose their retirement age based on their own needs and those of their family. Unfortunately for some, that decision will be forced by illness or death. But whatever your reason(s) to retire, it is highly individual and entirely up to you.
Nothing anyone else says about your retirement date should mean anything to you. It is yours. To each their own.
If you've retired early or are thinking about doing so, do you have a sense of guilt that you're no longer helping patients on a daily basis? Can it ever be enough? Comment below!
Great article. Screw the arguments of resident subsidization. We more than pay our fair share of taxes and subsidize everyone else in the process. degrees also matter. Retiring at 36 is very different than retiring at 58.
Exactly — Having paid ~$2 Million in taxes over the last 15-20 years, I think I’ve more than paid back the government for my subsidized residency.
I also think the stat that says it costs $100,000 a year to educate us in residency is a complete farce. That might be the subsidy per resident, but we’re primarily cheap labor. That government cheese is supporting research, administrative roles within the department, attending salaries, etc…
And it’s not like we’re the only ones who benefitted from government-funded education. Anyone who attended a public school at some point in their K-12 or college or graduate / post-grad education has been supported by tax dollars, but for some reason, doctors are singled out.
I didn’t use the “paid tax” point, but it’s a good one. The government has a lot of general programs that people sometimes don’t consider. Most have benefited from some.
Without my early Pell grants, and the subsidized student loans, it would’ve been much harder to get into medical school and succeed.
A foundation called the Selby foundation, also gave me a scholarship, at a crucial time that was so helpful that I wrote them later and thanked them profusely. It allowed me to work minimally during my junior and senior year of undergraduate studies.
Thank you “S”.
Live long and prosper.
Great essay!! We, medical people, are guilt by the system to work more; to do more; to pick up additional responsibilities without additional compensation. There will always be another chart, another patient, another cme or computer program to learn. When we move on from this lovely earth, a few doctors will be remembered by their patients. Most will ask, who will take care of me now?
Too many of us are not setting the ‘good life’ example. I don’t mean showing of number trinkets you have accumulated. But the well lived life. Our health is our wealth.
The retirement wheel wants us to wait to travel when our bladders are constantly trying to empty; when our knees can’t quite make it up the hill; when we can’t indulge in delicious foreign cuisine and so on.
I am grateful for all that has been afforded me. The government has played a big roll in covering the initial cost. Rest assure, I have paid my share and then some, of taxes and the interest on my loans. I worked in rural ERs; Native American reservation; inner cities and many other places where most doctors would rather not go. I never thought I was doing it to assuage my guilt for wanting to wanting to retire early. It is where the need was the most.
Time is the one thing we can’t grow; extend or buy more. Imagine all of the things you could do if you got out 5-10 or more years earlier. You may decide to volunteer in tropical clinic; mountain resort; jungle paradise to keep your monkey brain busy. Doing what you love but without having to do it to live.
Yes, I am looking forward to getting out before the usual exit plans without any guilt about it.
Assuming the finances work out as expected, I plan to retire early. The goal is before age 50 and hopefully sooner than that.
Why? Because I want to. No other reason is necessary. I gave up on caring what other people think in my early 20s and haven’t looked back.
If someone is bothered by the fact that a doctor wants to retire early, then I encourage that person to do the prerequisite work needed to matriculate into medical school, attend, successfully complete a residency, and then provide their own magnanimous services to society.
I hope your plans come to fruition.
I have been trying to get my children to “stop caring what others think”. It’s no easy task for the younger ones.
It’s freeing to focus only on the friends and family that are supportive and not judgmental.
It’s an issue that many patients I have treated struggle with.
Problem is the US system of education. Some foreign doctors begin medical school at age 17. Instead of traditional 4 years undergrad, 4 years medical school, 1 year internship, then 3+7 years residency and fellowship, we can chop off some unnecessary time off and streamline the process. Although there are some direct programs, these are far and few between. Not saying the traditional pathway isn’t a good way to be a more well rounded individual but the increasing cost of higher education makes it almost nonsensical in the current age.
I work as an ER physician and have moved to part time work (2 shifts a week) at the age of 53. I think the idea of health concerns really hits home, I was recently diagnosed with coronary stenosis in my LAD and First Diagonal. Before this I thought I was invincible. A recent colleague who was an ex-olympian and marathon runner dropped dead while on a Sunday run. I only hope I have the financial plan to do this, but as I am debt free, the only reason I was working was to increase my kids’ inheritance. They can work instead.
I keep a list of all the psychiatrists that I’ve known in the last 30 years as to what happened to them in their later years. It’s not pretty.
Unfortunately, there are a lot of medical issues that can come looking for stressed professionals in their 50s and 60s.
I’ve seen many colleagues who have had their careers, quality of life, or their lives cut short, and it came as quite a surprise.
