Classic Blog: Reviewing Retirement

EDITOR'S NOTE
Welcome to the “Classic Blog” series.

Two years ago, Dr Steven Moffic-a psychiatrist for more than 40 years-retired from practice. He wrote about his upcoming retirement in a blog that you can read here. And now, 2 years into his retirement, he reflects on how the Affordable Care Act might have hastened his decision to leave practice, and about the unexpected sense of emotional lightness he experiences now that he is no longer a clinical psychiatrist. He also offers some recommendations for his colleagues who are considering retiring.

This is the first in a series in which Dr Moffic (and possibly other bloggers) revisits the blogs he has been writing for Psychiatric Times for the past several years.

It has now been almost two years since I decided to retire and wrote the blog about my plans to retire: “Mental Bootcamp: Today is the First Day of Your Retirement.” And it still may be the first day of your retirement. For me, it is past the honeymoon period. Much has gone as anticipated, but there have been some surprises, both in society and from my perspective.

The ACA and retirement
My retirement came on the cusp of several major changes in psychiatry: DSM-5, reimbursement coding changes, new certification requirements for psychiatrists, and the emergence of “ObamaCare”-to name a few. Personally, I was relieved I wouldn’t have to adapt to all of these events, although they could turn out to benefit the field. Certainly, many have vociferously commented on the problems with certification in response to a recent Psychiatric Times blog on the subject. But by far the main reason I retired when I did was to take advantage of Medicare. That reason may diminish for many as ObamaCare emerges.

The February 5th American Psychiatric Association “Headlines” e-newsletter opened and closed with two items related to retirement. The first had to do with the (somewhat controversial) prediction that the “ACA Will Cause 2.5 Million to Leave the Workforce Over Ten Years.” If the ACA had been available before I retired, I would have retired earlier. Staying at work just to keep health insurance is not particularly satisfying, but many in the US have had to do so. The final item in the headlines was “Physician Shortage for Those With ACA Coverage Worse Than Expected.” It is not clear whether the shortage is partly because more physicians are retiring, but it does seem more likely a result of major insurers cutting their networks. Inevitably, that will put more work pressure on the “providers” who are left to do more work in less time.

The emotional hazard of empathy
I expected to enjoy more time with my wife and family, and I have. I won’t die regretting that I didn’t spend more time with my loved ones, as many do. I feel blessed and oh, so grateful.

Fortunately, with the exception of my teeth, my overall health-especially my mental health-may be even better now than before retirement. Why? I had not recognized the emotional and physical toll being a practicing and empathetic clinician took on me. In retrospect, that emotional toll lessened somewhat as 15-minute med checks became a regular practice. There just wasn’t enough time to go into depth with patients, even when I asked them what gave their lives the most meaning. I now wonder: can the lessening of this emotional toll be one reason why psychiatrists have gone along with brief medication checks as much as we have?

What a sense of lightness I feel. Now, I can attend better to almost every area of my daily life. Perhaps living more fully has led me to become a different type of psychiatrist.

Evolving into a public psychiatrist
Have I missed my work? That is the most common question I get. The answer has come to surprise me. My wife says that I’m no longer a psychiatrist, which is certainly true in some ways because I no longer see patients. True, I’m no longer a clinical psychiatrist. I do miss so many of my patients and feel thankful when I run into them and find out how well they are doing. Actually, they seem to feel less need to keep confidentiality now, including introducing themselves to my wife and letting them know how they knew me.

I continue to be a writing psychiatrist, even more so now-and I am free to say what I want without the fear that my job will be affected. I am still a speaking psychiatrist, presenting at meetings and conferences. I’m still a board psychiatrist, sitting on some professional and community boards if I think I can be of value. I can also quit doing any of these whenever I want.

However, most of all, I’m a public psychiatrist. By public psychiatrist, I don’t mean a public health psychiatrist. I mean it in the way I recall Ralph Nader once talked about being a public citizen, working for the greater good.

I had thought that people would share even less of their problems and questions with me once they knew that I had retired. It has been the opposite, as if no longer having patients meant that I wouldn’t view them in a clinical way. Did my new status de-stigmatize me?

I have been asked to do more publically, such as join in on panels to discuss movies that have psychological meaning; speak at synagogues on the overlap of religion and psychiatry; and become part of a project to build resilience in teenagers. And, most unlikely, I was asked to lead the memorial eulogy at our 50th high school reunion.

I wrote in my original retirement blog that Dr Nuland felt that the hardest task in retiring, even to his beloved and popular writing, was that he would “no longer be seen as anybody’s healer.” That may be true for surgeons like him, who can no longer cut up bodies and put them back together again, but not for this psychiatrist. I’m a different kind of healer-but still a healer of sorts. I retain my professional identity, as do a couple of other colleagues and friends of mine who have retired. One got more involved with his church; the other is addressing major problems in our mental healthcare system in Milwaukee.

This leads me to wonder if there is a way to get psychiatrists more involved in everyday life. As part of politics, and political gridlock and conflict? As part of the education of children, to teach more about how to achieve mental well-being? As part of the entertainment industry, given the shattered lives of so many celebrities? Must we retire to do this? We have so much to share and contribute to society.

Retirement recommendations
There are many things to consider before retirement. However, there may be a couple of recommendations I can pass on after two years:

• Plan for retirement, even if you don’t plan to retire. This means sound financial planning, developing other interests, and nurturing your relationships with significant others
• Retire, even if you are not retired. Take enough time off periodically, and completely, with no connections to work, so that you can feel emotionally free from concerns about patients and practice

Of course, there is no reason to retire if you really love your work and relationships just as they are.