Retiring as a Physician

Two retired internists reflect on how retirement affects one's self-image and how to succeed in retirement.

What is The Clinical Excellence Podcast?

The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.

[00:00:00] Dr. Cifu: On today's episode of the Clinical Excellence Podcast, we have Doctors Altkorn and Brukner talking about retiring as a physician.

[00:00:11] Dr. Altkorn: I think you have to really be ready to retire. You have to want to do it, and some people don't, I mean, certainly, we've seen colleagues who have worked into their eighties...

[00:00:21] Dr. Cifu: Yeah.

[00:00:21] Dr. Altkorn: ...whether they should or not is a different question.

[00:00:31] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast sponsored by the Bucksbaum Institute. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today I'm joined by Doctors Altkorn and Brukner. Dr. Diane Altkorn was a professor of medicine at the University of Chicago. For years Diane was a hugely respected primary care physician and general internist. She worked extensively on curriculum development and teaching at every level along the medical education continuum. She was a founding author and then editor of the hugely influential Symptom to Diagnosis textbook. For years she also served as a faculty ombudsman for the Pritzker School of Medicine.

Dr. Halina Brukner was also a professor of medicine and respected general internist at the University of Chicago. Halina held at one time or another every position in the institution. She was the director of the primary care group and once upon a time, interviewed me for a job here. She served as the vice chair of the Department of Medicine, the associate dean for Medical School Education, a position in which she guided the implementation of a new curriculum. And finally, she served as the dean for Medical Education for the Pritzker School of Medicine. Both Halina and Diane were always treasured colleagues and mentors and remain close friends.

Guys, thanks for joining me.

[00:01:53] Dr. Brukner: Great to be here.

[00:01:54] Dr. Altkorn: Great to be here. Thanks for asking us.

[00:01:56] Dr. Cifu: Diane, this is your third podcast with me, I believe.

[00:01:59] Dr. Altkorn: It is. I'm becoming a regular.

[00:02:02] Dr. Cifu: Um, so I'm not sure that this is more true for medicine than for any other profession, but I find that a lot of doctors really define themselves by being a doctor, right? If you ask people like, what are you, you know, they'll say, "Oh, I'm a mother, father, American, Chicagoan," whatever, but they'll also mention, you know, that I'm a doctor. And so when you retire, it seems like you lose something of your identity, maybe you become a retired doctor, but it's not as kind of front and center. So have you guys felt this and I guess like how have you handled it if you have? Diane, you want to?

[00:02:35] Dr. Altkorn: Sure. Well, I think based on the number of medical questions my family still asks me, um, they don't recognize I'm not a doctor, um, but I've thought a lot about how to refer to myself now when people ask me...

[00:02:49] Dr. Cifu: Yeah, yeah.

[00:02:49] Dr. Altkorn: ...what do you do or are you retired and what did you do? And I've landed on saying I am a retired doctor. Present tense.

[00:02:58] Dr. Cifu: Right.

[00:02:58] Dr. Altkorn: As opposed to I was a doctor. I don't like the "I was a doctor" because even though I felt very ready to retire and I've been very happy in retirement, I'm not a hundred percent willing to... A hundred percent give up that identity.

[00:03:13] Dr. Cifu: Interesting.

[00:03:14] Dr. Brukner: I could not agree more with that. Um, I am a doctor. I'm just not working as a doctor right now, and I think I'll always be a doctor. It is an integral part of my identity, but it is not right now the defining entity of my identity. I feel that everybody's life has different phases and I had an active doctor phase for almost, well, more than 40 years if you count all the training and everything, but in practice for 36 years and then all the training before that. So it would be crazy to say I was a doctor, I'm still a doctor, but I am now in just a different part of my life which I'm also immensely enjoying, and, um, also have a lot of questions asked about medical issues from people who know me, but, um, it is not the defining...

[00:04:20] Dr. Cifu: Got it.

[00:04:20] Dr. Brukner: ...part of my identity right now.

[00:04:22] Dr. Cifu: Do you say I'm answering this question as an educated, lay professional or something?

[00:04:29] Dr. Brukner: Well, I would just say I'm answering this question as someone who doesn't know your medical history at this point.

[00:04:35] Dr. Cifu: Yeah, yeah. Something that we've always gotten used to.

[00:04:37] Dr. Brukner: Right, and not being able to look in Epic is not a negative.