Thanks for the comment, Dr. Ellis. Most people aren’t honest or introspective about themselves, and I’m sad to say that’s as common with doctors in some ways; more than you’d expect. I congratulate you on your decision.
Just to be clear Chewbacca, my comment was a cautionary tale for all doctors and people in general.
I’m 58 and healthy. The folks I referred to had some bad health luck. So my comment is not introspective really. When I say “it’s not pretty”, I am referring to these others.
My situation turned out OK, mostly due to good health luck. One example: my wife noticed a spot on my back that I could not see. I had her take a photo of it. I looked at it and thought, “Sxxx, that’s a melanoma.” I set up an appointment for the next day.
The dermatologist was unimpressed, but removed it at my request. Result, melanoma. I had a total body PET scan that was negative. He subsequently cut a chunk out of my back with 1cm margins and it appears I dodged the grim reaper with my Stage IA fully respected lesion. I now have mild chronic pain in the respected area due to its location or the surgery itself.
This month long cancer odyssey further solidified my jumping off full time plans and of course, it’s possible the reaper will have the last laugh still. He always does, eventually.
I personally know no psychiatrists that “retired” aged 55-59 with their health and their first marriage intact. I know dozens who were retired by illness and/or disability.
The major flaw with the subsidization argument: the government didn’t really subsidize our residency education. They subsidized the cost of our labor to our residency hospitals.
I’ve seen programs that choose to expand their residency programs even though they are exceeding their Medicare funded slots. Why would this ever happen? In some circumstances, the value of the resident’s labor must still be worth the costs without the Medicare funding.
Years ago, I was on a state GME committee that modeled the cost to hospitals to replace resident labor and it was far more than we give residents credit for.
Residency is work, not school. Yes, you learn a ton, but that’s true of all people’s first jobs. Even people who do a structured rotational early-career program at places like GE are paid for that job, and have no further obligation afterwards.
Residents create more economic value than they cost, and the value of the subsidies goes to the hospitals, not the residents.
If you disagree, I welcome the discussion!
I agree on this argument also.
There were 10,000 babies born in Hillsborough County during my internship in OB/GYN.
I think I delivered 500 of them…no kidding.
Well said ! Agreed and thank you for your article .
I hopefully will be able to retire early and cut down work hours significantly before retiring. I’m an ER physician, and I feel I have more than repaid my perceived debt to society after working through COVID with poor staffing, coverage cuts, and pay cuts.
The pandemic put many in the grinder and chewed them up. Many of us that did front line work in the ER and on the medical floors and in ICU’s were tested and were lucky to live through it.
Two of the four psychiatrists on our inpatient psychiatry unit became ill with COVID. One was hospitalized and required oxygen and steroids.
I had friends who lost a spouse or a sibling. It certainly increased stress on the front line personnel in all fields.
Best of luck to you.
I must have missed the part where I agreed to give up my freedom to retire when I please in exchange to become a doctor. Where exactly was that mentioned?
It’s been four years since I retired from my Cardiology practice at the age of 63. I loved my profession and planned on working until I was either physically or mentally unable to perform my duties at a high level. Unfortunately, the same government that “subsidized “ my training “showed me the door”. Doctors no longer have the autonomy to treat patients to the best of their abilities. We are now forced to deal with a bureaucracy which places the almighty dollar above patient well being. I found that I could no longer work in a system where profits were placed above patient care. I could no longer be a party to treating a patient with inferior medications when there were much better treatment options or hearing many of my patients state that they could no longer afford the medications that would keep them alive. I grew tired and frustrated of banging my head against the wall of a system that does not care about the people they are supposed to serve. Yes, I am bitter and saddened as to how my career ended as I still had so much more to give to my current and future patients.
Forget those silly comments. Physicians don’t owe anyone anything not even an explanation of how much they work and when they decide to retire. There was never any such obligation. That’s just been conjured in the mind of people who have no idea what they’re talking about. What would be more productive is a root cause analysis of what drives burnout and early retirement and what could be done to improve working conditions and incentives for physicians to continue working. And I’m not even talking about monetary incentives though decreasing them has certainly exacerbated the situation. I’m talking about the increasing administrative burden that has made practicing medicine that much more arduous.
Exactly this. I had an interest-deferred loan that I started repaying after graduating from medical school. It took me 10 years to pay the loan off; the interest rate was 10%. I really don’t see how benefitting from deferred interest for 4 years obligates me to delay retirement. I pay taxes, consume goods, and contribute to society. I have never received an unemployment check, applied to public welfare programs, or used food stamps. I’d say deferring the interest on my loan for 4 years was an excellent investment by the US government. I don’t believe there is any justification for saying I am obligated to delay retirement.
The government told me they would pay the interest on my loans during residency. Then, the seas changed and they did not.
