Central Line
Episode Number: 148
Episode Title: Inside the Monitor - Hanging up the Scrub Cap
Recorded: November 2024
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VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ZACH DEUTCH:
Hello and welcome to the
Central Line Podcast. I'm your guest host, Dr. Zach Deutch. Today we have two
excellent guests, Dr. Lalitha Sundararaman and Aaron Tebbs, who are going to be
joining me. We're going to touch on a topic that impacts all of us eventually,
some of us sooner rather than later, which is retiring, or, as we have coined
the term, hanging up the scrub cap. I'm really looking forward to talking with
these two individuals, and thanks to both of them for joining us here today.
Let's start off with
some introductions. Lalitha, we know you've been on the show before, and of
course I know you well personally. We're very happy to welcome you and also Dr.
Aaron Tebbs, who's here for the first time. It might be good for listeners to
understand both of your current situations and why this topic of hanging up the
scrub cap is important to you.
DR. LALITHA SUNDARARAMAN:
Thank you, Dr. Deutch,
and a good day to you as well, Dr. Tebbs. Happy to be back with you and our
audience. I am an anesthesiologist from India. I was practicing there, came
over here, repeated my training, and I'm currently working at a large academic
center in Boston. There are many immigrants like me, happy in their adopted
country, but with family and sometimes emotional ties to their home country.
Along with my sister, Dr. Sumitra, I have also started a center in Chennai,
India to deliver equitable basic primary health and pain management services to
a swathe of underprivileged patients in the area. And that's kind of been my
lifetime ambition to kind of give back a little. And I have learned a lot from
my adopted country in the process. And this has really benefited me. I did not
benefit monetarily from the center, but I feel like I'm giving back and it
helps and it benefits my soul, hence my retirement plan would have to plan two
countries and requires careful planning every step of the way.
DR. AARON TEBBS:
Thank you, Dr.
Sundararamn. It's been a pleasure working with you on this edition of the
Monitor and putting together some interesting information that's come out of
the Committee on Late Career and Retired Members. I am currently the chair of
this committee. I am a cardiac anesthesiologist in private practice for the
past 19 years. I'm married. I have four children, one still at home. So I
consider myself in the sort of late mid-career stage, and I became interested
in this topic several years back, when my wife and I felt it important to move
all the way across the country to be closer to our family and aging parents in
specific.
So I went from being a
senior partner in my private practice on the Who's Who list of the hospital to
a junior partner in a who's that list in a new hospital. This major change in
my life got me thinking about other significant life events that are coming up,
and one of those is retirement. Retirement has consistently been ranked as one
of the most stressful, normative life change events, sometimes referred to as a
life quake. The interesting thing about the ASA is that we have a very large
silver tsunami, much like the rest of the United States. The baby boomers are
coming through, and the ASA has, of course, a large cohort of 60 plus age group
members, and they are all facing this very large, uh, life change event in
their near future. So Dr. Sundararaman and I have a very similar interest in
this topic in very different perspectives. One is a private practice, male
anesthesiologists. Another is an academic practice female anesthesiologist. Both
in our mid to mid late careers. And what we come up with is some very
interesting things to think about as we approach this next step of our lives.
DR. DEUTCH:
Most of us think about
financial issues when we consider retirement, but that really isn't the only
thing we should be thinking about, is it? What else should be on our minds when
we look towards retirement? Lilith, I'm going to have you answer that, if you
don't mind.
DR. SUNDARARAMAN:
Oh, sure. Thank you.
Zach. Definitely. Financial security with cushioning for contingencies is of
importance when considering retirement. Everyone is concerned that if they have
health issues or a situational changes, they should be an adequate financial
buffer. However, it's also of cardinal importance that you prepare others for
your retirement. I know this sounds weird. When you retire, it is stressful for
others as well. For example, your spouse is now going to see you every day at
home and marriages can get strained. Surprisingly, gray divorce that is,
divorce in the age group of 55 to 64 is 50% more common than those who get
married in their 20s and 30s. Keep your family and spouse informed about your
retirement plans, be they financial or personal. This is your own No Surprises
Act at home. For many of us all our lives, our job is a large part of what we
are and what we do and how we project ourselves. So make personal plans to fill
that void, which happens after retirement.
There is an interesting
study that I'd like to mention, which, incidentally, happens to be the longest
running study in the history of the United States, possibly even the world. The
study is ongoing and it has been running for 85 years. Study of adult
development conducted at Harvard Medical School. Now, the study aimed to answer
a quintessential question, probably the most important question of all: what
makes us happy? Now, this was analyzed in a cohort of people starting from
their 20s and followed on till today. One of the original members is even in
their 90s today, and the answer is startling. It's not education, social
status, money, power, or even health. It is interpersonal connections. Now,
several studies went on to corroborate that people's level of satisfaction with
interpersonal relationships at age 50 was even a better predictor of physical
health at age 80 than their cholesterol levels were. The end result is that
interpersonal connections and your own level of satisfaction is what determines
what you are after you retire.
DR. DEUTCH:
It sounds very
interesting. I was actually not aware of that myself.