[00:04:41] Dr. Cifu: Right, right. I talked to somebody over the weekend who said that she misses the people, but is very happy not to miss the anxiety. So, um...

[00:04:51] Dr. Altkorn: Exactly.

[00:04:52] Dr. Brukner: Well, you know, the way I would put it is what I really miss are the relationships.

[00:04:58] Dr. Cifu: Yeah.

[00:04:58] Dr. Brukner: The people, my patients, having the opportunity to talk to very interesting people who have lives that are interesting to me, but what I don't miss is the work of being a doctor.

[00:05:12] Dr. Cifu: Yeah. Yeah.

[00:05:13] Dr. Brukner: And I think for all the years I was working, I was more than willing to, um, to do that work.

[00:05:20] Dr. Cifu: Yeah. Do you guys still, I mean, when I look forward decades from now, um, that I feel like there are times that I can't appreciate the medicine enough because I'm so busy. I mean, are there times that you still feel kind of interested enough to dive into, you know, I don't know, what's going on in a journal or like read a New England Journal case presentation?

[00:05:49] Dr. Altkorn: I still do look at the journals. I get the New England Journal Table of Contents.

[00:05:54] Dr. Cifu: Yeah.

[00:05:54] Dr. Altkorn: And I always look at it and occasionally I read an article, um, I still get print JAMA for who knows why, and so I read through that. One thing I didn't anticipate when I retired was, I mean, I anticipated the relief I would feel at no longer feeling responsible for so many people...

[00:06:16] Dr. Cifu: Right.

[00:06:17] Dr. Altkorn: ...but I didn't anticipate the relief I would feel for no longer being responsible for keeping up.

[00:06:22] Dr. Cifu: Mm-hmm.

[00:06:22] Dr. Altkorn: I hadn't realized how much emotional energy it took as a general internist...

[00:06:28] Dr. Cifu: Yeah.

[00:06:28] Dr. Altkorn: ...working in a resident clinic where I really felt obligated to really keep up, not only for my own patient care but to be able to teach.

[00:06:37] Dr. Cifu: Right. And because they'd make fun of you if you didn't.

[00:06:40] Dr. Altkorn: And they would make fun of me. And so to read through a couple of journals and say, oh that's really interesting, but not feel this compulsion to read everything all the time and then remember it and put it into practice.

[00:06:57] Dr. Cifu: Yeah. So, this may sort of build on some of the things you guys said, but you know, when I think about my practice, um, there is, Halina, what you talked about is that boy, there are some people who, I love it because if I wasn't a doctor, I would never have anything to do with these people and like, that's an amazing opportunity, but then there are all the people in my practice who are, you know, colleagues, acquaintances, some of them who are good friends, and who I imagine that after I stop working, those people are still going to be in my life to some extent, but they'll be something different, right? Because I won't still be their doctor. And sometimes I think, oh, that's going to be really nice, other times I like wonder, will that relationship change? Is that something you felt?

[00:07:42] Dr. Brukner: Absolutely, um, I had many conversations with patients who were also my friends or close acquaintances or colleagues about how we would relate when I retired and what I kind of settled on for most of those relationships, I think, was acceptable to the patients, and it's this that when I'm your doctor and also your friend, colleague, whatever, it's complicated. It's not undoable, but it takes a lot of work and self-knowledge to do it in a way that will work. And once I retire, we can just be friends and that will be really nice. And when I had that conversation, most of the people with whom I shared that thought process were like, "That's great. I'm looking forward to that."

[00:08:50] Dr. Cifu: Yeah, yeah.

[00:08:52] Dr. Altkorn: Yeah. I agree with Halina. In many ways it simplifies the relationship, there's no longer this need to sort of compartmentalize certain things you know about them that you wouldn't know otherwise, that sometimes creep into your mind during a social interaction and you have to kind of push it back. And so it's nice just to be friends with the people you're friends with.

[00:09:14] Dr. Cifu: I wonder if we could do a better job of teaching that complexity, 'cause clearly, you know, listening to you guys, that's something that we all really experience, you know, in our lives. And I feel that in medical school and even in residency, the training was like, "Oh, you don't have relationships with people, you know, outside the office," which I have to say, when I was the recipient of that training, I sort of bought that and I understood it. And it wasn't until kind of being in practice for, you know, five years that I realized that's like completely untenable, you know, that you end up being close to these people either because you just get close to them in the patient-doctor role or because they're part of your lives in so many other ways. It's not like we work in a small town, but I think probably everywhere that doctors work have some part of a small town.