My student loan burden increased from $67,000 to $83,000 in that time.
I wonder if I got this wrong and all they said was they were going to defer the interest? It was 1990 to 1994.
Not sure what the rules were back then (I was in high school), but there has been bait and switch at least 2 other times. Loans became unsubsidized in 2012 and then this most recent “you’re going to get $10K/$20K forgiven and now you’re not”.
Retirement is likely still decades away for me , but I’m leaving my clinical job in a “cushy-lifestyle specialty” in my mid-30s for a career in industry for so many of these reasons. This pandemic has done a great job of clarifying my priorities for me, including more time with my friends and family; more time for myself to take care of my own physical and mental health, cook healthy food, and do the things I love; more time to be present in my children’s lives without constantly feeling regret at missing another (insert any event) and less of the stuff I can’t stand from entitled patients to insulting reviews because my medical opinion doesn’t agree with their “research” to fighting insurance companies to being called a “provider.” No one gets to their death bed and wishes they would have spent more time working, and I’m excited to make this leap early in life to an easier lifestyle in a job that pays better (and maybe will facilitate an earlier retirementI) and allows me to help people (the main reason I ever even went into medicine) at a greater scale without dealing with all the nonsense of healthcare delivery in 2022.
Sounds interesting.
Best of luck. One of my best friends left clinical Medicine after a decade and never looked back.
L, I totally agree. You make great points, I’m in a similar position, but not quite out yet. The “provider” thing is yet another way to demean and take advantage of physicians. When many physicians can’t discern, or have no choice (to buck the crowd and not get paid, so they think) to counter lies by the CDC and harm to patients, it’s easy to step out of this fascist system. I hope you help where you are going, but usually these things only get remedied once the system collapses.
Via email:
Dear Editor,
Very interesting column. While I appreciate anyone’s right to retire early, the question raised by some of those articles in the NYT, Atlantic, Freakonomics podcast etc. seem to indicate that there is an artificial cap on the number of physicians in the U.S. That specific issue was not addressed here.
That is, while some docs may decide to retire early or work part-time, the U.S. medical education system and residency program only allows a certain number of white coats each year. Indeed, I hear of “matching day” when medical school graduates do not get placed in any residency program due to the limited number of available slots. Not to mention the difficulty of gaining admission to medical school and graduating. On top of that, the Nurse Practitioner role is limited by the perhaps overly strict rules requiring physician oversight. Most of the articles suggest that the AMA and its members specifically limit the number of U.S. physicians to protect their own financial interests.
So if there’s a clear shortage of U.S. physicians, does not the early retirement and part-time career track of some doctors exacerbate that shortage? My assumption is that the medical system allowing entrance to so few each year does not account for early retirement and part-time work. No doubt individual physicians work very hard — impossible hours for some. What can the AMA and fellow physicians do to alleviate the shortage issue?
I’m not in the medical field but curious to know what WCI and its savvy readership suggests the profession do to alleviate the problem. Or, if these articles suggesting the shortage are incorrect, it would be good to understand another point of view.
Thanks for your consideration.
Best regards,
Yes, well, I don’t think “the AMA and its members specifically limit the number of U.S. physicians to protect their own financial interests.”
They do lobby to limit the scope of non-M.D./D.O. clinicians to protect patient safety.
Example: Chiropractors should not do plastic surgery, podiatrists should not do knee replacements, and so on.
From what I’ve read there is a current and worsening physician shortage. There are many reasons for this, beyond the scope of a short reply.
Many of the doctors who do leave practice “early” (whatever that is somehow defined to be) say that medical practice has become onerous and over regulated. Some here have said as much.
The current trends will likely continue. Earlier physician retirement, and increased use of non/physician “extenders” are here to stay. There is no political will to reduce these trends.
In the meantime, I stand by the sentiment in the article. One retires when one chooses, physician or not. There must be many reasons the average age of physician retirement has dropped over the last thirty years (from 70 to ~ 65) while life expectancy has increased.
One can fault insurance companies, the rise of the EMR, the encroachment of non-M.D/D.O. clinicians, lower autonomy, the trend towards employee physicians, cultural changes, or demographics. It’s likely all of these.
If you care about “shortages” and public policies that are sane, you should not be admitting more female physicians (who are nowhere near productive as men, like in all fields of economy that mean anything – as a group). Otherwise, stop talking about public policy. Beyond that, you could also pay doctors more AND increase their supply, while limiting the bureacracy and hospital lobby that makes doctors into cogs.
These aren’t political comments, they are facts. Or they are political comments, AND they are facts. Doesn’t matter for people who care about the truth, facts, and conclusions. Not feels.
This is a pretty overtly misogynistic comment and doesn’t help the conversation.
