Live Long and Prosper: But plan also for retirement

Dennis Jeanes
Manager, Communications & Advocacy
Canadian Orthopaedic Association

Starting in 2012 - notwithstanding the predations of misfortune, crime and disease - at least 400,000 Canadians will celebrate their 65th birthday each and every year for the next 20 years or so. In the phrase of demographer David Foot, Canada is in for a "grey interlude."


Mandatory retirement at 65 or any age has virtually disappeared in Canada, as a result of human-rights legislation designating the practice as age discrimination. Be that as it may, age 65 remains a significant milestone for many Canadians, both in terms of bureaucracy and biology.

In four provinces and two territories, recognized retirement or pension plans can trump rights legislation, thus imposing retirement at a designated age, usually 65. Human-resources staff in many academic institutions and private corporations typically approach faculty members or senior executives at age 60 to see what they have planned for the next five to ten years. And for those Canadians who were 55 or older in 2012, age 65 remains the magic number when they can apply for senior's entitlements without penalty.

Currently, about a third of COA members are aged 55 or more, and there is good evidence to suggest surgeons should slow down by 60, or they could pay a steep cost, says Dr. Robert Bourne, a former President of the COA and distinguished academic surgeon who retired in 2011: "I know of at least two studies by the American College of Surgeons, and another one from Britain, that found if general surgeons started slowing down and taking control of their lives at age 60, their life expectancy was normal. However, if they worked to 65 and beyond, what would you guess was an American general surgeon's average life expectancy after 65?...Three years."

Canadians are now living longer after age 65. Women can expect to live an additional 21 years on average, and men almost 18. While that is certainly reason to celebrate, as every orthopaedic surgeon knows, those extra years can become mired in chronic poor health. Statistics Canada has pegged disability-free life expectancy at a sobering 68.6 years. "Many of us will have a significant disability at age 68," says Bourne. "And if you work until you're 70 or 75, you may have given up the best years when you're healthy enough to travel or to do volunteer work or accomplish some life-long ambition. Suddenly those years are gone, and you're struggling."

Those words resonate strongly for Dr. Dana Fleming, who works in Windsor and is currently President of the Ontario Orthopaedic Association: "I'm turning 60 and something my father, who was an ophthalmologist, said to me when I started was that he decided to reduce his surgical practice to an office practice when he was 60. He felt doing surgery right up to the day you quit meant you couldn't take care of those last patients if there was a problem." Fleming's father, who was an avid skier, decided to set up an office practice in Vernon, BC, after he was required by UBC to retire at 65. With no real exit strategy, he worked all week and skied on the weekends until he was 75, when suddenly he was struck by a severe onset of Parkinson's disease. "He could hardly move for the next eight years of his life. He just sat in a chair," says Fleming. "Given that Parkinson's is an inherited condition, I intend to enjoy fully those ten to fifteen good years of life."

Although Fleming has call one day in eight, he's not sure how many 16-hour call days he has left in him. A painful foot serves as a reminder that he's not getting any younger. If he's to stop doing call, a by-law at one of the Windsor hospitals requires that he also give up elective practice: "I'm not adverse to changing to an office practice. The biggest concern is whether I can still make a living. I don't really want to assist. Also, our surgical income is being cut big time - more so than ever. So there are some real incentives to look at office practice, where I can do independent medicals, consults, insurance cases, things like that."

After discussions with his financial advisor, Fleming estimates that about five years of office practice will probably provide enough funds to fully retire at 65. Still, it's complicated: "My office manager is ten years younger than me and has been with me for the last 27 years. She's saying she wants me to stick around so she can retire, too. Also, one of the young guys wants to come home to Windsor to work, but my partners don't want to give up even more OR time." Sorting out the next moves for something like this takes time and focus, which Fleming finds in short supply since he also teaches. It's a bit of an anxious time. Like sky-diving there's no turning back once you transition from the OR: "I haven't jumped yet." But when he does, Fleming has promised himself that he'll make time to dig out of his desk drawer an early attempt at a science-fiction novel he's been trying to finish for the last 15 years.

Where Fleming is looking forward to the sedentary pleasures of writing in his retirement, Dr. Ralph Lapp of Victoria is experiencing a "hybrid retirement" that makes the most of the great outdoors at his doorstep and beyond, whether it be a cycling tour on his custom carbon-frame bike or sailing his blue-water boat or combining international medicine with eco-tourism in Africa. Since he and his colleagues are all very fond of the West Coast lifestyle, they've become adept at inserting downtime into their schedules. "We're getting much better at getting the locums in through summer time, spring break, that sort of thing," says Lapp, who is in his late sixties. "We'll have as many as two locums here at any one time, and they tend to be long-term. One guy has been here more than a year and just recently got the position we opened up, because his CV and interview were stellar."

