Forced out of retirement: Getting back into practice not always easy

Stung by investment losses, retired physicians often struggle to re-enter the job market. But there are jobs out there, experts say, if you're prepared.

By — Posted April 20, 2009

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At age 70, Kirtikumar Shah, MD, is back in the job market. Dr. Shah retired in 2004 and doesn't especially want to go back to work. But the gastroenterologist/internist from Houston has little choice.

Heavy losses to his investments have left him short on cash. "My wife and I are not extravagant people. Still, the 2008 stock losses destroyed all our plans," Dr. Shah said. "I have to go back to work."

Many other retired physicians, who also thought they had their finances in order, are joining the job hunt after the recent market meltdown.

Experts say there are jobs. "There are plenty of openings in almost every specialty, but especially primary care. Older doctors can help alleviate shortages in this area and some patients, especially elderly ones, prefer an older physician," said Phil Miller, spokesman for Merritt Hawkins & Associates, a national physician search and consulting firm.

But it's not always as easy as saying "I'm back."

If you've been out of practice for a few years, you might have to get yourself re-licensed, get caught up on all the continuing medical education you missed, and perhaps join a formal re-entry program.

Then, you have to contend with your own employability. There might be demands for you to know new information technology. The potential practice or employer may be seeking a guaranteed long-term relationship. The easiest jobs to get might require shift work, travel or other demands that you never had to fulfill before.

Several months after he began looking for part-time locum tenens work in gastroenterology, Dr. Shah was discouraged. He found he could not get liability coverage in that field because he had not done an endoscopy in three years. One practice wanted a full-time internist, but Dr. Shah would prefer less than 20 hours a week. He had hoped to work only days and in the Houston area but now knows that is doubtful.

"All this was unexpected," Dr. Shah said. "This has been an obstacle for me psychologically. But everyone knows someone who is going through the same thing.

Beginning the job search

Experts say before you jump back into clinical practice, you must assess what you want and are able to do. They recommend contacting agencies that can help you find work close to home and in your field. But, they warn, too many limitations could hurt your marketability.

You could also develop a relationship with another doctor to fill in when he or she takes time off, or do a job share with another older physician, said Fran Lavalette, president of Healthcare Facilitators, a physician practice management and consulting firm in Ocoee, Fla.

If you are willing to work full time, hospital-owned or large group practices could be good bets.

Alan Rahm, MD, a psychiatrist, left his Pennsylvania practice three years ago and moved to Tucson, Ariz. Both the time lapse and the venue change have proven problematic for his job search.

"If you haven't seen a patient from 18 to 36 months you will have a problem. The practices are concerned about your competency because they pay your liability insurance. If you have three good references and practiced in the last year or so there should be no problem," Dr. Rahm said.

Arizona does not require a re-entry program, according to its medical association's executive director Steve Nash, but other states do.

The North Carolina Medical Board has one of the more stringent programs. Any physician who has been out of clinical practice for two or more years must meet with a board to work on a plan for re-entry. The plan usually includes working with a doctor-mentor in their same specialty for about six months. Janelle Rhyne, MD, immediate past president of the medical board, said there is no cost to the physician, who can be earning a salary during this time.

Some states require physicians who have not practiced for several years to enter re-entry programs that cost between $5,500 and $30,000.

And as hard as it can be to find a position that they are suited for, or is suited to them, retired physicians also need to brace for possible age discrimination.

"The older you are, the less the chance of getting a job within the community you want. You can't discriminate based on age, but many hospital-owned and large group practices want a long-term solution, which older doctors can't or won't always give. With surgeons, there's a question of whether the older doctors will be able to perform physical aspects," Miller said.

C.W. "Bill" Rogers, MD, has felt both subtle age discrimination and the realization that his age, 77, makes it challenging to keep up with the rapid technological changes in his field of radiology.

"The few assignments I've gotten have been in rural settings. I believe when a prospective employer looks at my age, they think 'this old bird isn't up to the latest technology,' and I'm not," said Dr. Rogers, a radiologist from Lebanon, Tenn.

Before Dr. Rogers could re-enter the field, he had to requalify by reading a certain number of mammograms under the supervision of an active radiologist. He also took continuing education classes in mammography. Still, he admits he has had difficulty keeping up. "As you get older, your mind doesn't absorb facts as they did when you're in your 20s and 30s," he said.

Some doctors worry that their lack of experience with electronic health records could hurt them in their job searches, but experts note that the need for training is widespread, since different practices have different systems.

Possibilities for retirees

Not all retired physicians face job searches filled with angst and rejection. Lavalette said many retired doctors have successfully found part-time locum tenens work or government jobs, such as in prison systems. Others become professors, work for drug or insurance companies, or even start their own businesses.

