Editorial: Retirement—Dread or Dream? Reflections on Transitioning to a New Phase of Life

Orthopaedic surgeons relieve pain, help people walk again, return athletes to sport, straighten the spines of children, and so much more. We’re lucky to be able to do so much good. Why would we ever want to stop? We all have our reasons, and we can’t stop time. At some point, most of us slow down, and we must eventually decide to confront the “R-word”: Retirement.

How do we decide when to do this? What do we do with ourselves when we stop practice? How do we prepare for it? The reality is that being a surgeon is a part of our identity. Does our identity simply vanish when we walk out of the operating room (OR) for good? Of course not. But like raising children, there is no instruction manual for how to manage this new chapter and these new feelings.

We learn in part from the example of others. I had four chiefs when I was a resident and young attending, and they all retired differently. One never stopped coming to work until health prevented it, one cut back gradually on his practice until he thought he was “ready” and helped younger surgeons in the OR when asked, one transitioned to mentoring medical students and getting more involved with healthcare disparities, and one stopped practice and never looked back. There is no “right way” to do it.

As I got older, I watched some of my slightly more senior colleagues stop operating at some predefined and seemingly arbitrary age, even though their surgical skills were as good as or better than those of their more-junior colleagues. Others who are older than me continue to operate. It’s obviously a personal choice. And one that takes honest and, at times, painful reflection.

Here are three questions I’ve recently asked myself as I’ve made this transition.

How do I want to retire?

I believe that its best if we decide for ourselves when retirement will happen, rather than waiting for someone to tell us that it’s time to put down the osteotome. I was reluctant to retire “cold turkey.” I took a gradual approach. One issue that loomed large for me was whether I had the financial resources to retire and live in the manner that my wife and I envisioned. This was a difficult personal decision, but I had good financial planning advice and had started saving in residency, which made my decision easier.

In my mid-60s, I started to wonder whether my surgical skills, physical endurance, and mental acuity would diminish. I was concerned that I might make errors in surgical planning or execution. The thought of ending my career with a reputation-tarnishing blunder was my worst nightmare. Over time, I decided that my skills were best used helping my junior partners in the OR and limiting the number of physically challenging major tumor resections I performed. More recently, I’ve determined that it is time to trust my younger colleagues to take over completely.

For me, doing this was a relief and I don’t miss operating a bit (well, maybe a little). I was not surprised by this because although I enjoyed many aspects of the practice of medicine, being a surgeon was only a part of my identity.

The aspect of surgery I enjoyed most was the anatomy of the surgical dissections for tumor resections. I would read and re-read anatomy the night before a procedure and always learned something new. To me, the resection part of the procedure was the most interesting and important, and I loved to look at the specimen and histology with the pathologist after the biopsy or tumor was out. The reconstructive aspects were less exciting for me, although I think I was good at it.

I felt a sense of accomplishment after I removed a tumor, but the stress of the major procedures began to weigh on me. I enjoyed the intellectual challenge of making the diagnosis, discussing multidisciplinary treatment with our team, helping the families decide which surgical options were best for them, but the nights before surgery were often spent in fitful sleep before the big procedures and I would worry that the operation would not go as planned or I would make a major surgical error resulting in a complication. It never seemed to me that other surgeons had the same fears. Sometimes there were strong emotional struggles with doing an amputation or a rotationplasty. I would wonder if I was doing the right thing or if some other surgeon could do better. But seldom did anything untoward happen and my complications were similar to other surgeons. After the procedure, I would walk away and think to myself, that was actually pretty cool. What was I worried about? But then I would stress about the next one.

So, although I miss the satisfaction of successfully performing a difficult operation and curing a patient of their primary tumor, I do not miss the stress and I do not miss being in the OR. I do miss the talented people I worked with and got to know well over the years. In fact, I still have dreams of being in the OR. I guess that does not go away.

