When It's Time to Retire: Notes From the Afterlife

David Loxterkamp, MD


Ann Fam Med. 2018;16(2):171-174. 

In This Article

Abstract and Introduction


At the end of the Second World War, the US birth rate peaked at nearly 27 births per 1,000 population–a rate unparalleled in the previous 3 decades, and one that would not be repeated. That Boomer generation is now retiring. How do those of us caught in the wave feel about stepping back? Who will step in to replace us? And how will we replace the loss of purpose and fulfillment that comes from a career in medicine? A lengthening life expectancy has challenged many of us to consider the "second act" to our adult life. This essay describes the emotional turbulence of ending one career and contemplating the next.

I am in a dark and crowded banquet hall. The faces of those around me are only vaguely familiar, but soon I recognize my medical assistant, a nurse, an old friend and colleague. Everyone is laughing and drinking. I suddenly realize that this is the practice's annual holiday party. Someone asks me if it is time to read the Christmas Poem, a parody of "The Night Before Christmas" that I have written and performed for the last 30 years. I search my pockets, my vest, my empty hands. And realize that I may have forgotten to write one this year. No matter; it seems as if no one noticed, and the party churns merrily on. I startle–anxious, exhausted, confused–to the pulse of my alarm, just in time to shower and rush toward another workday.


Most of my patients call me "Doc." Inside the boundaries of this blue-collar community, I wouldn't respond to any other name. Nor would I have given it a second thought until I decided to retire at the age of 64.

From the start, retirement demanded hard answers: "Have I saved enough money?" "How will I pay for my health insurance, or coverage for my younger wife and still eligible son?" "If I decide to stay on in some capacity, am I still qualified for the job?" "If I decide to slow down or leave, what will I do with my free time?"

More oblique questions began to surface, like the wistful queries in the globe of an Eight-Ball toy. "Who am I when I am not at work?" "What is pushing me out the door?" "What would I be missing if I stayed in the game?" One cannot twist forever on a string of interrogatories, so I developed pat answers for those who were curious about my retirement. "It's a work in progress," I would smile, or "I'm still working at it."

While colleagues of mine have soldiered on into their 80s, I knew a year ago that my time was up. The old durable sense of purpose and drive had begun to shift. I wondered aloud what it would be like to be a grandparent, a volunteer, or world traveler. Self-confidence gave way to doubt; frustration nibbled away at the joy I derived from patient care. Ecclesiastes seemed to speak directly to me: "To every thing there is a season, and a time to every purpose under the heaven."

What keeps doctors in the saddle long past their prime is often the devil they don't know, a looming, foreboding afterlife of insignificance and decline. For now, we are cardholders in one of the most exclusive clubs in America. Our work is challenging, well-compensated, much appreciated, and in demand. It engages us with smart, curious, and, for the most part, like-minded colleagues. Very few of us are ready to give it up, even when we know we should.

The dream of last December came as I was stepping down from my role as a primary care physician. I had already resigned as the medical director for a 50-employee primary care practice, and now provided just enough acute care to qualify for benefits. It would be useful and satisfying work, I reassured myself. Less demanding. More focused. It would also signal the end of a career that had defined, bedeviled, and ultimately fulfilled me.