This is a great example of the “woke” never answering valid criticisms. It’s quite sad. Throw out a disparaging name/implied epithet and hope the emotions of the day cancel reality. Forget real solutions or thinking, that was for times long ago, right?
Chewie,
Physician Family called your comment misogynistic, which is true, and likely you are a true misogynist as well.
It’s quite sad when someone tosses out their ill informed, misogynistic opinion without backing it up with stats and references, then “throw(s) out a disparaging name/implied epithet and hope the emotions of the day cancel reality.”
Some of the best and most productive doctors and practitioners in other fields I have known have been women. Most of the worst have been male. My opinion is at least as valid as yours.
If you operate with your expressed viewpoint, you probably practice medicine with a bias, and other biases as well. Hmmm.
Indeed!
There are many reasons why female physicians and women “in all fields of economy that mean anything” make less money. No one argues that there is no gender gap.
In your comment, you paint all women with a broad brush.
You might consider reading ten articles on the phenomenon to broaden your view.
As the father of three daughters, I take issue with broad generalizations of “lower productivity” that are not informed as to the multifaceted causation.
Here is one that looks at the issue scientifically: https://royalsocietypublishing.org/doi/10.1098/rsos.181566
Here are two examples from my career:
1) A resident in my OB/GYN internship decided to have a baby during that year. Her six week maternity leave likely affected her one year productivity measured against the others in that class. Having babies and then usually being more involved in many aspects of child care would affect productivity. Men can’t have babies and the culture doesn’t really support “stay at home Dads” very well, so this is a broad effect. But we need new babies, right?
2) The Department chair at my longest employer was a woman whose husband was an anesthesiologist. He took a lot of call. She made a decision to work only three days a week and take no call for about a decade while her children were young. Later, when they were all teenagers, she became the CMO of the hospital..
3) I have had a “job and a half” for much of my career. This was only possible because my wife stayed at home creating, birthing, and taking care of our four children. Without her efforts, I would not have been able to drop to part time at age 58. By working at a Montessori school for twenty years, she was able to have all of them near her at work when she went back each time after recovering from pregnancy and childbirth.
Really, Chewbacca, read ten articles on the topic and inform yourself. Then have a daughter or two and you may feel differently.
Dr. Ellis, I think you missed his point, which admittedly was obscured by his more general comment about female professionals’ lifetime productivity. The point is that IF by becoming a physician, particularly a specialist with a long training pathway, one incurs a “debt to society” which is only discharged by working 50-70 hours per week in medicine until physically incapable of doing so, THEN women should not be allowed to become physicians. This would be a reprehensible position to take, and is morally equivalent to claiming that the physician training bottleneck obligates all physicians to work till they drop. BOTH POSITIONS ARE WRONG, because humans are individuals with rights. And the supporting data for this statement is above, where the differential in part-time work between male and female physicians is cited.
Chewie, I’m not sure where you get your data about women physicians working less, but in my family, I worked the 70 hour weeks on average for many decades, while my husband (also a physician) worked about 50 hours/week. Obviously this is anecdote, not data, but this was how our household functioned to allow one of us to check on our children once in a while (along with a lot of other family help). All of the other women physicians I interacted with (probably a 50:50 spilt, worked just as long as the male physicians of their respective specialties. Every family manages things the way it works for them, a lot of women, irrespective of their line of work put in more time at home with children/household management whether or not they work equal hours at paid work. I think the solution would be to equalize the home work if we want equitable hours at paid work, not refusing to let women out into the workforce. Also, I’m aware of the pay gap, but haven’t noticed articles on a decreased workload for women physicians. Especially given that the data that shows improved outcomes for patients of women physicians, their loss from the workforce might cause a decrease in adequacy of patient care.
The data is actually pretty clear on this. Women, on average, are more likely to go part-time or leave the physician workforce completely. There are lots of reasons why and some of them are terrible. This fact, of course, is not relevant to the individual decisions that a family makes. But it is relevant to broad discussions of the physician workforce. The fact that all docs are more likely to go part-time and retire early than they used to be and that women are even more likely to do so combined with the fact that med school classes are now composed of slightly >50% women has obvious and serious implications on the physician workforce.
