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Some thoughts for young surgeons

Preparing for Retirement

A recent discussion on one of the American College of Surgeons “communities” brought this topic to mind. I, myself, am in my last year of phased retirement and will be fully retired from clinical practice in less than a year. I thought I would pass some thoughts along to you.

Retirement is decades in the future. Your focus now, and for the foreseeable future, is on developing your skills. But there are two key things you can and must do now to make those far-off days go easier. These are:
1) Financial planning. Retirement is easier to contemplate if you have saved. When you are just starting out, it may seem like other priorities – paying back your school debt, buying a house, saving for your children’s college – are more important, but you should take advantage of every opportunity to set aside tax-deferred savings for retirement.
2) Developing outside interests (including surgical volunteerism). Decelerating and finding a new pathway for retirement is easier if you have a new focus for your energy and talent. Many of the things I'm going to list for older surgeons are good to explore during the latter half of your career, a decade or so before full retirement.

If you are an older surgeon, casting around for things to do: here is a very subjective list of some things that I think can work well, and others that are problematic. You are more likely to enjoy doing these if you ease into them during a decelerating phase of your career, rather than starting up from scratch.

THINGS THAT CAN WORK (Most of these are "volunteer", "unpaid" and many require that you work with or through a medical school)
1. Mentoring young surgeons. Either career guidance or discussion of complex surgical techniques.
2. Teaching anatomy to the medical students and surgical residents. Who better to teach it? Talk to you local Gross Anatomy course director, or your Residency Director and come up with a curriculum for the residents. Anatomy doesn't change and cadavers don't sue for malpractice.
3. Teaching surgical technique to residents in the simulation lab. Simulation lab sessions can always use an extra pair of hands. Talk to your local Residency Program Director.
4. Teaching ATLS. This requires instructor-level certification, but because the activity is concentrated in 1-2 days it may be easier for those who are not close to a med center. Make contact with your local Level I Trauma Center.
5. Teaching ATOM (advanced Trauma Operative Management). Also requires certification, but the activities are concentrated over one day. We have several older surgeons who travel from outlying areas to help teach ATLS and ATOM and their help is much valued!!! (There are probably other analogous courses in various other specialties, these are simply the ones I know about).
6. Teaching/facilitating small group sessions with first and second year medical students. These are typically weekly sessions over the course of a semester. You have to live close to a medical school and have an affiliation/get an affiliation with one to do this. The sessions are typically highly scripted and you will learn a lot about areas not necessarily related to surgery. The students are such fun, and the sessions are held in an atmosphere of mutual exploration! The courses vary from physical diagnosis, through case-based learning, through professionalism, and even into the medical humanities. Talk to the Medical School; if you are not currently affiliated, talk to the Department Chair first.
7. International volunteerism. Unfortunately, it seems like legal issues have made volunteering within the US more problematic - maybe someone has done this and knows how to make it work.
8. Local volunteerism through your County Medical Society - simple things like helping a free medical clinic - not surgery per se but simply being a physician.
9. Locum Tenens - the only thing on this list that actually pays.

THINGS THAT CAN BE PROBLEMATIC (I won't say these don't work, just that there are pitfalls)
1. Moving into a purely administrative role. A lot of people make this work, but I think you need to have "skin in the game" to really be effective. If you are representing surgeons, doing QI, whatever, you need to be a practicing surgeon. Do you want to be another “gal/guy in a suit with a clipboard” telling practicing surgeons what to do? Just my thoughts.
2. Expert Witness. The ACS statement (see: https://www.facs.org/about-acs/statements/8-expert-witness) suggests that you should have been doing those kinds of cases during the time when the alledged incident occurred. So, this is only something you can do (if you want to do it) for a limited time after leaving practice.
3. Limited involvement with patients - eg staffing a follow up clinic. Can be made to work, is this really how you want to spend your time?

Anyway, some thoughts to keep the discussion going. In my past life as Department Head, "retirement" discussions were the third rail of departmental administration. It's better all around if you and your group/department know your plans in advance.
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