Lakeside Medical Musings

Retirement: Two Years On

I haven’t written a blog in quite a while, but after Ruth received some wonderful feedback at a party she attended this week  — thank you, Russell, for giving me the nudge I needed! —  I have decided to plug in the old Smith Corona, shake out my fingers, and get back to work — which, coincidentally, is my blog topic for today. My good friend, Rob, is retiring this week, but before he did, we had the opportunity to talk about this whole retirement gig, including some of his trepidations about it, which naturally cascaded into additional introspection about my own retirement two years ago.  This past week I worked at CMC Pineville for two long weekends over the Christmas holiday period and, no, I’m not doing ad hoc weekends as an alternative to filing for food stamps  — Although I must say, now that I’m retired and occasionally find myself in a grocery store, I’m shocked at how expensive food has gotten! —  I decided to go back to doing hospital work on an occasional basis for many reasons, and I thought today’s musings could prove to be good information for newbie retirees whenever that label becomes applicable to you…

Consider something as simple and basic as your name. I have been called “Dr. Scherr” since my first year of medical school, way back in 1975. Back then, even lowly medical students were always referred to as “Doctor.”   When I thought  about it, I realized that encompasses my entire adult life!  Once I retired, I was still now and again called “Dr. Scherr,” but I didn’t feel like a doctor.  I was a golfer, a gardener, a poker player, a volunteer health insurance navigator, and a fisherman—but not a physician — not any longer, anyway.   I quickly realized that it’s exactly this intrinsic loss of identity that is the most difficult part of retirement for me.  I have certainly learned to fill my days with activities that I  enjoy and people whose company  I (mostly) get to choose, and I definitely relish and embrace the lack of stress associated with not working. But not feeling like a doctor, not feeling needed — and valued — in the capacity that was my professional life, is a much bigger adjustment than I ever anticipated.  I certainly have more time and energy now to help guide my friends through the minefield of  modern day medicine with their individual medical problems,  and the rewards derived from the sincerity of their outspoken appreciation is enormous, but it is honestly not the same as having your opinions and your expertise truly needed on a daily, actually hourly, basis.  I have spent some time volunteering at a free medical clinic that sees internal medicine patients, but I haven’t practiced outside of a hospital with acutely ill patients  since the 90’s.  Office-based medicine is not what I know how to do best anymore, and I found that I sincerely missed the underlying high-energy heartbeat of a top-notch acute care hospital.  I trained to be an ACA Navigator to assist people in getting insurance through the Affordable Care Act, and I have found this endeavor to be very rewarding.  But as rewarding as my volunteer work is, it, too, is not what I have been doing for 50+ hours per week for the last 35 years.  I finally had to face an inescapable fact: I missed being a physician.

It’s dangerous to generalize, but it seems to me that when a person retires from a career that they have been successfully and happily doing for most of their life, the void that is left in the composition of their identity can be excruciating.  The loss of the camaraderie  that you took for granted between you and your coworkers adds to the emotional complexity of retirement.  The nurses, physicians, administrators, social workers and secretaries that were a part of my every day — from the simple “Good morning Dr. Scherr! How are you doing?” to the more complex  and fraught “How much did you enjoy your Falcons thrashing the Panthers on Sunday?” is gone.  There is often a significant amount of isolation associated with retirement.  The people that you were so close to, for so long, lose contact with you, even though you all swear that won’t happen.  When you retire, you cross a previously  unspoken and undefined line  — they’re still in the trenches and you, Buddy, are not. Suddenly, you are no longer on the same team, fighting for the same wins. Your golf and poker buddies — along with the time for increased contact with your spouse and your kids — make up for some of this, but it is not the same.  There is a relationship in a work environment  that is built on a partnership not found in recreational activities.  I was a part of a team and now I am not.  I miss that, and so will you.