It's a long road to
become an anesthesiologist, and as Lalitha pointed out, some people have even
had to do it twice. And this job is indeed a big job which can be consuming.
And the profession in that way can, for many of us, become our identity. What
benefits have we seen for those people that stay involved in the profession?
Aaron, I'll have you answer that one, please.
DR. TEBBS:
Sure. Thanks for that
interesting question. So as you mentioned, in our profession, being a physician
is a large part of our identity. We don't say we work in healthcare, but we are
physicians. So who are we when we no longer are able to practice medicine? In
addition, when we hang up the scrub cap and walk out of the OR for the last
time, we are at risk of losing many of our social connections. And as Dr.
Sundararaman said, with the Harvard Adult Development Study, research has
confirmed how important it is to maintain these social connections and
professional connections in our life and retirement is no exception. A critical
finding from the Harvard Adult Development Study, and I quote here, “the number
one challenge people faced in retirement was not being able to replace the
social connections that had sustained them at work.” Loneliness kills. It's as
powerful as smoking or alcoholism.
DR. DEUTCH:
Okay. ASA's Committee on
Late Career and Retired Members--and being the ASA committee, we need to have
an acronym, CLCRM--was established in 2019. It's been very active. Um, can we
hear about what that committee has been doing and specifically what that
committee has done with the survey that it conducted of retired members? What
are some ways that anesthesiologists can stay involved with the profession?
DR. TEBBS:
So the Committee on Late
Career and Retired member has been formed, in part to help the silver tsunami
coming through the ASA, the fastest growing cohort with the information and the
tools to help them during this transitional phase of their career in life. I'd
like to start off and talk about a definition of a late career member. So first
of all, the working definition for our committee is the 60 plus cohort. Other
authors have posed the definition of being 20 years or more in your practice.
But for this purpose, we're saying the 60 plus age cohort and the retired
member is defined as someone who no longer receives income from actively
practicing anesthesia.
So a couple of
interesting things. A late career and retired member of cohort. When we look at
all the cohorts in the ASA, we ask them, how important is the ASA to you? Would
you recommend this organization to others? The highest net promoters of the ASA
are the late career and retired members, which is a fascinating thing. These
are the people who have been there the longest. They've seen, you know, the
goods and bads and the ups and the downs of this, of this organization. And
they're the ones that are the highest promoters of the ASA.
So we ask retired
members of the ASA in the 2019 Retired Members Survey, what do you want from
the ASA as you are in retirement? And this is what they said. They said
specifically, we want educational opportunities to learn about things that are
specific for us in our phase of late career and retired member. We want
opportunities to mentor the next generation. We want the opportunity to serve
and give back to the ASA. And we want to have a voice in the ASA. And we want
to be able to advocate at the state and national level. And very importantly,
we want to maintain our connections with our colleagues.
Okay. So how do we
facilitate this? This is what the Committee on Late Career and Retired Members
has been focused on. So what have we done? So we have, first of all, focused on
the educational pieces. At the ASA in problem based learning discussions,
panels, interactive tutorial sessions. We've published things now in the Monitor
and we're working in the podcast angle today. We basically have put together a
group of really, um, in my opinion, the best late career and retired
anesthesiologist to sit on this committee, and we've pooled the wisdom and
experience of these people to try to answer some of these questions. And many
of the annual meeting offerings have been a combination of these members of the
committee answering the questions that the retired members were asking in the
retired member survey done in 2019. For example, problem-based learning
discussions like title things like I'm happy I'm retired or a panel retirement
ready, set go or professional contributions. I'm retired now what?
And then some interactive tutorials. Now, very interestingly, these tutorials
have all sold out the last two years and the problem-based learning discussion
as well. And the panels have been very well attended. Approximately 17% of our
attendees at the annual meeting are late career and retired members, and
they're asking for more and more of this educational information. So that's one
thing we've really focused on.
Now, another thing that
we've looked at is the definition of what a retired member is. And when we
looked at this, we found that there was an age discriminator that said you had
to be over a certain age to be a retired member. And we said, that's not who we
are anymore. That may have fit 20 years ago, but today we have retired members
of all ages, and we found a better definition, and we were able to get the
bylaws changed to reflect that. And the next thing we did, and this is an
article by Dr. Berry, and he talked about the eligibility for FAFSA being
opened up to all qualified members. Previously retired members were excluded
from this. Not, I don't think, because anyone wanted to exclude retired
members, but they just weren't considered when the FAFSA program was set up.
In regards to
mentorship, this is a thing that has kind of spun off of the committee on late
career and retired members into another ad hoc committee, and Dr. Lisa Solomon
is chairing that. And I think Dr. Sundararaman sits on that committee as well
about how we can mentor the next generation better.
And finally, in terms of
getting a better voice for our retired members. One thing we've done in this
committee is to designate retired members to sit on specific committees that we
feel are important, thus giving a better voice of retired members within the
ASA.
And then finally look
for in future annual meetings, some late career and retired member meetups. So
there'll be things like perhaps having coffee together with people in your age
group, in your stage of your career, and a place to sit and talk and connect
with, with other people that are going through the same thing that you're going
through. And no surprise, there are a lot of people in the ASA that are looking
at retirement right now. It's termed the silver tsunami for a reason. And the
ASA is is no exception to that.
