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VIEWPOINT: Leaving Neurology: Lessons Learned After a Long Career

Foa, Richard MD

doi: 10.1097/01.NT.0000418595.81081.bc

It's been over two years since I put aside my reflex hammer and retired. While two years isn't a long interval, and certainly too short a time to proclaim success, I feel like I'm off to a good start. When I first announced my retirement, I was frequently met with wistful looks and muttered queries about how I would manage or what I would do. I would respond with unbridled optimism about finally pursuing all those ambitions or interests I'd put on hold while engaged in my neurology career. Two years later that optimism is tempered.

My relatively long career spent caring for neurology patients made me increasingly sensitive to the impact of physical impairment on personal freedom — and appreciative of my still good health. The teaching component of my career — with exposure to students, residents, and younger practitioners — kept me aware of the importance of life-long learning and the restorative value of new experience. And while neurology continuously offered those opportunities, the time was right to challenge myself to grow in an entirely different direction. Since retiring, I'm ever aware that retirement is less an end than a beginning; less a time to look back at what once was and more a chance to look ahead at what might be. To be really rewarding, retirement is an opportunity to creatively reinvent oneself and is, in that way, not unlike a new career.

Perhaps that is what makes the idea of retiring so difficult. Or why “retirement” for many resembles the career just ended; only without some of the obligations or any of the pay. Certainly after laboring for decades to acquire the knowledge and experience that make us experts, it is frightening to let go and to start again. The “retirement” that I have sought may bear little resemblance to the “retirement” that you contemplate for yourself. So let me touch briefly on what I've done.

After finishing residency and fellowship, I spent 33 years practicing and teaching. Packaged into that time were a number of career changes and two serious attempts to do other things. In both instances I was attempting different work rather than retirement; and during both departures I quickly returned to some form of practice. In the first “break,” I became a graduate student in philosophy and bioethics at Georgetown University. Bioethics then became an important part of my career. After resuming practice and, ultimately, joining the full-time neurology faculty at Georgetown, I left again to operate a B&B on Cape Cod. I subsequently returned to clinical care. In retirement, I was looking for neither a sabbatical nor a change in my neurological career but for something at once new and distinct and free of the obligations or constraints of employment.



Like a career, retirement profoundly affects spouses or partners and family. So mine is really a joint venture with my wife. It started on March 1, 2010. To celebrate the moment, we looked at our proverbial bucket lists and headed off in opposite directions — me to Nepal to gaze upon the Himalayas and my wife to Costa Rica to gaze upon the surf. Each refreshed, we joined together for a trip to Europe and to begin to work on a different relationship than we'd had before. And while not the same as being together at home, a long trip was a way to learn that we could enjoy each other's company on a continuous basis.

Having developed a love for the beauty and craftsmanship of small wooden boats while on Cape Cod, I took a big step and enrolled in “boat school.” I chose a program at the Northwest School of Wooden Boatbuilding in Port Hadlock on the Olympic Peninsula of Washington. It was a challenging and exciting experience both for the skills I was taught and for my interaction with a talented and diverse group of classmates and instructors. Ranging in age from late teens to early 60s and from widely varying backgrounds, their common traits were creativity, a focus on craftsmanship, and a love of boats.

For that time, I was “living the dream.” And, like all dreams, it came to an end after one year; leaving me with new skills but, unlike classmates seeking work as shipwrights, without direction. So now I must face the challenge of what I will do for the rest of my life. At the moment, I work on the restoration of historic wooden boats as a volunteer, do woodworking in my own shop, pay attention to family, and contemplate whether and how to reintroduce neurology back into the equation. To be honest, I don't know what balance will be struck but having the freedom to decide is both heady and sobering.

I don't think that the choices I made during my career and what I've done since should be a model for others. However, I do believe that my approach to retirement has many elements that are worthy of consideration by others.

First, it is important to be done with what you're doing. This requires acceptance of what you've accomplished and recognition that you aren't going to be the one to do what remains. Age notwithstanding, if there's still a burning need do more in the clinic, teach next year's curriculum, join the next clinical trial, or publish more research, then it isn't the right time. And perhaps it will never be. Vacations, sabbaticals, or career shifts are better responses to fatigue or burn-out.

Next, be ready. Timing is critical. This not only means being financially prepared but also thinking about when the best opportunities may arise to do what you next want to do. About being financially prepared, I can only say that one needs a clear sense of the lifestyle one wants to preserve and its affordability. Other important factors are one's health and the readiness of spouses and others for your retirement. Few of us think of retiring alone but that may happen if a partner isn't simultaneously ready. Conversely, joining someone already at home may require renegotiation of a relationship not built on a lot of togetherness. This is at once similar to the challenges our patients face when they need to leave a job or reshape their life priorities as their neurological condition changes, yet profoundly different. In my voluntary, indeed sought-after, retirement I am privileged to be able to plan. And while we all need to remain sensitive to our patients' lack of choice, this should not rob us of the possibility or the excitement of retiring.

When the time comes, make a dramatic break. This will not merely punctuate the change but help to turn one's mind away from the career that has been left. Go somewhere special or do something to which you have aspired to make the moment a celebration. It would seem dispiriting to me to retire with no more immediate plans than to catch up on sleep, play a few extra rounds of golf or, worse, “do nothing for a while.”

Have a short-term agenda worked out. Know how you will acquire new skills or retrain yourself to become good at what you hope to do. Find the courses you want to take, decide where you want to go or what services you want to provide, and figure out how to enroll or get started. Also, think in terms of becoming expert in those endeavors since I believe self-esteem is tied to being respected for the quality of your work rather than what, exactly, you do. A short-term agenda should be further connected to a long-term plan. If your goal is to sail around the world, plan a way to share the experience for a long time afterward. After boat school, I hope to restore or build boats for years knowing I will have to tailor projects as my age advances.

Finally have an escape route, at least until your confident about your choice. Retirement may not be what you hope for. You may miss the challenges, the collegiality, or the income. New activities may be less fulfilling. So until you know it's the right thing, stay in touch with your old self.

Dr. Foa has retired (more than once) after more than 33 years in neurology and is currently volunteering to restore historic wooden boats.

©2012 American Academy of Neurology