A Day at the Office: Smooth Transitions—Setting Up the Next Phase of a Professional Life

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For better or worse, my career as a private practice orthopaedic surgeon defines me. But as I enter the latter half of my professional career, I am starting to consider my life beyond my practice. When will I retire? How will I walk away? Physicians inevitably retire from medicine, but just a rare few do so at the right time—that sweet spot in a surgeon's career when the skills remain, but perhaps the willingness to dedicate oneself to the work fades. Indeed, I find that most private practicing orthopaedic surgeons are reluctant to give up their practices, unwilling to leave behind the legacy and reputation they have built for themselves.
I certainly empathize with physicians who tenaciously hold on to their final years, even as they dip a toe into the retirement pool. In the world of business, one would characterize our profession as having tremendous “entry barriers.” After training, we must successfully pass board certification and maintain that certification over a period of decades. Private practicing orthopaedic surgeons are not guaranteed patient referrals; good will and an outstanding reputation must be developed through years of availability and selfless service. Walking away from all of this “sweat equity” after years of labor must be incredibly difficult.
Still, how we cross that threshold is vitally important. From a business perspective, our private practices need effective and efficient succession planning to smoothly recruit and effectively retain new talent. Behind every retiring physician who decides to stick around a little longer is a disappointed surgeon eager to make his or her own mark on the practice. It certainly can be awkward. What if that surgeon feels marginalized and decides to leave? Instead of a smooth transition, the practice has two surgeons out the door and no replacements lined up.
After watching many physicians waffle about their decisions to stop practicing and waver on their future plans, I am struck by the ones who did it with class and grace. I recall one prominent orthopaedic surgeon who walked out on his last day and vowed never to roam the halls of the hospital again. He left exactly when he said he was going to and never became the “former chief” that continued to live out the glory years in conferences and in the physician's lounge. He left at the zenith of his spectacular career, and that is how everyone remembers him.
I have heard that younger physicians—the millennials (Generation Y), those born between 1977 and 1995 or so—aren't as professionally invested as us older physicians. The younger ones sometimes are accused of being less dedicated to patient care, unable to devote themselves as completely to the needs of the sick and injured as doctors of eras past. I'm a member of Generation X (those born between the mid-1960s and the mid-1970s). By reputation, we are hardworking, but self-centered. But I'm not sure any of these labels explains much in this setting. While I've heard that the 80-hour workweek restriction during residency has caused Generation-Y physicians to perceive patient care as “shift work”, and because of that, they do not take full ownership of their patients, my own experience with Generation Y has been far different. Many of the best of the 96 orthopaedic surgeons and physiatrists in my group are from Generation Y. I can't think of a single one who isn't totally devoted to patient care and to the profession. That being so, I doubt that “retiring poorly” will be a generational phenomenon. I suspect that physicians to come will do it just as badly as I am on track to.
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