I’m glad you chimed in Jim. I find the question of women in medicine a tough one. When I used to interview med school candidates regularly, we of course tried not to let gender be a deciding factor and any discussion of it would QUICKLY be silenced by the head of interviews. However, studies I have seen say 1) women are more likely to practice in underserved areas/communities which is good. 2) on a PER PATIENT basis their patients have better outcomes and feel like more time is spent with them (both 1&2 are excellent), 3) they do work less hours, have lower patient panels on average and hence have less pay. Personal experience. I was one of 8 in our fam Med residency year, only male. Only one other person had kids. No difference in work for most part. After worked as faculty teaching- men and women faculty worked about the same- women seemed to take more OB call/weekends and men more inpatient call/weekends. Current practice 11 providers 2 men. Only 3 people work “full time,” the 2 men and 1 of the 9 women. I end up seeing a lot of their patients when they are not here and about 50% ask me to take them on as patients because their provider is “never available”. (To which I have to tell them my panel is full, I cannot work more. I am sorry). every 3 months it seems like another one of the female providers cut back (especially after babies which makes sense). So personal experience would match that women physicians work less ON AVERAGE then men in primary care. It does lead to shortage and that should be acknowledged. Should it mean that we change admission criteria- I don’t think so because of 1&2 above but it does mean we need more providers overall. (To be fair to them though, the men that do not want to work FT choose urgent care and work their 8-12 shifts a month). Finally, I would be interested to see if Women practice LONGER though. Their life balance may average out in the end.
Couple thoughts as well:
1) my wife is also a provider and works part time. She loves to work and finds it an escape. I have offered to cut back MANY MANY times so she can work more. Truth is she doesn’t want to. Being “the mom” is too rewarding and I think that is a good thing for the kids. She is a better mother than I am father. So, not bad that women make that decision. It is a personal one with other benefits.
2) on the other side of things. I work full time because I feel an obligation to society and see a shortage. HOWEVER, I do see it causing some burn out and as Jim has pointed out multiple times, avoiding burn out (and divorce) is one of the best investments. Hence- anyone who feels that cutting back can let them serve longer- KUDOS and support (within reason of course- still gotta provide good care but that can be balanced depending on the field with semiretirement, part time, teaching, etc). I agree that we both have an “obligation” but that we are NOT servants.
Also as people have said, need to look at your own life and not sacrifice too much. That is where I am now. Ate like crap to stay awake and function through day, gave up exercise and travel to meet needs. Now working back in those things to achieve balance.
Interesting assertions on your points # 1 and 2. Never seen that data. Got some links?
Thanks for sharing your personal experience.
I have no qualms about retiring early as far as it pertains to the government having subsidized my education. In fact, I know have paid back the government multitudes more than they ever paid for my education and training. I would also like to add that it is in large part due to the government’s unfunded mandates over the years (among other government wisdom) that have led me to retire early.
It’s possible that some specialties take steps to limit their workforce and keep salaries high (looking at you, Derm) but for the most part the number of training slots is constrained by the Medicare funding described in this post. Therefore it is the U.S. Congress, not the AMA, which can increase the number of training positions.
As someone who works in academics, I would predict that the issue of part-time work and early retirement will only magnify in the future. The willingness of trainees to sacrifice for patient care (or even, sometimes, for their own education) is much lower now than it was 10 years ago. Perhaps they are smart to prioritize their own wellness, but I don’t think many attending physician jobs have embraced/mandated “wellness” policies the way that the ACGME has. This disconnect is a recipe for a rude awakening after training and early burn out.
I would submit that the most effective approach to the physician shortage is to make it more attractive for doctors to stay in medicine. Maybe that’s being more open to part time work. Maybe it’s restoring respect and autonomy. Maybe it’s reducing administrative burden. Maybe it’s as cheap as writing “wellness days” into someone’s contract. I don’t see that happening because medicine is a business and the folks running those businesses are focused on short-term profits. That often goes along with squeezing physicians as hard as they can.
I heartily agree.
Thank you for your reply.
If I currently work 65-70 hours per week and drop back to 40, does that qualify as “part-time”?
I paid my agreed upon obligation to the US Army. I never practiced a day in Pennsylvania where I went to med school so all they got for their subsidizing my med school was the gratitude of my parents- the PA taxpayers happy to have a local med school for their kid. I started medicine with 15+ minutes to see a patient and finish a chart in pen during that time and the chance to leave work after 9 hours some days, 10 hours most days not on call. I ended medicine with <15 minutes to see the patient and completing the chart had to happen after I left the patient with onerous documentation and computer access to do so. If I could have worked a 40 hour week I'd still be working. But I guess that would be 1/2 or 3/4 FTE in my last job and they weren't open to that. So like the author I figure I already worked 45 years of full time by the time I was in my 50s.
At one of my most satisfying jobs, I was the Medical Director of a Geriatric Psychiatry unit. I did it for eleven years.
My last few years there, a new administrator came on board and said, “What makes you think you are supposed to work forty hours?” I answered, “My contract.” He pulled it up and showed me that it said “a minimum of forty hours”. At that point, I had been working 40 hours per week plus some weekends for years.
He then told me what they really wanted: 25% more work and less salary, more “incentive based pay”. I secured another job at the same wage with no weekends and quit.
The contract offered was so onerous, two of the four of us quit. After this experience, I was much more clear in my negotiations with subsequent employers.
