THE BIG QUESTION…WHEN IS IT TIME?

The quality of my life, if not my life itself, was saved by an amazing and talented physician after a colonoscopy with another physician revealed an exceptionally large, aggressive yet pre-cancerous lesion.  That physician wanted to do major surgery.   I was referred to another physician who pioneered a techniqueenabling removal of such large lesions without removing large parts of the colon and bowel, which in my case, would have required me to wear a bag the rest of my life.

I was 46 when Dr. Waye, who was then in his early 60’s,performed the successful procedure.  I saw him every 2 years afterwards.  Before each colonoscopy, I would sit in his office where he would review my medical condition.  In his mid 70’s, I began interviewing him as well.  I wanted to make sure he was still up to the task.  In fact, I jokingly began to ask him to hold out his hands to see if I could detect a tremor.  It became a running joke until he finally retired in his 80’s.  It was not really a joke and his hands stayed steady.

How does a physician, or anyone else know when to retire?

This is obviously a timely topic, with a 78- and 81-year-old running for arguably the most important job in the world.  Politics aside, the same question should be front and center for any healthcare professional.

Aging is an inevitable part of life, and for professionals in demanding fields like surgery or many areas of dentistry, it raises important questions about when it might be time to step back or step aside. Dentists and surgeons must maintain high levels of precision, dexterity, and mental acuity to provide the best possible care for their patients. As they age, the question arises: How can they determine when they are too old to continue practicing at the required level? And, perhaps more important, why would a doctor avoid facing the realities of diminished capacity?

Why would grandpa or grandma not give up the keys to the car?  The answers are not too dissimilar to those facing doctors who are experiencing decline.  Among the reasons can be any combination of these:

When approached by a potential client, one question I always ask is; Do you have a transition plan and roadmap?  Invariably the answer is either NO, or if there is some plan, it’s not SMART (Specific, Measurable, Achievable, Realistic, Time-bound).  The next question has to do with needing the value of their practice to achieve financial freedom.

Here, most doctors who own their own practices answer in the affirmative.  The value of their practice IS part of their transition or retirement strategy.  This was the reason I formed Practice Perfect Systems in 2015.  At that time, I began seeing an alarming trend of dentists (though it could be any healthcare practitioner) transitioning into less strenuous, physically demanding roles and therapies. In the case of dentists, it was into dental sleep medicine and TMJ.  Others just opted to reduce their time spent in the practice.  The result of these transition strategies was to lower the value of the very thing they were dependent upon to have a successful, fulfilling, and happy retirement.

These well-intentioned practitioners were turning their businesses into a hobby, just at the time when they needed maximum equity from it.

When this was pointed out, a panoply of the excuses listed above came out. “My patients need me.”  “What else would I do?”  “My wife and I would be at each other’s throats.”

Emotional reasons are the most difficult to overcome. Even cognitive and physical decline can be difficult to measure and accept.  Coupled with a financial incentive not to quit, the result is that too many, well meaning doctors linger when they should have put down the scalpel, hang up the handpiece or stopped buying increasingly greater magnification tools.

No objective system exists for doctors to know WHEN the time has come to move onto another phase of their career.  Until such a system is implemented, the public is at the mercy of doctors who might not be serving the public’s best interests.  The American Medical Association (AMA) has been considering competency assessments for years.  And while some hospitals and medical systems have started age-based screening, there is currently NO national standard.  Here too there is a bias NOT to inaction.  Some of these reasons include:

Since 1975, the number of practicing physicians has increasedby more than 300%.  This, despite the research that shows that between the ages of 40 and 75, cognitive ability decreases by 20%.

Is Older Wiser?

Similarly, the age of dentists has been increasing, with the mean age hovering around 50.

All healthcare professionals would be more likely to self-regulate if they were encouraged and taught how to proactively deal with the barriers to retirement mentioned above.  It’s time for the professions to educate their constituents and offer them a pathway that will help practitioners transition more successfully and protect the public from those who lose capacity and are more likely to cause harm.

“First, do no harm.”

To a safer healthcare system,

Michael