Dr. Rogers has been traveling to the three states where he is licensed to do locum tenens work since last year, when he returned to work after losing almost half of his retirement income. He says he could easily get more work, but limits himself to one week per month.

Experts say there is plenty of locum work for older physicians. Miller said about 45% to 50% of locums are retired or semi-retired. Locums agencies pay the physician's salary, liability insurance, travel and accommodations while on the job. However, locums work can involve travel, living out of a suitcase, shift work, getting medical licenses in several states and longer-term assignments.

And even with locum work, age can be a factor.

"I have been told the contract was awarded to someone else in the past. This is probably because of my age, but of course no one will tell you that," Dr. Rogers said.

David Singer, MD, found fulfilling work in the prison system after retirement. An internist, Dr. Singer began working at a Concord, Mass., prison about two years ago to help pay for the round-the-clock care needed for his grandchild, who has severe disabilities. Investment losses have kept the 79-year-old working there.

"For me, the job had to be part time and flexible enough so it doesn't eat up my life like it did before," said Dr. Singer, who previously worked in a large medical group.

He said working in the prison has been interesting and challenging, and he is working with people who really need him. "They are very respectful," he said.

Floyd Krengel, DO, is 77 and working part time in Asbury Park, N.J., examining people with work-related injuries for insurance companies. Dr. Krengel, a former family physician, co-owns the company with a retired surgeon. "This is a very easy job. There is no strain, no hassles from insurance companies."

Dr. Krengel recommends anyone who will be changing fields upon retirement to do part-time work in that field beforehand. "It helps you get your foot in the door," he said. Experts also suggest that if there's a possibility of needing to return to work, that physicians, within a year after retirement do part-time or volunteer work to eliminate any liability problems and maintain clinical skills.

Several months into his job search, Dr. Shah is doing some charity work, which was his original post-retirement plan. But he is still looking for a paid position. He has opened himself to evening work and internal medicine, his second choice.

Although frustrated with the obstacles, Dr. Shah said he knows he may need to make even more adjustments. "You need to swallow your pride. You need to be flexible and bend according to the circumstances."

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Retirement plans

A survey from October 2008 gave a snapshot of physicians' strategies for retirement. But a severe stock market slide has many doctors rethinking their plans. As yet, no survey has captured how these numbers might have changed. Here's a breakdown of responses from 2008:

45.5% of physicians older than 50 would retire if they had the financial means.

44.5% of physicians 50 and younger would retire if financially able.

20.3% plan to cut back in the next 3 years.

11.0% plan to retire in the next 3 years.

10.2% plan to work part time in the next 3 years.

7.5% plan to do locum tenens work in the next 3 years.

Source: "The Physicians' Perspective: Medical Practice in 2008" Merritt Hawkins & Associates for The Physicians' Foundation, October 2008 (link)

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Putting retirement on hold

One tumultuous year on Wall Street has forced Mark DeBard, MD, to postpone his retirement.

Like other physicians, Dr. DeBard felt his retirement goal was attainable -- until the recession hit.

The 57-year-old emergency physician from Columbus, Ohio, holds little hope that he will be able to recoup 2008's 40% loss in his investments by 2011, when he had planned to retire. He's not sure he could recoup it by 2017, when he turns 65.

"Disappointed is the biggest word I would use to describe my feelings right now," Dr. DeBard said.

In addition to other savings, you need at least two years' worth of expenses in cash and no financial liabilities before you can retire, according to Michael Reiman, president of Reiman Financial LLC, physician financial advisers in Dallas. Experts say that's a standard many physicians had reached before the market decline, but that is out of reach now.

Dr. DeBard said his current income can sustain him, but he knows that won't be the case in retirement. He is putting his house on the market to buy something smaller, less expensive and easier to maintain. He also would like to pay off his downsized home before he retires.

Still in question is whether he will work part time once he quits full-time work. He may do academic or administrative work at The Ohio State University, where he teaches.

Dr. DeBard is certain on one point. "I know I can't continue to do full-time emergency work mentally or physically past age 65. It's been a grueling career.

"If I can't find something else, I'll cut my lifestyle down even further."

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AMA puts focus on senior physicians

During its Annual Meeting in June, the American Medical Association will host a free continuing medical education program on older physicians in the work force.

The CME program, "Keeping Senior Physicians in Practice: Issues of Competency, Recertification and the Value of Experience," will be held Saturday, June 13, at the Hyatt Regency Chicago.

The program is designed to help attendees understand the value that senior physicians bring to a practice, the most common age-related issues to be aware of, and practical solutions and adjustments to address those issues.

John A. Fromson, MD, assistant clinical professor of psychiatry at Harvard Medical School in Boston, will be the keynote speaker. The program is sponsored jointly by the AMA Advisory Committee on Group Practice Physicians, Organized Medical Staff Section and Senior Physicians Group.

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