[00:10:04] Dr. Altkorn: Well, in some ways we do work in a small town.

[00:10:06] Dr. Cifu: That's true.

[00:10:07] Dr. Altkorn: The Hyde Park neighborhood is a small town.

[00:10:08] Dr. Cifu: Yeah.

[00:10:09] Dr. Altkorn: And I will say that, for me, it seemed to work better if I was already friends with someone and they said, "Can I come see you?"

[00:10:18] Dr. Cifu: Right.

[00:10:18] Dr. Altkorn: As opposed to people for whom the relationship started as kind of standard doctor-patient and then it became clear we had some things in common, or maybe we had kids going to the same school and they kind of said, "Oh, can we have coffee?"

[00:10:32] Dr. Cifu: Right, right.

[00:10:33] Dr. Altkorn: And I did do that once or twice, and it just didn't really seem to work.

[00:10:38] Dr. Cifu: Yeah.

[00:10:39] Dr. Altkorn: And so then if that came up, I would just say, "You know, let's just kind of keep our relationship in this setting."

[00:10:47] Dr. Cifu: I think also the people who...

[00:10:49] Dr. Altkorn: So it's kind of interesting. I'm not sure what else to say about it.

[00:10:52] Dr. Cifu: Yeah. I think also the people you're friends with first, I always feel like there's a little bit of ground rules that you lay down. You're like, "I'm happy to see you. I see other friends, but you have to understand X, Y, and Z."

[00:11:05] Dr. Brukner: Yeah. There were, I mean, there are some patient relationships that begin as feeling very transactional.

[00:11:14] Dr. Cifu: Right.

[00:11:14] Dr. Brukner: And those would not be good ones to make into friendships or to try to turn into friendships. And to be honest, when I retired, I was kind of relieved to not have to deal with those but I do think that my friends with whom I had those conversations that we talked about before, um, it really did work really well.

[00:11:39] Dr. Cifu: Yeah.

[00:11:40] Dr. Brukner: And we are friends now in a good way.

[00:11:43] Dr. Cifu: Yeah. That's interesting hearing you describe, you know, a subset of relationships as transactional, 'cause I think that's definitely true. I think there are some doctors who thrive in those relationships and others who don't. And I do like it when people come in and make it clear that that's what the relationship is from the beginning because you sort of like, you know what you're getting. So let me ask you this, I and I'm sure you guys were in exactly the same position, you know, while you were practicing, that as a general internist, seeing a lot of older people, you see a lot of people go through the transition from work to not work. And I've certainly seen, you know, my share of people who sort of fail at retirement, right? In a completely sort of unscientific study, I think it's my male physician surgeons who tend to do the worst, but I don't know, do you think that we as doctors are set up for that particularly? Or, and I don't know, how do you guys think about not failing, succeeding at getting an honors in retirement?

[00:12:53] Dr. Altkorn: Um, well part of it is what Halina already alluded to, this idea that there's different phases in your life...

[00:12:59] Dr. Cifu: Yeah.

[00:12:59] Dr. Altkorn: ...and that this is a different phase. I think you have to really be ready to retire.

[00:13:06] Dr. Cifu: Yeah.

[00:13:06] Dr. Altkorn: You have to want to do it. And some people don't. I mean, certainly, we've seen colleagues who have worked into their eighties...

[00:13:12] Dr. Cifu: Yeah.

[00:13:12] Dr. Altkorn: ...whether they should or not is a different question...

[00:13:15] Dr. Cifu: Yeah.

[00:13:16] Dr. Altkorn: ...but they were clearly not really ever ready, and I think probably most... And yes, you should do a little planning about what sort of activities you might want to do or do more of, or start or whatever, but mostly I think you need to give yourself permission to not be busy all the time. And that as doctors, we are trained in an atmosphere where we're expected to be busy, you know, now only 80 hours a week, but when we did it, it was 90 or 100 hours a week, and that you're expected to be busy all day long when you're at work and even busy when you're at home when you're not at work. And so you have to learn to be okay with, okay, "Yesterday I went on a walk and then yesterday I went to the grocery store and yesterday I talked to a friend and now I'm just going to read for a while." And you have to let yourself think that's okay.