By the time you retire, your children will have — hopefully — successfully  managed to separate from you both physically and, to an extent, emotionally, and they just don’t need you, or your input, nearly as much as they did when they were growing up.  While I love being an empty nester, I miss not being as involved in my children’s lives, and I doubt I’ll ever get used to hearing the details of crucial events in their lives only weeks after they occur.  Not being needed hardly at all is the mark of your children’s successful transition to adulthood  — what we all want for our children — but believe me, while you celebrate their success, you just simply miss that daily catch-up on the details of their lives that you took for granted over the dinner table every night for so many years.

And your own health starts to become an issue.  There is little as frustrating to me as not being able to read a menu in a nice restaurant when I have forgotten my reading glasses and have to turn on the super-bright flashlight that my cell phone can produce.  Ruth hates it when I turn on that light so I can see the menu printed in 5-point type that only 21-year olds can see — she says it screams to the entire restaurant ” OLD PEOPLE OVER HERE!” — but I do it anyway. (Does she want me to starve?) But these kinds of vision changes are only the tip of the age-related iceberg; the aches and pains that develop in joints and muscles from doing the simplest things, tasks you’ve accomplished with ease your whole life, are a constant reminder of the aging process.  And then, one day, we eventually develop the significant medical problem that starts our gradual or, God forbid, rapid descent into ill health or old age.

But let me not get too gloomy! There are lots of positives in retiring and aging.  When I was a child I had plenty of time but many restrictions on what I could do.  As I grew up, my free time grew more precious and my financial resources were more limited.  These days, as a retiree who saved and planned well, I have both the time and the money to do what I enjoy doing. And I do! It was a shock to realize I will never again go on a vacation — since a vacation involves time off from work — but I can go on trips almost any time we choose. Traveling is one of our top priorities in retirement, and we truly enjoy it, so we travel frequently, often to see our grandsons who, by the way, are remarkably easier than raising your own children and add an inexpressible joy as well as a new depth to your life.  I enjoy playing golf, taking naps whenever I feel like it, and eating at 9pm, if that’s when I’m hungry.  There’s no longer much difference between a Tuesday or a Saturday, except it’s definitely easier to get a tee time on a Tuesday. This palpable, quantifiable lack of stress in my life is something I haven’t felt for as long as I can remember.  What a feeling of freedom! I really do like being retired.  But I also really miss not working. Aaah, the duality of life!

So what do I advise my retiring friends?  I remind them that every Big Life Stage comes with a printed warning on the label: Retirement is great, but it doesn’t come without a price.  Go into it with the knowledge that this will be the biggest change in your life since your first child was born or you started your career.  Make sure you do the fun things in life that you have put off, and do them as soon as you can, because no one gets a guarantee about tomorrow.  Work on your personal relationships — enjoy your family and friends and make certain  you don’t become socially isolated, probably more of an issue for men than women because of the inherent differences in gendered social needs. Maybe that is just a sexist preconception (Rebekah? Comments?) but I see this as a definite risk factor in many of my male friends.  My biggest advice is this:  if it is at all possible, continue to do some of the things you that you did professionally.  Do them in smaller bites and on your own terms, but  acknowledge that this work is what made you who you are for so many years. And if that need is left unfilled, it can grow and fester into a true identity crisis.

As I disclosed at the start of this blog, I worked at CMC Pineville over the Christmas holidays. Just like I have worked the Christmas holidays  for over 35 years.  And it was a double bonus — not only was it a help for my physician partners, but it made me feel like me again.  And for that, I am very grateful.

Happy 2016 to all of you. Please pass this on, comment, let me know what you’re thinking when you read my thoughts. That’s what keeps people writing!









15 thoughts on “Retirement: Two Years On

  1. Russell Ranson, Jr.

    So glad to have met Ruth and to have had some part in encouraging you to resume writing this blog. Really hope you will continue writing regularly. I am probably 90% retired and have gradually wound down over the past 6 or so years. The 10% I still work keeps me plugged into my industry and is satisfying. I can imagine that retiring “cold turkey” would be tough. Like you, I have found a great deal of satisfaction in volunteer work.

    I hope you will write about your thoughts on opposing fee for service and what you suggest as a viable alternative.