What do you think the reason is for “managers” or the higher ups being so indifferent about pushing people to do more and then quit, making the resulting situation worse than the first? I can see being greedy, but not when you lose way bigger by people finally calling your bluff. Is it that they don’t care about opportunity costs, at all?
As we’ve talked about in other places (and you are lucky being older at least you got some of that old golden age cheese), what’s the incentive for a younger physician to work more or harder (especially if single) when he gets crushed by taxes for working harder and longer weekends? It’s not like a doc is making the trade of working 10 years for a million so he can retire at 50. That might be worth it. As it stands, why strive for even 300k when the time and stress is huge and 150-180 as an IC allows the pass through QBI and you pay half the taxes, with much, much more time? The incentives are mostly perverse.
It does seem crazy that someone has to write a post defending their retirement at age 58. That’s a full career, 58 isn’t young at all. It just shows how much a sense of duty and self sacrificing is part of the culture of medicine and the entitlement of the public towards doctors. I think the author has somewhat internalized this culture as well, otherwise why wrote a post about it? Also looks like he isn’t even retiring he’s going part time 2 days a week. He’s still serving patients and bringing decades of experience to help them so shouldn’t feel guilty at all.
Consider the military — 20 years is a full career there, and per online searching the cost to train a military pilot is 5-10 million, so even with the higher estimate of $100k a year for residency the medical education cost is way less than military pilots and the military service requirement for pilots is 8 years.
I agree with you and I’m 11 years younger and not even doing two days a week. I’m at 6 shifts a month so that’s more like 1.5 days a week. That 20 year thing does weigh on me a bit though. Somewhere inside I feel like I should do 20 years, but I’m not sure what to count exactly. If I count my two years of clinical rotations as a med stud, I’m working on my 22nd year. If I only count residency, I’m working on my 20th year. If I only count after residency, I’ve got three more years to go to get 20 in. And do I really get to count the last few that I’ve been working part-time? But the 20 is totally artificial. I paid off my “debt” for med school in years ago by serving my country and I don’t feel any debt for residency training. My labor paid for my education. Maybe not as an intern, but certainly overall by the time I graduated.
The “twenty year” goal and how to account for it is interesting.
I count all my work years, even the part time years. I had a bicycle paper route for over a year at age thirteen. That was hard work, especially on a Sundays. I could only fit twenty Sunday newspapers in the bag and so, had to make five trips before school. Later, I had another longer bicycle route at age sixteen. Up every day by 0400. By age eighteen, I had a car route with over 500 customers that was forty miles long. Every day, every holiday, up at 0300, done by 0730, then off to community college.
I was a dishwasher at Red Lobster after high school for $3.35 per hour. That may have been my worst job. I was a fry cook for two years while in early undergrad at $4.50 an hour. I was an occasional chemistry and math tutor for $7 an hour. The only years I did not work at all were my junior year of undergraduate and the first two years of medical school.
I count the working clinical rotations in the third and fourth years of medical school. I count all of residency, including the three years in Psychiatry after my grueling OB/GYN internship. I moonlighted all three of those psych years. I did compensation and pension exams almost every Saturday at the VAMC for $75 each. I covered whole weekends at a detox facility for $900 each. I dictated discharge summaries for attendings for $10 each, twenty at a time.
So, for me, it adds up to about seven years of work prior to medical school, two years in med school, four years in residency, and then twenty eight full time years after residency, not “double counting” any times of 80 hour weeks.
That is 41 years of work…and I still work half time now. If you want to exclude all that prior to being an attending, you can, but some of that work was arduous. They called it “character building”. I call it hard work.
One regret I have is not having saved more in order to be free of work entirely at age 58. As one comment mentioned, “58 is old”. It’s simple luck that I can still hike five miles on challenging mountain trails two days a week, swim a half mile two days a week, work out with my children when they let me, and still zip line in Mexico.
My point is, that if I could have retired sooner, I would have, and if I could have retired completely, I would have. There is nothing like freedom from work.
My best friend (age 5 to 55) is dead from an MI. A good friend from my physician triathlon team died at 45 (a drunk driver killed him). A running friend of mine died at age 46, despite being in great shape. He died at work. A nice NP at my old job recently died two months after a lung cancer diagnosis at her age 66. Her main concern at diagnosis was when she could get back to work.
Best to you in resolving the “when is it enough” dilemma. I think it’s coming into focus based on your cutting back. At some point, trading life hours for money loses its draw. There is meaning to be found in leisure, increased time with family and friends, optimizing wellness, new hobbies, and pursuing avocation while one can.
For sure. I guess if I count every year I’ve worked, I’m already well over 30. But you’re right, there’s no one I have to justify it to except me.