[00:14:04] Dr. Cifu: Yeah. It's funny when you, you know, I like the sort of phase of life and I'm trying to think, as you were talking about other phases that you kind of have full control opting into because maybe there aren't that many other phases like that. I mean, sure there are things like, you know, marriage and having children and whatever, and yeah, those are all decisions you make, but they're also sort of, okay, this is the time to do this and I can choose not to or to, but you're sort of in a way forced into it if you're going to go in that direction.

[00:14:42] Dr. Altkorn: Mm-hmm.

[00:14:43] Dr. Cifu: And retirement is something that maybe there's a twenty-year period where maybe it's right or wrong for you.

[00:14:52] Dr. Brukner: Well, I think especially for most of us whose careers have been really intense and a constant balancing act that we become very good at and Diane mentioned, you know, your personal life, your children, your relationships, your family, plus this very big job that most of us have that is multifaceted as well. Giving that up is a little scary even when you feel ready, but... And I think for some people it is not the right thing to do, but I can tell you that the immense kind of relief and, um, happiness that comes with being able to give yourself the permission Diane alluded to is beautiful. And so I think while it's not the right thing for everybody, it is certainly the right thing for many of us to let go of. You know, I have said this to other people, but the weirdest thing about retirement is not having the time for me, it's not that all this time is there that you can do whatever you want with, or, you know, mostly, but it's just not getting a paycheck. And it's not that even... It's not even the money because obviously if you are going to make the choice to retire, you have planned that this is something you can do, but you know your whole life you have been, you know, working, I have been working and the idea that all of a sudden that's not... That's the tangible thing that's weird. And you know, I kind of smile about it when I feel that way, but that was of all the feelings that I had, that was the most disconcerting.

[00:16:55] Dr. Cifu: Okay. I've got one more question, which I didn't prepare you guys for 'cause I just thought of it, and don't let me get too personal, but to inspire people, I don't know, what is the one thing that maybe you've just appreciated the most about, you know, this most recent phase of your life? Either, you know, things that you've been able to do that you weren't able to do, things that you're able to put more time into, I don't know, what do you think?

[00:17:19] Dr. Brukner: I can name a few.

[00:17:20] Dr. Cifu: Yeah.

[00:17:21] Dr. Brukner: So number one, a few months ago we took the longest vacation we've ever taken.

[00:17:26] Dr. Cifu: Nice.

[00:17:27] Dr. Brukner: We were gone for three weeks.

[00:17:28] Dr. Cifu: Wow.

[00:17:29] Dr. Brukner: And we're planning another trip in January for three weeks, far away abroad, something that we were not ever able to, you know, the amount of time that we would never have been able to take if we were both working and so that's one thing. Another thing is that to some extent, my identity as a physician is augmented now by my identity as a grandparent. And I have been able to have the flexibility to spend the time that I want with my grandchildren who are not in the same city as I am. And so those kinds of things make me happy and make me feel that I'm using the time well.

[00:18:11] Dr. Cifu: Right.

[00:18:12] Dr. Altkorn: So I look forward to having grandchildren so I can fill up my time with them and...

[00:18:17] Dr. Cifu: We got to pressure your children at every possible...

[00:18:20] Dr. Altkorn: Totally, we'll be sure they listen to this podcast. Um, so I don't know if this is going to come out sounding too self-centered, but I've really valued having the time to just kind of do what I want.

[00:18:34] Dr. Cifu: Yeah, yeah.

[00:18:35] Dr. Altkorn: Or to not do anything and to be able to help out, say this young couple we've become friends with in our building who just had their second child last week and so I can do some grocery shopping for them.

[00:18:48] Dr. Cifu: Yeah.

[00:18:48] Dr. Altkorn: And help out at the synagogue and I've started volunteering at a pet shelter and you know, just trying out some different things.

[00:18:58] Dr. Cifu: When you said it was going to be self-centered, I thought you were going to say that you're happy to have time to just entertain the great thoughts that you have continuously. I realize neither of you said you're happy to have the time to accept podcast invitations all the time.

[00:19:10] Dr. Altkorn: Oh, but we are, we'll come back anytime.

[00:19:12] Dr. Brukner: We just can't say no to you, Adam.

[00:19:14] Dr. Cifu: That's right, that's right. Well, thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas on the Bucksbaum Institute Twitter page.

The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.