The Optimized Doctor

Fighting Burnout: Lessons From Centenarians

Jeffrey Benabio, MD, MBA

June 06, 2022

"Here and now is what counts. So, let's go to work!" –Walter Orthmann, 100 years old

How long before you retire? If you know the answer in exact years, months, and days, you aren't alone. For many good reasons, we doctors are more likely to be counting down the years until we retire rather than counting up the years since we started working. For me, if I'm to break the Guinness World Record, I have 69 more years, 3 months and 6 days left to go. That would surpass the current achievement for the longest career at one company, Mr Walter Orthmann, who has been sitting at the same desk for 84 years. At 100 years old, Mr Orthmann still shows up every Monday morning, as bright eyed and bushy tailed as a young squirrel. I'll be 119 when I break his streak, which would also put me past Anthony Mancinelli, a New York barber who at 107 years of age was still brushing off his chair for the next customer. Unbelievable, I know! I wonder, what's the one weird trick these guys are doing that keeps them going?

Walter Orthmann

Of course, the job itself matters. Some jobs, like being a police officer, aren't suitable for old people. Or are they? Officer L.C. "Buckshot" Smith was still keeping streets safe from his patrol car at 91 years old. After a bit of searching, I found pretty much any job you can think of has a very long-lasting Energizer Bunny story: A female surgeon who was operating at 90 years old, a 100-year-old rheumatologist who was still teaching at University of California, San Francisco, and a 105-year-old Japanese physician who was still seeing patients. There are plenty of geriatric lawyers, nurses, land surveyors, accountants, judges, you name it. So it seems it's not the work, but the worker that matters. Why do some older workers recharge daily and carry on while many younger ones say the daily grind is burning them out? What makes the Greatest Generation so great?

We all know colleagues who hung up their white coats early. In my medical group, it's often financially feasible to retire at 58 and many have chosen that option. Yet, we have loads of Partner Emeritus docs in their 70's who still log on to EPIC and pitch in everyday.

"So, how do you keep going?" I asked my 105-year-old patient who still walks and manages his affairs. "Just stay healthy," he advised. A circular argument, yet he's right. You must both be lucky and also choose to be active mentally and physically. Mr Mancinelli, who was barbering full time at 107 years old, had no aches and pains and all his teeth. He pruned his own bushes. The data are crystal clear that physical activity adds not only years of life, but also improves cognitive capabilities during those years.

Dr Jeffrey Benabio

We also have seen that people who retire are at greater risk of memory problems, compared with those who continue working. Some cultures know this instinctively. In Japan there is no word for "to retire." Instead, the elderly carry on talking about ikigai, which translates as their purpose for living. Everyone there has something to contribute, and that sense of being valuable helps keep them healthy into their 90s. Assuming that an older physician is competent and able to maintain a high quality of care, ought we not encourage more to continue working? Not only could we use their help, but also we might learn a lot from them about care for patients and care for ourselves. As for beating burnout, it seems the one trick that these ultraworkers do is to focus only on the present. Mr Orthmann's pithy advice as quoted by NPR is, "You need to get busy with the present, not the past or the future." These centenarian employees also frame their work not as stressful but rather as their daily series of problems to be solved.

When I asked my super-geriatric patient how he sleeps so well, he said, "I never worry when I get into bed, I just shut my eyes and sleep. I'll think about tomorrow when I wake up." Now if I can do that about 25,000 more times, I'll have the record.

Jeff Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Benabio is @Dermdoc on Twitter. Write to him at dermnews@mdedge.com .

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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