By Anthony Ellis, WCI ColumnistIn 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 One must resort to incomplete and outdated statistics to get an estimate of what this means for people in general and for physicians specifically.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:
How to Retire Early as a Doctor
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?
If the government didn’t subsidize, the cost would be left to the patient. If the patient couldn’t pay, then health care would be rationed to payors only. Frankly I subsidized healthcare by subscribing to medicare, medicaid and insurance instead of runing a cash and carry practice and letting the patient fight with the insurers for reimbursement. From my POV the critics don’t deserve a POV. My choice to terminate my career was mine to make wholly on my whim. I became wealthy because I managed my career choice and investments well, not because of some government subsidy.
At age 67 as an orthopedic surgeon, I decided that I wanted to do an office based practice, but would continue to pull my call with backup for any surgeries. My partners in my specialty group were quite happy with the proposal as they would get my surgical referrals. However, the hospital owned multispecialty group we were part of disagreed. The CMO said “we have no need for an orthopedic surgeon who does not operate”. By the way, that was 28 months ago and my replacement will hopefully start in another month!
I am71 and very healthy,mentally sharp.No cognitive problems. I love delivering babies. But, the socialsed medical system does not want me, because of my age. The administration is auditing all my charts, wants me to take a psych evaluation, and giving me a hard time, and basically forcing me to retire. So, the moral of the story is that the government wants total control of Medical practice, and will scape goat the doctors as and when anything goes wrong. If the doctor retires, he is a jerk! If you keep working, you are a jerk! Only the government and the administration are right at all times. People, wake up! Socialism and communism are failed policies!
Part of me thinks the author writes this because he feels guilt. What we say as readers really will not change that, and where that guilt comes from is inconsequential. As others have pointed out, there are many variables that enter the decision to retire, and it is intensely personal. What we may owe society is not driven by what we do but who we are.
I agreed with the belief that I have a “contract with society” to no t retire after they trained me. But then I got sued, for a patient I never saw. The plaintiffs attorney dragged me through the mud, blackmailed me, and there was nothing I could do about that. I nearly committed suicide. Once that occurred, I realized that society had broken the “contract” I owed them. Thanks to the lawyer sodomites, and their bedfellows, the physician “expert witnesses”, I got out of this mess of a healthcare system and retired early. Screw the “physician-society contract”.
I’m sorry to hear that you went through that hell. I know the feeling as I have been through the same brother.
Very sorry to hear about both of your experiences. If either of you are interested in writing a guest post about what happened and what you learned, even if you wish to stay anonymous, here are our guest post guidelines. https://www.whitecoatinvestor.com/contact/guest-post-policy/
I’ve been through it too. And it was a factor (not the only factor) in my decision to leave medicine.
Retire when you want without guilt. Anyone who disagrees doesn’t understand.
The government may subsidize resident education but it receives a lot of services while paying Medicare and MediCaid fees to physicians.
Sorry, but there days it takes 3 graduating residents to replace 2 retiring physicians. Younger physicians definitely do not want to work the hours we worked.
Last time I checked this is a free country. One can retire whenever they want.
Interesting article, thank you for writing about this topic.
“Contract – a written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” – Oxford Languages Dictionary
I believe the main problem with the “contract to society” argument is that there was no discussion of any contract before or during training. I never entered into a written or spoken agreement regarding the terms of my future employment. I plan to retire when I think the time is right. If society would like doctors to work longer, it should make this contract explicit, or better it should work to improve the healthcare system in such a way that doctors desire to continue to work.
I’m trying to figure out where this article got posted to get all this new interest in it. The article is almost 2 years old. Where did you come to it from?
I was linked from a Doximity Medical Business News email:
https://www.doximity.com/collections/993ddf2d-e32e-4193-a726-f9851dec337e?_eda_link_uuid=67a93c8e-2f9f-4c8c-b307-0f33fbef1c5f&_r=1&_ref=digest&_t=fa9dd09d-dbb5-4b0d-9752-fd7f3742b4e1&clicked=true&featured_item=news-articles%2F9329c54e-94c1-4b1f-bb5b-cca7a2ce5887&position=1&source=email_doc_news%3A%3Amedical_business_digest&utm_campaign=doc_news%3A%3Amedical_business_digest&utm_source=doximity-eda&utm_medium=email
I figured it was something like that. They just usually link to newer stuff.
I left clinical practice (academics) in my late 40’s when I seemed to be burning out-I worried about making a mistake and putting a patient’s life at risk. Even worse, I became extremely anxious with the prospect of being sued-something I knew would destroy my soul since hurting any patient in and of itself would be devastating-let alone the legal consequences. I am often wracked by guilt at having left medicine so early-not least because I loved my field. However, the personal risks around liability, the post-Covid working situation and the negative experiences of my friends and colleagues who have stayed in the field reinforce my decision. I think the concept of staying in medicine because of a debt to society overlooks its litigious and blame-oriented focus. If practicing as a physician were perhaps more along the lines of pre-insurance, pre-litigation, pre-Google knows all, I suspect that the issue of early retirement from medicine would lessen.
Pre-insurance and pre-litigation? What century are you talking about going back to?
At any rate, while there is no doubt that there is a psychological hit to getting sued, and I’ve met many docs who mention that as one of the reasons they retired early, the actual risk of losing personal assets in a malpractice lawsuit is incredibly low.