At some point in the last few decades, society decided (perhaps unwittingly) that we wanted medicine to be a customer service industry and medicine reorganized itself accordingly. These are but some of the consequences of that reorganization. I’ve never heard ethical qualms about going part time or retiring early from Google or Coca-Cola or GM or 3M. “Government subsidized” training in medicine is a straw man that has already been neutralized by the above comments; it is no more true for docs than it is for Google engineers or Coca-Cola managers…
And yes, how about the teachers and other public “servants” that I know that made as much as a low level doctor and retired with tax payer bloated pensions for easy jobs, and guaranteed money, many of which were 2-3 days a week or had summer’s off? It’s funny how ridiculous the comparisons are that no one makes. By the way, I’m being nice, I could burn these people for being really low level big picture, especially compared to doctors and what they had to go through – but Average Joe knows where his bread gets buttered … even though those days are running out now, too.
I’m a doctor, married to a teacher. You are going to have a very difficult time convincing me that she is somehow overcompensated relative to me.
The degree of severity of my point is dependent on the state, I will grant you that. I’m going to laugh if you tell me you are from a state that I suspect, but don’t know for sure – just have an inkling. I would ask to please reveal if you would be so kind. I’m guessing that I’ll have a hard time convincing you due to factors not having to do with reality. I can obviously make the case.
Let’s start by agreeing that the idea that residents are directly subsidized is false. Residents are “subsidized” when hospital systems accept federal supplemental hospital payments (SHP) and then use that capital however they please (think real estate empires, c-suite bonuses, and the like with little to no oversight). A similar argument is made by universities when they accrue massive endowments while excessively increasing tuition payments and offering increasingly spartan living/working conditions to both students and faculty. Rather, residents are employees doing valuable work via direct patient care. Dividing how much money hospitals receive from SHP by the number of residents employed there then suggesting that the residents somehow owe it back as a form of debt is particularly sinister. Physicians, like all human beings, have the right to autonomy and should be able to retire when the conditions make doing so viable.
I did the math on this and the hospitals easily make money, and a good amount of it, off of the Medicare funding. The amount they get per year is over 2x the salary, and for young people, their benefits aren’t used or really all that expensive. Plus, residents technically are covering the high value times too (late/overnights) so it is totally dishonest the way most consider what’s going on.
A similar occasion I always talked about was how I paid the most in tuition at my private medical school (prestigious one too) during my 3rd year, but all I did was follow the resident along – I did very little to cost the system anything at all that year. What did they pay for, a coordinator for each rotation that administered the Shelf Exam and did a few other things? Reflecting on that is funny, it’s so ridiculous. What’s funnier? 4th year was only mildly less expensive than 3rd year.
I’m 72. 5 IHS years @ 60 hours/week, 23 private practice years @ 84 hours per week (=2.1FTE). Now doing locum tenens and telemedicine, alternating 4 day weeks with 3 day weeks. If you ask me what I want life to look like in (x) years I’ll ask for exactly what I’ve got today. I love my work, passionately, to 40 hours/week. I love it but not with passion to 50 hours. I like it OK to 60 hours, and after that I start thinking about Doing Something Else. I work for market rates (I don’t volunteer) out of consideration for my younger colleagues.
My oldest daughter is a physician and I told her she’d better not work the same kind of hours I did.
The Millennials have a point.
You seem to have worked very long hours throughout.
I agree that it becomes much less enjoyable after 50 hours per week and once you get up to 70-80, well that’s just no fun at all.
I don’t think it’s healthy to work 60+ hours a week, let alone 70-80, but plenty of people (and docs) do it.
I think it sets one up for serious regret, but you seem unaffected?
My solution: reform medical education: Put the premed and preclinical material online at minimal cost. Pass Part 1 and apply for clinical spot, preceded by 4 mos instruction: interviewing, physical exam, and statistics. If you must weed out, do so with 2nd language fluency. Primary care becomes the Canadian model: 2 years with the option to do a 3rd year in OB, surgery, ER, or anesthesia. Expand clinical slots and residency positions. Result: more docs willing to work fewer hours for less pay.
Lots of wisdom there. The likelihood that the way we are currently doing it is the very best way to do it seems low.
A bigger issue with early retirement is the many people who go part time or quit in their 30s. Doctors marrying Doctors has increased the number of people who do this. The government did pay a lot for our training and education and there are limited slots. It is contributing to the doctor shortage and is an issue that needs to be addressed.
For sure it contributes. As a physician workforce issue, it is huge. But on an individual level, I can’t fault anyone who works less than full-time or doesn’t work at all. What is your proposed solution?
My solution: reform medical education: Put the premed and preclinical material online at minimal cost. Pass Part 1 and apply for clinical spot, preceded by 4 mos instruction: interviewing, physical exam, and statistics. If you must weed out, do so with 2nd language fluency. Primary care becomes the Canadian model: 2 years with the option to do a 3rd year in OB, surgery, ER, or anesthesia. Expand clinical slots and residency positions. Result: more docs willing to work fewer hours for less pay.
