Improving Retirement Transition Policies for US Academic Surgeons

A surgeon’s decision to retire is often a difficult one, impacting both their personal and professional identity. Many surgeons do not proactively plan for retirement and operate well into their 60s.¹ Successful retirement from surgery is a complex multi-factorial process that requires self-awareness, teamwork, self-efficacy, and autonomy.² The complexity of this process may pose as a barrier to retirement-planning, thus increasing the reluctance for surgeons to begin the transition to retirement.³

After a comprehensive review of the retirement policies and support of 110 academic medical centers nationwide, we found that all of them offer a traditional, general Employee Assistance Program (EAP) consisting of a variety of free and voluntary counseling services and referrals to support all employees, including surgeons, with overall life and work issues.

Out of these 110 medical centers, only 25 large healthcare systems (22.7%) offer a voluntary, phased pathway retirement consisting of structured, gradual transition from full-time clinical practice to complete retirement over 1-5 years, with prorated salary and full-time health and welfare benefits.

Retirement for surgeons is a complicated process that may require a more personalized plan than a general EAP can provide. Whether fully stepping away from medicine or just reducing their clinical duties, retirement may look different to each surgeon. Regardless of what they envision as their life after retirement, each surgeon must find some purpose for their time.^4,5 With only 22.7% of academic medical centers providing a structured, gradual transition towards retirement, many surgeons do not have the resources necessary to begin planning the end of their career.

With retirement being a deeply personal decision, many surgeons may feel that they are expected to navigate this process alone.⁶ The lack of surgeon-specific retirement resources may reinforce this mindset and cause many surgeons to delay their planning process. While many surgeons can identify the time to fully retire, many others do not have a plan in place on how to transition away from their clinical practice.³ Simply providing young surgeons with information regarding the options for retirement provides surgeons with a framework for how the retirement process may look.

In the academic setting there are a variety of methods in which surgeons could reduce their clinical load while still being involved as a surgeon. One of the methods that multiple academic centers have adopted is providing retiring surgeons with roles in the affiliated university. Taking on a role as a teacher or mentor allows retiring surgeons to play a role in supporting the next generation of surgeons. Mentorship allows surgeons to continue participating in surgical care, while slowly lessening their clinical burden. Many retired surgeons have expressed interest in stepping into a mentoring role.⁷ Providing a formal mentorship position for retiring surgeons allows for a gradual decrease in clinical responsibilities, while still providing surgeons with a sense of fulfillment.

A phased reduction in clinical responsibilities may be accompanied by a reduction in work hours and a potentially prorated salary. Early financial planning is an integral part of a successful retirement. Many employee assistance programs provide resources for financial planning, which should be integrated into the surgeon’s overall plan for retirement. Unlike the psychosocial and clinical aspects of retirement, many surgeons begin planning their financial plans earlier in their careers.⁷

With a decrease in clinical responsibilities, there will also be an accompanying increase in free time. It is vital for surgeons, who are accustomed to busy schedules, to find an interest outside of medicine in preparation for retirement. Dr. Larson describes this as finding an “encore career,” in which the retiring surgeon will find purpose beyond medicine.⁸ Mentorship from previously retired surgeons can plant this idea of life after surgery into the minds of young surgeons, which allows them to properly prepare for the future.

It is important to note that we did not review the retirement transition policies of non-academic surgical practices. Non-academic US surgeons face unique retirement challenges compared to their academic peers. Without institutional retirement plans or formal phased-retirement pathways, non-academic surgeons often navigate the end of their surgical careers independently, influenced by private practice overhead, malpractice costs, and personal health.

Nevertheless, both academic and community surgeons would benefit from support and guidance to help them identify the best pathways to achieve their goals for a graceful transition into retirement.

In conclusion, retirement is a major decision for any professional but holds even more weight for surgeons. General retirement resources that most academic medical centers provide for their surgeons are informative, but do not address the specific problems that surgeons may face when retiring. Effective retirement plans must address the financial burdens, psychosocial barriers, and adjustment in clinical responsibilities. Because many surgeons would welcome a phased and gradual retirement, a very important future intervention is for academic surgical departments to re-imagine and adjust their workforce structure to allow their senior surgeons more time to focus on preparing for retirement while still using their accumulated expertise to care for their patients, mentor and coach their younger colleagues, and teach surgical trainees and medical students.