(when) Is it Time?

Near the end of June, 2010 we received an inquiry from the AGD that included these questions with a request for an early response. This inquiry was stimulated because of a story about a vascular surgeon who, while practicing at age 78, had a patient die.   These are the questions:

 

  1. Many dentists are practicing into their older years.  What could be some clues for aging dentists that might tell them it’s time to stop–or slow down?
    2. What are some of the psychological/emotional challenges that dentists face when deciding whether or not to retire (or semi-retire)?
    3. While there is no set age in the United States required for dentists to retire, what are some ways that older dentists can “check” themselves to ensure that they are still practicing at their peak?

Due to the short notice for the meeting, there were only four of us in attendance. However there were many thoughtful e-mail comments bouncing back and forth prior to the meeting and they contributed significantly to the discussion.

First some general comments regarding competence and retirement:

1) It is agreed that competency is variable across all ages. There are some young dentists with   barely minimal competency and there are older dentists who are highly competent.

2) At any time in a dentist’s career, the ability to provide competent care can deteriorate.

3) Safety and well-being of patients is always a dentist’s primary concern.

4) The seeds for the best transition decisions are sowed when dentists decide on dentistry for a  career. Those expectations for the career dentistry determine, in large part, the happiness and satisfaction derived from dentistry and how long to remain active in dentistry.

5) Stress management and health play an important role throughout a career. Poorly managed, they can lead to burnout, deteriorating quality of care, and less fruitful retirement decisions.

Specific comments, some from the meeting, some from e-mail:

INTERNAL FACTORS (Decision largely from within the dentist.)

A) “I didn’t want to get to the stage when someone else would tell me to stop.” Be proactive.

B) “I don’t have the daily stamina as when younger, so I work until 3 PM.”

C) “There was a willing buyer so I took advantage of the opportunity. I didn’t want to make the major capital investment to bring in the latest technology and major upgrade of equipment.

D) Fear can influence how a person thinks about retirement.

E) Perception of finances

F) Self esteem

G) Lack of social network outside of dentistry.

H) Lack of outside interests/hobbies.

I) “I just knew.” (It was time to retire.)

J) “Chose the procedures you like to do, (are good at), and stop doing the stuff you don’t like to do.”

H) Lack of enthusiasm.

EXTERNAL FACTORS  (Decision largely comes from outside the dentist.)

A) The staff usually “knows”.     Problem..If dentist leaves, jobs for staff may disappear.

B) Patients who “know” may just leave and say nothing.

C) Malpractice suits

D) Board discipline

E) Physical limitations

 

Competence is the standard for care, not ‘peak” performance.   Signs of incompetence include:

  1. Patterns of mistakes
  2. Patterns of complaints from patients or staff
  3. Patterns of bad results

Rather than through the use of objective criteria, dentists have generally been conscientious about knowing when to retire.   At a recent meeting of our local group a retired dentist stated, “I just knew” it was time.

At this point it seems that there is not a need for establishing objective criteria, because there is no evidence that there is a broad based problem. In general, dentists seem to get out before there is a problem.

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