Dear Readers: As the Liminal Space matures, we are realizing that liminality can come in various points in our life. Today, we highlight the story of a clinician educator who has been a founding mother of faculty development in Canada. She has paved the way for so many of us to follow in her footsteps. Now she is sharing her story about transitioning into retirement. For most of us, this may not be on the top of our priority list, but we are excited to have Allyn share her story so we can learn from her. – Teresa (@TChanMD)
By Allyn Walsh (@allynewalsh)
The practice of medicine is highly addictive.
The first decade or two are so much work and bring so many challenges that it can be difficult to recognize why it is that physicians tend to avoid giving it up.
Oh yes, the lack of any pension, the performance of the stock market and other financial reasons are commonly cited. But the practice of medicine both in the clinical and the scholarship realm insidiously becomes more and more satisfying. Providing interesting and frequently fascinating work, the opportunity to do meaningful work, and to receive recognition and praise just often enough keeps us going. Medicine has us hooked long before we realize it.
I have been fortunate to split my time in both a busy family practice and an academic environment. I knew that I (mostly) enjoyed my work, with all its diversity in content and context, but it was not until I had the opportunity to take a one year sabbatical that I realized I had a problem.
I certainly worked at a more leisured pace that year, and I can’t say I missed being on call but part way through I realized that I was filling my time completely and that the peaceful afternoons at the university’s faculty club and the days devoted to my hobbies were not going to be a part of the sabbatical.
I realized that if it was not possible for me to go from 100 MPH down to 50 MPH, I was going to have real difficulty going down to 0 in the retirement I anticipated in 10 years.
Why not work for longer? Why stop at age 65?
We are all being encouraged to work longer, well beyond the traditional 65. I could not bear the thought of working when colleagues felt I should stop. Physicians are not good at letting their colleagues know when they have gone over their “best by” date. We have all seen and felt badly for those who continue labouring on, with others picking up the pieces, correcting the mistakes as they can, and wishing that the colleague would just “retire already”. I did not want declining abilities to impact a patient or family.
The literature on the abilities of the aging physician is concerning (see Eva 2002, Durning 2010, Lee 2012) and while I recognized that there is great individual variation, I am also aware that there is a sweet spot for us all, after which our abilities decline. I believe that if I waited till that sweet spot, it would be too late, even if I had the capacity to recognize it when it arrived. I drew a line in the sand, 10 years in advance and began getting ready.
My first step was to assess my ambitions, and what I wanted to achieve professionally. Like many other physicians, I have energy and ambition, although the direction of that drive has varied over the years. I decided that I need to make a decision about whether to advance my career or not.
With 10 years of professional life left, the answer was obvious: take on meaningful tasks, but ones that weren’t necessarily going to lead to the next great thing. I decided to take on roles from which I would continue to grow and learn, that would make a contribution, but would also allow me to begin an intentional slowing down of the demands of work. With the myriad of opportunities available in academia, the difficulty is in being selective.
I found that the most helpful way to choose was to ask myself: Will my life be better or worse if I take this on? And for almost everything, the answer was “worse”. Academic roles come with time limits for many good reasons, and I chose each role with my end date in mind.
My greatest concern was with clinical work, as declining abilities in this realm can carry terrible consequences for others.
A generalist by nature, it was difficult to find ways to focus my clinical work. Mindful of the literature, I gave up on call work with its demands for rapid de novo decision making and lack of oversight. I concentrated on chronic disease management including mental health, minor acute illness, and gave up antenatal and well-baby care with their rapidly changing standards of care. I was very fortunate to be supported in this by both the academic Department of Family Medicine at McMaster and Stonechurch Family Health Centre.
If this sounds easy, it was not. Including medical school, I have been in medicine for 46 years. This represents 70% of my entire life. I became an adult as I became a physician. My personhood is inexorably linked with my physicianhood. I have shed more than a few tears as I relinquished tasks and said good bye to colleagues and patients. And of course, although now retired, I continue to volunteer time on committees and to support colleagues in various small ways. I anticipate that with time these activities will increasingly be replaced with ones from my long list of retirement undertakings, none of which have anything to do with medicine. I haven’t yet been able to give up reading journals, both clinical and academic. Time will tell if 10 years of planning have paid off.
All I can say is – so far, so good!
Further reading
Eva, Kevin W. The aging physician: changes in cognitive processing and their impact on medical practice. Academic Medicine 77.10 (2002): S1-S6.
Durning, Steven J., et al. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century. Journal of Continuing Education in the Health Professions 30.3 (2010): 153-160.
Lee, Linda, and Wayne Weston. The aging physician. Canadian Family Physician 58.1 (2012): 17-18.
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