Orthopaedics in Victoria has undergone a revitalization of late with the launch in early 2013 of Rebalance, the brainchild of surgeon Dr. Patrick McAllister and physiotherapist Stefan Fletcher, who is now CEO. Rebalance is a multidisciplinary group practice for musculoskeletal care that unites area surgeons under the same roof with rehab and sports medicine health-professionals, a specialist in osteoporosis, and an expert in prosthetics and orthotics. An X-ray facility is slated to move in next door.

The new centre and treatment model provide a perfect platform for Lapp to extend his career in a variety of ways, which is welcome since "it became apparent that retiring at 65 was going to be a little dodgy financially. I stopped operating March, 2011, but I'm actually in the operating room more than I've ever been, as an assistant. Sometimes, I'm in there five days a week." He still has an office for seeing the occasional arthroplasty patient for follow-up and doing independent medico-legal assessments. Another of Lapp's new jobs in the clinic is to do triage: "I'm referring cases based both on wait time and area of subspecialty. We're trying to keep the playing field level so that guys are all fairly equally busy. Almost half of the referrals coming into the clinic are directed to the first available surgeon."

When he's not at the clinic, Lapp has taken on community responsibilities as president of the congregation at his church and as rear commodore of the Victoria Yacht Club. And while funding a comfortable, active retirement means still working, Lapp notes "we all like to stay engaged with the group. It's a culture that's a bit addictive. It's important for us socially. And we like to be busy. Since there's a lot of demand for surgical assists, the transition is pretty easy."

Robert Bourne began giving serious thought at age 63 as to when and if he should retire at 65, after human resources at the University of Western Ontario began sounding him out about his plans. As the chair for orthopaedics at the university and head of orthopaedics at four affiliated hospitals, "it bothered me that I was making lots of decisions my younger colleagues were going to have to live with for ten or twenty years. That's when I started backing out of these various leadership roles."

A number of requests to review complaints lodged at the College of Physicians and Surgeons of Ontario against young surgeons really helped crystalize Bourne's decision to retire. Typically, these surgeons took locums in remote locations because they urgently needed work and, as bad luck would have it, the patients that ran into trouble were often the last or second-last cases before the locums ended. And even though the surgeons had made arrangements for follow-up, the patients felt abandoned and complained to the College. If found guilty of lax practice, the surgeon has a permanent black mark against his/her name, which must be divulged when applying for full-time work in Ontario. Given the fierce competition for few jobs, such a black mark amounts to immediate disqualification.

"In all honesty," says Bourne, "I probably could have kept going on a little longer, except that I've spent my entire life as an educator of young orthopaedic surgeons, and when I started to see how many were unemployed, I felt that when I reach 65 I'd better get out of the way. In my particular instance, they were able to hire two people, who started with half my resources for each of them. And over the course of the next year or two they'll both be up to a full hundred per cent. So I felt very good about that."

Now that he's retired, Bourne says he has a pretty full slate. He's received more invitations as a visiting professor than ever before. He's on the University Hospital board of directors and continues to take part in Operation Walk Canada's ongoing missions to Guatemala and Ecuador to provide joint-replacement surgery. Bourne remains involved with the Canadian Joint Replacement Registry at the request of his successors. Also, he has been asked to provide expert opinion with regard to metal-on-metal total hips and is still doing some design work with one of the device companies: "Life is full. Plus we have the grandchildren, so it's just perfect."

One surprise was government relations. "You retire and something miraculous happens," says Bourne. "You get involved with government like you never did when you were practising. People think that you no longer have any conflicts of interest, so you get asked for advice by people like a health minister or her deputies. I think this is an opportunity for retired surgeons to help solve some of the problems we have. You have the knowledge, maybe a more balanced perspective, and now you have the time."

Bourne advises young surgeons to invest in themselves very early in their careers. He, like Dana Fleming, believes that the COA should hold a symposium on the whole issue of retirement and develop some CME for residents: "Just how to prepare. And not only financial advice, but also how to have a meaningful life. We all know people who retired and died a couple of years later. I think the trick is how to lead a fulfilling retirement. It's like your work, if you don't put much into it you don't get much out of it."

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