By the Numbers

How and when should ophthalmologists consider retirement?

Here are seven points to consider to help you shape the rest of your career and your retirement.

“Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.”
– Dylan Thomas

“We should retire the word ‘retirement.’”
– Herve Byron, MD

“Retirement at 65 is ridiculous. When I was 65 I still had pimples.”
– George Burns

There are a bit more than 15,000 actively practicing ophthalmologists in America. Given the typical 35-or-so-year career span, this means that just more than eight of these eye surgeons retire every week.

One of these weeks, it will be your turn, too.

The youngest ophthalmologist I ever knew who voluntarily retired was in his mid-30s, financially independent and disillusioned by the profession. The oldest ophthalmologist I have ever worked with was 50 years older when he retired and fighting it all the way.

Between these two extremes, we have the typical program:

  • Struggling and appropriately self-doubting at 35;
  • Hubristic at 45, and conquesting your way to the biggest, baddest practice possible;
  • Wiser at 60, and financially independent or nearly so;
  • Mildly, even pleasantly fatigued at 66;
  • And ripe for retreat at 68.

This is all in keeping with the accepted arc of nature: birth, growth, maturity, senescence. But the universality of retirement, along with decades of contemplation and the example of older peers, does not make the process any easier for any surgeons that I know, who enter their sixth or seventh decades as complete retirement novices.

Based on 40 years of conversations with peri- and post-retirement surgeons, here are a few questions and observations for you to consider. Although most of these points will be more meaningful — perhaps even poignant — to the eye surgeon who is 55+ years old, it behooves ophthalmologists at every stage to start contemplating these.

1. Do you have enough money to last the rest of your life? This sounds like a technical question to ask your accountant or financial planner. But it is really more of an emotional question to explore with your spouse, priest or counselor. I know happily retired eye surgeons who left the profession with not much more than Social Security and modest, flexible lifestyle costs. And I have also known surgeons with eight-figure retirement accounts who overstayed in medicine out of economic anxiety, biting their nails all the way to the grave. As it turns out, being anxious and perfectionistic is a generalized personality trait that makes for great surgical diligence, but also great discontent during one’s retirement years. If you are fortunate, four variables will all be aligned: your desired career span, savings pace, capital burn rate in retirement and lifespan. If you suspect this will not be the case, you should work, starting as early as possible, on adjusting one or more of these four dependent variables so they are in better alignment.

2. Do you have enough life left to accomplish your remaining professional goals, as well as your personal ones? What goals are left in each of these two domains? Although you are not an internist or oncologist or cardiologist, you probably have a decent instinct for how old you are biologically and how many sentient, physically active years you have left. Take a moment right now to write down “the number.” (No matter how old or young you are, this is a sobering exercise.) Then spend a few minutes writing down what is left of your bucket list. Now compare the number of years you have left with your list. Which one is longer, your life or your “life list?”

3. How old is old? This question should be the most natural and deeply contemplated by anyone engaged in a largely geriatric medical specialty. But it seems to be as confusing to eye surgeons as it is to the rest of us. Some ophthalmologists have been conditioned by our society to view 65 years as the more or less natural, entitled retirement age (and anything beyond this as overstaying). Such surgeons visibly senesce as that fearsome birthday approaches. They introduce self-deprecating language into their daily conversation: “Now that I’m in my 60s ... .” Other surgeons, such as Herve Byron, a dear early mentor of mine and the original author of this column until shortly before he passed away, do not conflate birthdays and infirmity. As a practical matter, if you want to practice longer because you enjoy it (or have nothing more interesting to retire to) or need to practice longer to top up your retirement savings, reset your biological age with healthy habits and reset your mental age by banishing cultural expectations.

4. What part of ophthalmology do you like more: the techniques, technology and financial rewards, or the human relationships, which abound in any medical practice? In my experience, technically and financially motivated surgeons are the ones less enthralled by medicine and the ones most urgently racing toward retirement. By comparison, client experience shows if you fall into the latter category and are the kind of provider who likes your patients as much or more than the surgical act itself, the last decade of your career will be happier and more fulfilling, irrespective of the pace at which you have to step away from difficult cases or long office hours.

5. What was your peak professional year? (However you may think of this: skills, surgical volumes, income, etc). Do you miss that year, and is there a way to find your way back to that place? Some clients look back on their glory years (most often in their 40s or early 50s) and in the back-third of their careers simply stop trying. They skip national meetings. Their professional journals stack up. And thus begins a spiral to obsolescence and diminishing professional confidence and pride. If you are in the midst of this kind of professional funk, there are numerous opportunities to ramp back up. These most commonly involve a deep dive into one interesting domain, rather than trying to gain back skills across the board of a profession that is increasingly subspecialized. Find a presenting condition, testing modality or procedure that is most interesting to you, and apply your tuning-up there.

6. Do you have any goals left beyond medicine? Indeed, are you retiring from medicine or to something else? The latter mindset seems to be preferred, based on my conversations with surgeons who are looking at their careers through the rearview mirror. The most happily retired docs were ready to move on to the next challenge. This can be something grand — founding a mission or teaching a program overseas — or simply an interest set aside from when ophthalmology and raising a family took over your life. One really happy surgeon I knew focused the rest of his life on learning Spanish and traveling to Spanish-speaking countries. Another one became a grammar school teaching assistant. You do not have to launch a national foundation or run for office to have a fulfilling retirement.

7. Are you and your spouse on the same page? Let’s apply a broad assumption here. The current crop of retirees is from a generation in which a mostly male ophthalmologist cohort married a mostly female homemaker cohort. Whether you are in one of these traditional arrangements or have a spouse who has 10 years left as CEO, what does your partner think about when and how you plan to retire? What is on their bucket list? How much of their list overlaps with yours?

“Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.”
– Dylan Thomas

“We should retire the word ‘retirement.’”
– Herve Byron, MD

“Retirement at 65 is ridiculous. When I was 65 I still had pimples.”
– George Burns

There are a bit more than 15,000 actively practicing ophthalmologists in America. Given the typical 35-or-so-year career span, this means that just more than eight of these eye surgeons retire every week.

One of these weeks, it will be your turn, too.

The youngest ophthalmologist I ever knew who voluntarily retired was in his mid-30s, financially independent and disillusioned by the profession. The oldest ophthalmologist I have ever worked with was 50 years older when he retired and fighting it all the way.

Between these two extremes, we have the typical program:

  • Struggling and appropriately self-doubting at 35;
  • Hubristic at 45, and conquesting your way to the biggest, baddest practice possible;
  • Wiser at 60, and financially independent or nearly so;
  • Mildly, even pleasantly fatigued at 66;
  • And ripe for retreat at 68.

This is all in keeping with the accepted arc of nature: birth, growth, maturity, senescence. But the universality of retirement, along with decades of contemplation and the example of older peers, does not make the process any easier for any surgeons that I know, who enter their sixth or seventh decades as complete retirement novices.

Based on 40 years of conversations with peri- and post-retirement surgeons, here are a few questions and observations for you to consider. Although most of these points will be more meaningful — perhaps even poignant — to the eye surgeon who is 55+ years old, it behooves ophthalmologists at every stage to start contemplating these.

1. Do you have enough money to last the rest of your life? This sounds like a technical question to ask your accountant or financial planner. But it is really more of an emotional question to explore with your spouse, priest or counselor. I know happily retired eye surgeons who left the profession with not much more than Social Security and modest, flexible lifestyle costs. And I have also known surgeons with eight-figure retirement accounts who overstayed in medicine out of economic anxiety, biting their nails all the way to the grave. As it turns out, being anxious and perfectionistic is a generalized personality trait that makes for great surgical diligence, but also great discontent during one’s retirement years. If you are fortunate, four variables will all be aligned: your desired career span, savings pace, capital burn rate in retirement and lifespan. If you suspect this will not be the case, you should work, starting as early as possible, on adjusting one or more of these four dependent variables so they are in better alignment.

PAGE BREAK

2. Do you have enough life left to accomplish your remaining professional goals, as well as your personal ones? What goals are left in each of these two domains? Although you are not an internist or oncologist or cardiologist, you probably have a decent instinct for how old you are biologically and how many sentient, physically active years you have left. Take a moment right now to write down “the number.” (No matter how old or young you are, this is a sobering exercise.) Then spend a few minutes writing down what is left of your bucket list. Now compare the number of years you have left with your list. Which one is longer, your life or your “life list?”

3. How old is old? This question should be the most natural and deeply contemplated by anyone engaged in a largely geriatric medical specialty. But it seems to be as confusing to eye surgeons as it is to the rest of us. Some ophthalmologists have been conditioned by our society to view 65 years as the more or less natural, entitled retirement age (and anything beyond this as overstaying). Such surgeons visibly senesce as that fearsome birthday approaches. They introduce self-deprecating language into their daily conversation: “Now that I’m in my 60s ... .” Other surgeons, such as Herve Byron, a dear early mentor of mine and the original author of this column until shortly before he passed away, do not conflate birthdays and infirmity. As a practical matter, if you want to practice longer because you enjoy it (or have nothing more interesting to retire to) or need to practice longer to top up your retirement savings, reset your biological age with healthy habits and reset your mental age by banishing cultural expectations.

4. What part of ophthalmology do you like more: the techniques, technology and financial rewards, or the human relationships, which abound in any medical practice? In my experience, technically and financially motivated surgeons are the ones less enthralled by medicine and the ones most urgently racing toward retirement. By comparison, client experience shows if you fall into the latter category and are the kind of provider who likes your patients as much or more than the surgical act itself, the last decade of your career will be happier and more fulfilling, irrespective of the pace at which you have to step away from difficult cases or long office hours.

PAGE BREAK

5. What was your peak professional year? (However you may think of this: skills, surgical volumes, income, etc). Do you miss that year, and is there a way to find your way back to that place? Some clients look back on their glory years (most often in their 40s or early 50s) and in the back-third of their careers simply stop trying. They skip national meetings. Their professional journals stack up. And thus begins a spiral to obsolescence and diminishing professional confidence and pride. If you are in the midst of this kind of professional funk, there are numerous opportunities to ramp back up. These most commonly involve a deep dive into one interesting domain, rather than trying to gain back skills across the board of a profession that is increasingly subspecialized. Find a presenting condition, testing modality or procedure that is most interesting to you, and apply your tuning-up there.

6. Do you have any goals left beyond medicine? Indeed, are you retiring from medicine or to something else? The latter mindset seems to be preferred, based on my conversations with surgeons who are looking at their careers through the rearview mirror. The most happily retired docs were ready to move on to the next challenge. This can be something grand — founding a mission or teaching a program overseas — or simply an interest set aside from when ophthalmology and raising a family took over your life. One really happy surgeon I knew focused the rest of his life on learning Spanish and traveling to Spanish-speaking countries. Another one became a grammar school teaching assistant. You do not have to launch a national foundation or run for office to have a fulfilling retirement.

7. Are you and your spouse on the same page? Let’s apply a broad assumption here. The current crop of retirees is from a generation in which a mostly male ophthalmologist cohort married a mostly female homemaker cohort. Whether you are in one of these traditional arrangements or have a spouse who has 10 years left as CEO, what does your partner think about when and how you plan to retire? What is on their bucket list? How much of their list overlaps with yours?

PAGE BREAK