(I posted this earlier, but I really meant to reply to your request for a solution. Evidently we’ve already started down this path.)
So ban student student romances in med school? I met a charmer on a plane once who was very distressed I was dating a doctor (now my spouse). He said (rich) docs should all marry those who aren’t docs to spread the wealth around. (He wasn’t offering to date me; charming as he was, I think I wasn’t his type.)
Communistic dating eh? Although he was right that wealth marrying wealth concentrates wealth for sure.
“We are fortunate government-funded machines of empathy and altruism whose only purpose is to serve humankind in a masochistic grind until we die on our feet in service.”
Thank you for this. Love it. There is a broader unspoken social contract of sorts that physicians are expected to pretend to have that mindset. When I 1st ran across the term ‘remuneration,’ I was like ‘what is that?’ From context, I deduced ‘pay.’ So why don’t they just say ‘pay?’ Because we’re supposed to pretend money doesn’t matter to us or at least discussing it is beneath us and ‘pay’ sounds dirty.
Part of this may’ve evolved as a marketing strategy to avoid the perception we are arrogant, self-involved, elitist, over-paid golfers using patients to pay for our country club fees, mansions and beamers. Okay. But somewhere along the way some people (physicians and non-physicians) internalized this unconscious expectation that physicians are some sort of obligatory martyrs to society.
Ever seen shaming of office-based primary care physicians who ‘let’ hospitalists round on their hospitalized patients instead of pouring in extra hours to do it themselves? Or an older doc. lamenting the unwillingness of younger doc.s to take over a private practice where one is basically on call nearly 24/7? Or even the claim being a physician ‘is’ a calling (which it is for some, but not all)?
Many physicians are pushing back against this mindset. I see it in articles like yours.
Renumeration and compensation are pretty funny ways to say pay aren’t they?
I have not been shy about getting paid a fair wage throughout my thirty years.
Several times I voted with my feet.
I think doctors need to be self advocates as to pay, but I remember it being a taboo topic in medical school. No one talked about money or their student loans. It was considered beneath doctors to look at their pay.
Hopefully we’re getting rid of that taboo.
A very well written, lucidly argued article.
I’ve retired at age 72, after 47 years as an MD, 37 of which were as a psychiatrist.
The point raised about the total hours worked by physicians has been one of the most overlooked by the various governmental planners! I too have put in MANY 60 hours work weeks.
It’s not only the number of doctors that needs to be considered! NO, it’s the number of doctor HOURS!
If the same number of doctors worked 60 hours a week in the past and are now willing to work only 40 hours a week why, with one fell swoop you’ve lost a 1/3 of your medical workforce without losing a single body!
Several of my psychiatry peers who do inpatient work hit this 60 hour week consistently.
Several of us have a full time job (40-50 hours) and a side gig doing weekends.
If some younger doctors figured out that life and tone are finite, and pursuing things may not lead to happiness…well, good on them.
Congratulations to you on a long career! Did your health hold up? Are you living a great life presently?
Thank you for your comment.
“Every individual can choose their retirement age based on their own needs and those of their family. Unfortunately for some, that decision will be forced by illness or death. But whatever your reason(s) to retire, it is highly individual and entirely up to you.
Nothing anyone else says about your retirement date should mean anything to you. It is yours. To each their own.”
Absolutely agree with the article and comments. My addition would be to state that if medical training were a contract that was to require a certain number of years of “payback to society,” this would need be explicitly spelled out on entry to medical school. And of course this would further decrease the number of people who would choose an increasingly less rewarding profession.
I agree that if it’s not in the contract…it’s not in the contract.
Most physicians I have known work plenty of hours for enough years to qualify for “a career and a half” by age 50-55.
If physicians incur an obligation to work a minimum number of hours or years before retiring, then that should be codified into a legally binding contractual agreement at the time of acceptance into medical school or residency training.
The system exploits us sooooo much, from beginning to end, that it’s a joke to say early retirement is exploitative.
FWIW, my father is a psychiatrist. Solo practice his entire career (plus shared call with other solos). It was a different time.
He is still in solo practice–at age 87, working out of his senior independent living residence. He pivoted to telemedicine during the pandemic, and still see patients virtually two days a week. He does his own billing.
His parents lived into their late nineties, and he is blessed with good health–still playing tennis singles.
I keep encouraging him to retire, and his response is, “I like what I’m doing. I’m good at it. It gives me a sense of purpose.” Also, I think he needs the social connection, as he is widowed and divorced.
So–you do you. Keep working or retire when you want to. Only you can live your life,. No one can live it for you.
Sounds like he is blessed with longevity and function and enjoys what he is doing.
Congratulations are in order!
Thank you for your comment.