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AANS Neurosurgeon | Volume 28, Number 2, 2019


Counterpoint: Just Walk Away

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Editor’s Note: To read another perspective on retirement, read “Point: Retirement and the Myth of Sisyphus.” Recently, we received a letter in response to the Point and Counterpoint articles from Peter W. Carmel, MD, D. Med Sci. Click here to read the letter. 

Just walk away? It makes no sense. A neurosurgeon will typically spend four years in college, additional four years in medical school and then seven years completing their residency (perhaps with additional years of Fellowship training as well). As a result, neurosurgeons rarely start their post-graduate careers until they reach their early 30s. Thus, abrupt retirement at 65 results in little more than a 2:1 year return on investment! The age of 65 is such an arbitrary number; a nearly mythical and magic retirement age based on grossly outdated data from 1965, the year Medicare began. At that time, men could anticipate in an average of just 1.8 additional years of life (women fared slightly better with 8.7 long years still anticipated). Today, men can reasonably expect to live to 80 and women beyond that. Given this anticipated longevity, let us consider several “typical” scenarios for today’s retiring neurosurgeon.

Koyaanisqatsi (Life Out of Balance)
There are neurosurgeons (we all know them) who live, breath and eat neurosurgery. If they have families, they see them very little. They may play golf (with passion) but only occasionally. While their resumes are long, their personas beyond that of neurosurgeon are extremely limited. These individuals approach retirement with dread, usually shrouded in expressions of “still at the top of my game” and “my judgment more than compensates for diminishing skills.” To just walk away would mean disaster for the individual as well as their friends and family. What is the right alternative? Don’t be a Koyaanisqatsi neurosurgeon*.

Late Bloomer (aka Ang Lee Syndrome)
Some neurosurgeons come late to the dance. Perhaps they traveled, worked on Wall Street, had another career, etc., but for some reason, these individuals started late. More than likely, their debt load is high (current figures suggest more nearly $200,000 debt is common), their compensation is declining and families started late. As is true for our Koyaanisqatsi neurosurgeon, to just walk away for our Late Bloomer would be a disaster. They are neither financially nor emotionally prepared. What is their alternative? Just keep working; though perhaps consider adjusting practice to meet the changing needs of the aging spine, joints and vision (to name a few).

Gettin’ Better All the Time (Beatles Syndrome)
Increasingly, neurosurgeons are moving beyond the traditional boundaries of neurosurgery practice in their professional worlds. Many obtain additional degrees (MBA, MPH, JD, etc.) and use their considerable skills in a variety of roles such as medical directors, administrators or policy advisors. This path can evolve in a myriad of ways, may or may not be planned and can devolve by choice or through imposition. However the progression, the approach of retirement becomes much more flexible as nonclinical and part time options can be entertained. The Beatle syndrome can offer the important dual perspective on medical practice and related endeavors that only a clinician has. The value of this to the future of healthcare is priceless; walking away should not be required.

Clearly, these fictitious neurosurgical types do not capture the full complement of individuals who practice in our fascinating profession. The impact of long days standing in the operating room, nights on call and the natural effects of advancing age, all contribute to an intensely individual decision about when to leave the operating room behind. Financial, familial and other personal decisions are likely to exert influence as well. Giving priority to work life balance throughout one’s career (including early training) along with attention to forward planning, will enhance the likelihood of making the right retirement decision possible for each individual. This must be a neurosurgeon’s mantra – to devote the professional acumen we require of ourselves in patient care to the care of ourselves.

But, there is one more neurosurgeon-type not yet discussed:

Pat Kelly
Patrick Joseph Kelly, MD, FAANS, is a neurosurgeon apart. He worked hard, accomplished much but always insured there was a person beyond and apart from those things. After years of dedicated service to research, teaching, mentoring and clinical excellence, he graciously stepped down and made a clean break. If you are a Pat Kelly, then maybe you can just walk way.

*Associate Editor’s Note: I encourage everyone to read this incredibly important issue of AANS Neurosurgeon. The absolute importance of work-life balance should not be underestimated.

Leave a Reply

Vikram Prabhu | March 23, 2016 at 9:30 am

Dear Deborah,
I enjoy reading your columns and you always hit the nail on the head. You also have a very nice writing style and it is appreciated. I feel privileged to serve on the AANS neurosurgeon board. Michael and you are the leaders of this great endeavor and this issue is wonderful, as always.
Look forward to seeing you at the AANS.
Warm regards,