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Thread: When Should A Doctor Retire?

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    Question When Should A Doctor Retire?

    When Should A Doctor Retire?

    08 Dec 2008

    The absence of evidence-based guidelines makes decision making very difficult for Medical Boards in attempting to ensure that normal cognitive decline in ageing medical practitioners does not compromise patient safety, according to an article in the latest Medical Journal of Australia.

    Dr Robert Adler and Dr Conn Constantinou of the Medical Practitioners Board of Victoria say that, when it comes to the medical profession, the question of timely retirement is linked to issues of public safety.

    "This places a particular responsibility on medical practitioners, their colleagues and medical regulatory authorities," Dr Adler said.

    The ageing process affects cognitive speed and short-term memory as well as those cognitive faculties involved with problem solving.

    "Knowing when to give up practice is an important decision for most doctors, and critically difficult for some," Dr Adler said.

    "The prospect of retirement may be daunting for doctors who feel they have few rewarding recreational or professional options to satisfy the demands of an active mind."

    The authors suggest several steps a doctor can take to accommodate cognitive changes.

    "Many procedural specialists choose to cease procedural work. Older practitioners can adjust to some cognitive changes by allocating more time to each patient, using memory aids and by seeking second opinions."

    The authors say the problem facing Medical Boards is that there are no agreed guidelines to help decide what level of cognitive impairment in a doctor may put the public at risk.

    "Compulsory continuing professional development and re-certification seem inevitable."

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    Should Doctors Retire?

    With age-ing, problems of old age set in, even for practising doctors. Dimness of vision because of developing cataracts, hearing problems and joint pains are a common feature. Some develop hypertension and diabetes. Others may have digestive disturbances. Remembering names of patients and even drugs can cost an effort. Certain amount of cerebral atrophy is associated with old age, which may translate into learning difficulties for the doctor for newer techniques and methods of investigations.

    Science is advancing so fast that unless one keeps up with CME, library and/or internet, he will only become a back number.

    Changing times have brought in changing attitudes. There may be no longer the same concern for the patients or fellow doctors, as the aging doctor might expect. The other problem of advancing age is losing friends and colleagues to death, disease and infirmity. For those doctors who are still upright the question is to retire or to go on?

    In foreign countries the options are easier. Being welfare states, retirement brings in rich benefits, a handsome pension, old peoples clubs and promotion of hobbies. In India, unless doctor has made himself secure, options are fewer. Besides the savings might not be commensurate with the rising price index. Joint family systems are dying out and nuclear families are the in-thing. Many old couples live alone because children have gone abroad. So passing time alone in the house may be a problem
    I feel those doctors who can work, should work. They need not work “centre stage” but accept a less stressful life style. Health check-up, desk job consultations, charitable clinics, administrations is what I have in mind. Teaching, writing books and medical articles for those who enjoy doing it. Taking to alternative therapy like yoga, acupressure, acupuncture, aroma therapy, etc. is a good option for the enterprising type. Unfortunately there are not many employment opportunities for aging doctors at present. The Government and NGO’s should help create some.

    Loneliness must be combatted because too frequently it leads to depression. In Japan they encourage the elderly to indulge in brain stimulating exercises like solving crosswords, playing chess or bridge. Learning to dream and fantasizing is very important. They hold classes where the senior citizen learns to paint, draw, sing or write poetry.

    In our city laughter clubs and travel clubs have sprung up - which has brought happiness to many people.

    For a single doctor, with nobody to stay with or unwilling to settle abroad with his children, remarriage ought to be considered. Companionship is very important with advancing years. It may not be the culture of our country but aren’t we adopting many other conventions of the West?


    How can a Doc retire early?

    Docs start earning quite late in life – at least the big bucks come at a late stage.

    So is it really possible for a Doc to retire early?

    It really looks difficult. Docs unless they are super specialized and have created some kind of aura about their capabilities do not really earn the mega bucks of sports star or a film star. However, they do have a lot of flexibility in their profession. They can be on their own, be in a partnership or grow it like Dr. Reddy of Apollo Hospitals.

    Having established that it is a good idea to retire early, and to never stop, how does one go about doing this?

    Investing early and well, normally means the doc can retire early and well. If things are done properly then by, say, age 55, or whenever the kids are coming off the doc’s financial hands, the income from investing starts to exceed the income from the practice. This is a great position to be in, particularly if the income consists largely of unrealized, and hence un-taxed, capital gains. Also given our current tax structure where there is no INCOME TAX on dividends, the doc may be in a good position to retire.

    Interestingly, most docs continue to practice even when they are at this point. But thankfully they can skip the long hours, choose lesser locations, and work more sensibly. They can also decide to and take many more holidays and long weekends. And there is a huge difference between the doc driving to work because she wants to, and the doc driving to work because she has to. One is happier than the other.

    The major issue here relates to the costs of general practice. Unfortunately Docs do not have much training in considering Fixed Costs, Variable Costs and Marginal Costs! Not all costs fall just because the doc is doing fewer sessions. Many costs, for example, rent, some wages, depreciation of equipment and so on, stay the same regardless of how many sessions are completed each week. These costs are called “fixed costs”. This is because they are fixed irrespective of how many sessions are completed each week.

    It is also called a Period Cost. At the end of the period, the cost has to be paid – immaterial of whether the equipment or place got used. A common mistake is to assume that there are no fixed costs. A doc completing, say, 7 sessions a week (only Mornings) and making Rs.15,00,000 a year may reason that his income will fall to, say, Rs.950,000 if he cuts from 12 sessions a week. Sadly this is not so. More probably, because fixed costs stay the same, profit falls by much more than this, say down to Rs.700,000, if not less.

    How can he avoid this?

    There may be some options which he can consider:

    1.He may start teaching at a Medical college including doing sessions on how to handle customer psychology. Lady docs are sometimes preferred because of better soft skills.

    2.The doc can stop practising solo or in a group practice where costs are shared equally irrespective of the number of sessions.

    3.The doc should try to change to a practice structure where all costs (or virtually all costs) are variable costs not fixed costs.

    4.The doc can join a friend who has similar ideas and become a partner. One of them could used the infrastructure in the morning and the other person in the evening.

    5.The doc could also get into an arrangement with 2-3 junior docs who will use the geography of his practice are – and split the fees.

    6.One more alternative is to sell a portion of his practice to a deserving junior and get into a fee sharing arrangement.

    Many of these arrangements may look difficult, and in many cases involves the DOC selling all or part of the practice to younger Docs. In at least one case I know the doc used his practice till his age of 81, but sadly many of his customers had gone away. He had to just sell his premises to a dentist. The practice fetched him nothing. Surely retirements could have been better planned.


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