I now see clinic patients and focus on getting to know them better. During my career, medicine became more of a business than a profession, and the production pressure to see as many patients as you could in a day took priority over how you treated them. Now, I spend as much time as I think my patients need. I relish the luxury of getting up in the morning and knowing I’ll be visiting with patients, some of whom now are old friends. The more-relaxed pace gives me more time to spend on their questions, to try to allay their fears, or to help them find peace with sometimes-terminal diagnoses. I think of it as having a day filled with fascinating conversations with interesting people. One thing I have learned over the years is that even if you can’t solve all the problems, and in the tumor setting that is often the case, you can always offer hope. Sometimes a patient enters the room with unrealistic fears about their diagnosis and you can reassure them and alleviate the fear if the diagnosis is benign. For patients with more serious conditions, you can let them know that you will try to guide them through a pathway toward cure and never abandon them if things don’t go as well as we would like. Those are the aspects of patient care that I cherish, and I will miss that when I stop.

Will I have too much free time and be bored?

I met an internist a few years ago who took up wood-turning (I didn’t even know what this was until I went to his workshop). He joked that for the first 5 years he only made wood chips, but he is now turning logs into beautiful vases, bowls, and lamps. A retired friend of mine plays bluegrass music with his brothers and makes mandolins from cigar boxes. I have played the clarinet since childhood and enjoy classical music. I am now trying to learn Klezmer and jazz. I also love to read, and I’ll know I’m “fully retired” when I can read the New Yorker each week, cover to cover. Sport is a great outlet for many of us, although rugby or basketball may have to be replaced with golf and pickleball. Walking with my wife, children, friends, or dog provides exercise and enhances my relationships as well. Never stop moving.

I realize I’ve deprived my family of my presence for many years. They—and I—are enjoying making up for the lost time, so time gets filled faster than I imagined it would. Then again, sitting on the deck and watching the trees and ocean is also fulfilling. Either way, the time goes quickly, and I’m learning to prioritize how I fill it.

Part of that recipe for me is remaining professionally engaged, albeit in some new ways, and with new goals. Senior (and recently retired) orthopaedic surgeons know the profession of medicine. Staying active in local, national, and international professional organizations is one of many ways to “pay it forward.” It is possible to volunteer anywhere in the world to teach local orthopaedic surgeons or to assist in surgery or clinical care. Non-profit organizations or boards are always grateful for contribution of leadership expertise. Our local communities or involvement in other aspects of our universities are also possibilities as Michael Chapman MD has described [1]. I have done some of these activities and these experiences allow me to not only give/share my expertise with others, but they offer me new opportunities for developing new colleagues and friends.

How do I make my exit?

My wife says I’ve already flunked retirement because I am still very busy. But I plan to stop patient care completely this year. When I do so, I plan to keep learning, while also learning to enjoy life in ways that were not possible when I was working 60 hours to 80 hours a week. I am making this transition at my pace, and I’ve made a plan, sort of.

I get to decide the tempo of my exit. While I knew I wanted to take a gradual approach to retirement, I also knew I was walking away from the best job in the world. I’ve been a cancer surgeon, an educator, a researcher, and a department chair. I had the opportunity to build a department almost from scratch and enjoyed nearly every moment of that 17-year run. How very fortunate I’ve been.

The beautiful thing is that I did not necessarily have to do a full stop to exit. I continue to attend grand rounds and conferences, teach students and residents, and help my junior colleagues by seeing clinic patients and offering advice on complicated patient problems. And of course, I still edit for CORR®.

As I mentioned above, I had no trouble filling the time I used to spend operating and being an administrator. I really enjoy reading history and novels. I continue to take music lessons and enjoy chamber music and playing in an orchestra. I may even finally learn to play the piano! My wife and I enjoy traveling and will do more when it’s safe and stay as active as possible. I took golf lessons last summer and enjoyed it. I never thought that would happen! I may take courses at a local college on topics of interest to me.

I believe maintaining connections with friends and loved ones, staying active, finding new interests, and being open to new experiences are key ingredients to a rewarding retirement. We all studied and worked very hard to get to be orthopaedic surgeons. We worked long hours during our professional careers. We do good for other people. At a certain point, we also deserve to do good for ourselves.