    I would also appreciate your writing about your thoughts on drug pricing. As I understand, the USA is the only county that does not regulate drug prices. Consequently drug companies charge USA more than other countries simply because they can. That is why Canadian pharmacies can sell to USA customers cheaper than USA pharmacies; because their costs are lower. PhRMA has the largest lobby in Washington. PhRMA collectively is the most profitable industry group on Wall Street. Medicare is explicitly forbidden by law from negotiating drug prices, undoubtedly as a result of lobbying. I favor free markets where there is competition but in too many cases there is no competition in the drug industry. What do you think and suggest?

    Looking forward to many more educational posts to come.

    Happy New Year to you and Ruth!

    With appreciation, Russell

    1. John Post author

      Russell, thanks for reading, commenting and encouraging. I do plan on writing another piece on fee for service and alternatives. Hopefully the significant amount of healthcare rationing that exists in our current system which is based on a patient’s ability to pay will be replaced with something that is based on medical effectiveness. Neither our country nor any other country can afford all the health care that everyone wants to sell (or buy).

      A pharmaceutical post will also be forthcoming but the industry itself has shown its greed and abuse of the American medical system so clearly that I want to make sure I have something to add. Again, thanks for reading.

  2. John Post author

    Thanks everyone for their comments. I had hoped this would be a topic that many people could relate to. It always is reassuring to find out that we are not alone in our emotional responses to the stages of life. (John Adams, I am not sure why you brought Obamacare in to this discussions, but I would suggest you read some less biased sites to find the real reason healthcare is the way it is today. Very little of the mess is related to the ACA. I will certainly have some posts on this later, but for today, let’s enjoy and adjust to our retirement.)

  3. johnadams1782

    Hi John, Glad to see a new post from you. Not being a professional as you are, plus being about 20 years older, I am not in a position to work part time during my retirement. However, in fairness, you retired at a younger age than I did. Because of y past employment in the health insurance field, I seem confined to trying to conceptualize ideas regarding the ACA, which I feel was the wrong approach to the right problem. I read an article by a doctor from New Jersey, regarding the subject that you might find interesting. Granted, he is apparently in private practice as opposed to being hospital based as you were (are). Anyhow I thought his analogies were interesting.

    Dr. John Tedeschi compares American health care system to a plane crash.

