What Happens When I Retire?

I’m still trying to find more information in the literature about retirement for psychiatrists. What happens to psychiatrists who retire? In fact, there is an article published several years ago with an interesting title: “A psychiatrist retires: the happening.” It was written by Dr. Norman A. Clemens, MD, a psychiatrist who was a psychoanalyst for many decades and retired in his mid-seventies. Dr. Clemens writes from the psychoanalyst’s perspective. He had many psychotherapy patients with whom he had developed long term therapeutic relationships. He was in private practice. His situation is vastly different from mine in those respects.

As a consulting psychiatrist in the general hospital exclusively, I have no long-term relationships with patients. I am so busy that I have no time for an outpatient clinic practice in the academic medical center where I work. I see my patients in the general medical wards, the critical care units, and, less often, in the specialty medical clinics.

My role is to, above all, understand the interaction of medical illness with psychiatric symptoms and to find some way to ameliorate them. My time is limited because I’m paged from all over the hospital throughout the day. Often, I see patients for only one or two visits—and never see them again. The C-L Psychiatrist is the fireman of psychiatry. My colleagues in medicine and surgery call me for help in putting out fires: suicide statements or attempts, the terror and agitation of delirium, the medically unexplained physical symptoms, the depressed and demoralized.

I don’t conduct formal psychotherapy like Dr. Clemens did. I do my best to sit and listen to the patient. It’s the main part of supportive psychotherapy, which underpins all others. My main prop is a chair (not a couch), any chair I can find in the room. If there are none, either I or a medical student or resident trots out to the hallway and fetches one for me. A few years ago, a colleague gave me a folding camp stool that I now carry around, slung around my shoulder. It’s very handy.

After a consultation, I then speak with the physicians who called me for my help. Frequently, nurses, social workers, medical students, residents, and other learners are present. I often sit down for that, too. I teach them and they teach me.

And also, I think about the larger perspective, which is the shortage of psychiatrists generally. About 60% of psychiatrists are over the age of 55 and many of them, including me, will soon retire. This will augment the need to replace us.

So, what happened finally to Dr. Clemens? How did he cope with retiring? Did he really retire? At the end of the paper, he confesses that he mourned for the patient relationships but relished the freedom. And he frankly admitted he’s not “totally retired,” still engaged in teaching. He says he doesn’t know if he could ever fully retire from being a psychiatrist or a psychoanalyst.

I spend a lot of time ruminating about how retirement will affect me. Dr. Clemens’ practice and mine differ in many ways.

However, there is this similarity. My retirement will no doubt affect many others.

Clemens, N. A. (2011). “A psychiatrist retires: the happening.” J Psychiatr Pract 17(6): 425-428.

            The author uses his own recent experience as a basis for discussing the actualities of retiring and closing a private, solo, psychiatric practice of psychotherapy and psychoanalysis. The extended process includes a personal decision about whether, when, and how to retire; preparation of patients and arrangements for their ongoing care; dealing with legal requirements and professional obligations; and the mechanics of closing an office one has occupied for decades. Not the least of concerns is one’s own personal transitions in lifestyle, professional persona, attachments to patients, and engagement in psychotherapeutic or psychoanalytic treatment relationships.

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