As a “mature physician” of 65, I found that I disagree with a significant proportion of Dr. Kaufmann’s essay [“Knowing When It’s Time to Quit,” Summer 2003]. I am at the stage of my medical career where I am working because of my joy in the practice of medicine and the feeling that I have something additional to offer to my patients. This is true of many physicians in their prime, who have continued to expand their base of medical knowledge and perhaps are now more willing to listen. It would be a shame for the medical community and for patients to lose such a valuable resource.

When I lose the desire to continue to learn, lose the joy of going to my office and talking with my patients, then I will move to another phase of my life, retirement.

Mark W. Lischner, M.D. ’65
Roseville, Calif.

To my former fellow, Herbert Kaufmann: I read your recent essay and was delighted at your eloquence if pained at your conclusion that doctors should retire. I am grateful as I approach 80 that you left unspecified the age for desuetude. You condoned your own retirement by saying that aging doctors grow out of touch with junior colleagues who prefer their own peer group anyway, that older practitioners no longer understand the science in medical journals and that—in your words—they grow irrelevant as far as their colleagues are concerned.

I failed you as a teacher if you imagine that most of the people who come to see me require that I trace the twists and turns of amino acids. It may be fun to read the latest science, but little of that is required to care for patients in the office or clinic. There are nowhere near enough physicians, and we who are spared can make a contribution by working part time in an office or clinic to let someone else bear the heavier burdens of the hospital. We need elderly doctors in our intensive care units, not taking care of patients and not, one hopes, lying in a bed, but as knowledgeable patient advocates wandering around the unit asking questions about what is being done and why, and to what purpose. The intensive care unit might even be a place for elderly doctors to talk to the families of the patients being taken care of by younger experts.

There is much good also to be said for the viewpoint of the old, who have had experience and now have the leisure for contemplation. It takes staying power, iron pants and stamina—and a willingness, no an eagerness, to accept a changed role. People may think that you are irrelevant, but as long as you are convinced that you are not, you have something to say to them.

Howard M. Spiro, M.D.
Professor emeritus of medicine
New Haven

This letter is excerpted from a longer essay by Howard Spiro that appears in full below.

Dear Herbert: I am responding to your essay and Howard Spiro's response. You eloquently describe how, as we get older, our relationship with our medical community changes—a discomfort and reality all physicians must experience. At some point in time, I agree, it would be wise to retire. At what point in time this happens will depend on the individual.

Change in life is inevitable and we all respond differently. Your response, seemingly, was to retire; Howard's was to adapt to it by accepting a “changed role”; and mine was to create a new career. I also retired three years ago, and although I loved the medical community that I left behind, I decided to enter a new field and way of life. I have been auditing courses at the Yale School of Forestry and Environmental Studies and am volunteering as a stewardship coordinator for a land trust. Like Howard, I have a new niche, friends and colleagues, and I am enjoying my new life immensely.

I would like to believe retirement is a beautiful phase of life when a physician becomes free from the restrictions of a lifelong medical career. The time that decision is made and the life that is subsequently chosen will depend on one’s attitude, desires, ambition and health, not age. the three of us have made our choices.

Vincent A. DeLuca Jr., M.D. 
Clinical professor of medicine (retired) 
Branford, Conn.

Herbert Kaufmann’s article was interesting and useful. I retired at 70 to run a vineyard and winery. My experience is described in a chapter in a book called Doctors Afield, published by Yale University Press in 1999.

In my time at the School of Medicine, there were a number of optional courses. Are those still offered? If so, I would suggest an elective on retirement. Young people entering medicine often have a narrow view of the world. Retirement is certainly not what they are thinking about. When I retired from psychiatry and psychoanalysis, I was struck by how many of my colleagues hung on way past the time when they should have quit. They had nothing else to do. Some planning earlier in life would have served them well.

George W. Naumburg Jr., M.D. ’45 
North Salem, N.Y.