    Obamacare will wreck many family budgets in 2016, but the safety and health of patients are also at stake. Over half of the largest Affordable Health Reform co-ops have failed spreading panic in the White House. To make matters worse, a prominent doctor compares the American health system to a disastrous plan crash.
    Each day passengers aboard aircraft fly confidently knowing there is a certified and licensed professional pilot at the controls in the cockpit. But what if the government required two separate and autonomous pilots to work the controls simultaneously?
    “The consequences, within minutes, would be disastrous,” states John P. Tedeschi, a licensed pilot in Robbinsville, NJ acknowledged yesterday. “Unfortunately, with constant interference from the government and insurance companies, that is exactly what is happening to doctors – every hour of every day.”
    “The ability to fly a plane is the result of the wisdom of aerodynamics and mechanics,” Tedeschi explains. “The pilot must have a comfortable and working relationship with his machine before he can operate it precisely and safely. There cannot be two captains on the flight deck. The pilot makes sure the equipment is properly maintained and that there is enough fuel for the trip. If the owner of the plane wants to save money, however, common sense dictates he cannot expect to have the same outcome using less fuel and less maintenance.”
    Not only is Tedeschi a pilot, he is also a physician and has been practicing medicine for over thirty years. With the wisdom of both the pilot and doctor, he cautions that the government is treating passengers far better than American patients seeking medical care.
    “The doctor, a certified and licensed professional, is second-guessed every step of the way and is told how to practice medicine,” Dr. Tedeschi explained. And they are being forced to provide care “not based on individual patients or their issues; rather, based on ‘how much it costs,’ and whether such a treatment or procedure is ‘really needed’ determined by computer-generated algorithms, not by the individual’s condition.”
    Dr. Tedeschi, a renowned, knowledgeable and honest critic of Obamacare, aims his truths straight at insurance companies.
    “They are directing physicians on what is – or is not – appropriate treatment. It’s all about money. Not safety. Not healthcare. Money,” the doctor stresses. “What if these same companies entered the cockpit and began to change the flight’s ‘checklist’ in order to save time and money? Or employed unqualified or incompetent people in the passenger compartment to outline the safety features of the aircraft and what to do in an emergency? It wouldn’t be long before disaster struck.”
    “Sadly, it’s not a ‘what if’ scenario anymore,” charges Dr. Tedeschi. “It is happening now in medicine. Physicians cannot be second-guessed or directed to perform their craft by individuals and forces with less experience.”
    “Many times, when flying an aircraft, an unexpected complication arises,” he elaborates. “The pilot may contact Air Traffic Control and request a change in flight plans. The pilot, however, remains in control; still in charge.”
    “The controllers’ main response and obligation is to assist the pilot with whatever is needed – not to distract the pilot from the problem at hand, but to assist in the main mission of flying the airplane. The first thing a pilot is taught in learning to fly is ‘first fly the plane,’ and then solve the problem.”
    But with Obamacare, “physicians, on the other hand, are repeatedly interrupted and challenged with every decision they make on behalf of the well-being of the patient. They are misdirected and ordered to adhere to ‘flow sheets’ that have absolutely nothing to do with the safety or care of the patient,” Tedeschi points out. “Medical decisions today are dollar-driven. And that is contrary to the oath that all doctors take.”
    Dr. Tedeschi illustrates the failures in the American healthcare system by considering that when a pilot declares an in-flight emergency, “Air Traffic Controllers hear the Mayday – but instead of reacting immediately to help solve the problem, they first demand that the pilot fill out several forms, explaining the emergency, how it happened, why it happened, what they need in order to correct the problem and, then, depending on how much it will cost, controllers respond, ‘Flight 123, please hold your position while we secure approval for your request.’”
    If American health is intended to be improved, why do the latest Gallup polls now indicate that about one-third of all citizens are putting off medical treatment because of costs? In 2001, only 19% delayed care because of money.
    In October, physicians, nurses and medical staff were bombarded in October with what one doctor termed “one of the biggest Obamacare blunders toward government controlled medicine.” Thanks to the Affordable Care Act, a new system called “ICD-10,” made the 14,600 codes used for diagnostic and procedural codes inflated to about 70,000 overnight.
    Physicians and analysts who have used ICD-10 indicate the system is far more complex, extremely detailed and is burdensome. Various estimates reveal that tax payers are paying $5.5 billion to $13.5 to implement ICD-10 nationwide. Experts reveal the suggested benefits from this bureaucratic monster will only be $.7 billion to $7.7 billion for the next decade. This new coding mandate, along with Electronic Health Records (EHRs), have changed the medical profession for the worse according to many critics.
    “The obligation and responsibility of the physician, to present to the third party payer, is like a pilot asking to be cleared for take-off after a complete flight check was satisfactorily performed,” explains Tedeschi. “And then being told by the control tower that the manner in which the flight check was performed needs to be presented in a ‘different language,’ no longer verbally, but written in a format that changes year to year — or the flight is cancelled.”
    He equates the Obamacare “Control Tower” as “being operated by lawyers, businessmen and politicians” with the EHR requirements being like “pilots having to document, in writing, every move they make on the flight deck –every switch they throw, every button they push, every instinctive move they make. And if they don’t – even if the plane took off and landed safely – they would be financially punished by the ‘Form and Document Police’ for not following the rules.”
    Tedeschi observes that pilots, by their training, nature and protocols, do a “walk around” and then cockpit check for aircraft safety prior to each flight. After starting the aircraft, “RPM’s are increased, a run-up is performed, the transponder is set, the pilot marks a course and makes a flight plan with full concentration, and finally radios the control tower for clearance to taxi.”
    “The tower responds, ‘Sorry, Flight 123, we can’t just take your word for it that you did the flight preparation, you need to put it – plus all your thoughts – in writing, before you can push back from the gate,’” Tedeschi continues. “Have I not done this hundreds of times and logged thousands of hours in the air? Do I not know what I’m doing? You need this in writing? For EACH flight?”
    “Finally, after all of the bureaucratic requirements are fulfilled – and you’re at a cruising altitude about to settle back and enjoy the flight – a message comes in demanding you put the plane on auto-pilot and fill out a form that asks questions about 27 previous flights,” Tedeschi cites. “And failure to do so, quickly, will result in your loss of a pilots’ license and be forced to land at the nearest airport.”
    “This is the world of medical audits,” Tedeschi offers. “Doctors are bombarded daily with ongoing demands to justify previous medical decisions, all under the threats of loss of license to practice medicine, withholding payments and possibly being charged with fraud.”
    “The instructions are for immediate compliance – to drop everything at the moment, despite the number of people in the waiting room – in order to fill out the forms,” he continues. “And patients wonder why the doctor is late – or spends most of the time entering data into a laptop – rather than concentrating on their well-being.”
    “Control medicine – and you control the population,” Dr. Tedeschi emphasizes. “Welcome to the world of medicine. Welcome to the world of government control.”

    Wishing you and your family the best for the new year.

  4. Claire Brown

    I have missed reading your blogposts, John. This one is so poignant and rings true to me. Every aspect of life is nuanced and all significant decisions have complex consequences- I think that’s a good thing.

  5. Rebekah

    I am so grateful you wrote again. As you may or may not know, you’re a tough nut to crack and no matter how many times I call and chat, you never really discuss your thoughts. You extrapolate on decisions, logic, and frustrations with the world around you, but as your daughter, these mental musings of a real human are gems I will always treasure because these are the things I wanted to hear my whole life. Thank you for sharing. You are never not needed and between Toby and I I think you receive your fair amount of ‘in the moment’ info. I love you dad. Please keep writing, whenever you want to. I will never stop listening.

  6. Ann Doss Helms

    Excellent post. I’ve thought about this issue — reporters don’t get a title, but we do work in jobs we love that tend to define us. I have wondered what I’ll be like — and how people will relate to me — if and when I finally retire.

  7. Cathy

    Thank you for writing in your blog again ~ I’ve missed your musings. You’ve got the best of both worlds with being able to work PRN/part-time/contract with your career in retirement. I hope to be able to do the same.

  8. Liz Willison

    I was so excited to see your blog and it was a perfect read at a perfect time. This is the year I and 3 friends have chosen to retire the end of December. I will miss and fear the loss of everything you mentioned, my work family, teamwork, daily assignments,etc.. Another fear surfaced – losing the great company benefits. Since I am the single provider for my household I started thinking will I actually be able to do this retirement thing. My company offers full benefits for part time (20 hours) a week personnel. So this is something to think about over the next few months. Thanks for sharing your perspective on a subject for all. Happy New Year to you, Ruth and the whole family.

  9. Pete Rauch

    This is a must read for everyone who is about to retire. Some how it needs to get to as many human resource departments as possible.

  10. Ingrid Sturm

    Glad to see your blog again. This was very interesting to me as well because I did feel that I lost quite a bit of my identity when I retired. I struggled as a woman working in the ’70’s through the ’90’s and worked my way up the ladder in NYC in the advertising field, then came back to NC to work and had another struggle with anti-feminism, only then to later retire in Las Vegas, a “good ole boy town,” where very few people ever asked me about my background or what I did before moving here. If anyone asked us as a couple what we did before moving here, all the questions were directed to my husband. I had to reestablish myself as a whole new person, who was retired and played golf, tennis, bridge and sometimes mah jong. Very few people in Las Vegas have any idea of what my identity was before I moved here — so I had to establish another one. My life here feels very frivolous, but I do love the life I lead now. I do, however, still miss the importance I felt with the identity I had for 25 years. Your blog really made me think about the big change. But it has all been good…and what could be bad about living in Vegas?!!
    Happy New Year to you and Ruth!

  11. Greg

    Great post John! Really good advice. Thanks for dusting off the smith corona. I always look forward to your posts. Thanks for writing. Happy new year!