DR. DEUTCH:
That's an excellent
recap of ASA related activities, especially that that committee work, and I
appreciate that. Um, moving on to a sort of a broader approach to this topic.
Um, many people have sort of a perception about retirement that the way you
started is the way you finish it. But like most things in life, it evolves. Can
we hear a little bit about the stages that occur in retirement and understand
why thinking about those stages and that evolution is important. And Lalitha,
I'm going to have you answer this, please?
DR. SUNDARARAMAN:
Thanks, Zach. Retirement
can always be explained in simple terms as: go go, slow go, and no go. I know
it sounds pediatric, but it actually covers everything. Our lives are ruled by
our jobs for a large part. In our early and mid-career, we're constantly trying
to gain experience, do more cases, maybe publish more, and definitely try to
earn more for the family while raising a family. We're always on the go,
wishing we had octopus hands. But then there comes a time when our body tells
us to slow down. When our kids need us less and we have more time to focus on
what's important to us. And that would be the slow go stage. The slow go goes
on. And sometimes we also have people doing locum jobs in this interval to kind
of give their bodies some time to adjust while still doing our jobs, until we
reach a point when doing long cases is no longer enticing due to the associated
physicality and emotional tiredness. This is accompanied by financial and
interpersonal security and most importantly, emotional contentment. It has
reached no go. When that no go stage is attained. When you feel that you have
attained all that you have to attain and you look forward to what's ahead, that
is a no go stage. That's when retirement happens.
DR. DEUTCH:
Interesting perspective.
I had never thought of it that way, but it seems very logical. So this kind of
food for thought for all of us, no matter what stage we are in our careers. Um,
we talked a little bit when we were discussing the committee activity from CLCRM
about mentorship. It's been described clearly that this cohort of late career
anesthesiologist and retired anesthesiologist can play an important role in
mentoring the next generation of practitioners. Can you talk about the value of
mentorship, not just from the perspective of the mentee but what the mentors
themselves get out of it. And Lalita, I'm going to stick with you for this one.
DR. SUNDARARAMAN:
For a mentor mentee
relationship to work, they should be well matched and that is of cardinal
importance. Many late career and retired anesthesiologists have been through
the grind and have a variety of experiences and talents that match what the
mentees are looking to get. The knowledge that comes from real world experience
is invaluable, and is what many mentees seek when they are attempting to
navigate the same hurdles. What do you do when your surgical colleagues don't
listen to you because you're young? Your mentor can advise you and say, don't
worry, I got this. I'll tell you how we handle this. What do you do when your
H-1 visa was rejected because your international medical school forgot to send
in their response in a timely fashion? If you have a matched mentor, you will
get the answer. Don't worry, I got this. I'll tell you what to do. The wealth
of knowledge and experience is a treasure trove and invaluable for the person
who taps it. And that's why it's so important that mentor and mentee matching
be really good. Now, one of the spin offs, which happened from the late Career
and Retired Members committee, was the AD Hoc Committee on Mentorship. The ASA
has actually started a mentorship program wherein you can actually log in into
the website and you can match your mentor and mentee. You can actually log in,
put in all your mentor details, and then a mentee can also create a profile and
log in and put in their details. And then the website matches both the mentor
and mentee. And when there is such a matching which happens, you know you're
just made for each other. And this is like our online version of maybe a dating
app, but this is a marriage which is really made in heaven because both parties
will benefit from it. And you might ask, how does a mentor benefit from it?
Well, all the experience which the mentor has had in his life, he is now able
to pass on to another person and encourage this person to actually step forward
using his experiences. And that gives a level of satisfaction which nothing else
can. When you know that somebody else has benefited from your teaching and your
experiences and your real world experiences, it kind of benefits the soul. And
the other way that many mentors can help is by also teaching other aspects of
life which they've gone through, which are like how to manage small kids. You
know, when you have a really busy life and when trying to, like, go ahead in
private practice. All these are advice which you given as the mentor in the
adult mentorship matching program. And I think therefore it is a mutual benefit
well thought out program by the ASA.
DR. DEUTCH:
Okay, so moving on from
mentorship and thinking about another way we can leverage the experience and
wisdom of people in late career and retired is in the advocacy realm. So this
is obviously an area where all hands need to be on deck. We need any voices we
can get that are knowledgeable, experienced and able to represent us well. So
Aaron, I'm going to ask you, can you talk a little bit about the role that late
career and retired anesthesiologists play in advocacy and, um, maybe give a
little encouragement for people that have kind of been sitting on the sideline
to get involved.
DR. TEBBS:
Yeah, I'd be delighted
to address that. Continuing along the lines of mentorship, my mentors in ASA in
Maine, where I practiced the majority of my career, I connected with them
through my state society. And then they encouraged me to get involved, and I went
with them at their encouragement to the ASA Legislative Conference, which is
every year in May. And I sat by their side while we met with our senators and
our representatives on the state and national level, and we were able to tell
them why physician anesthesiologists are so important in improving patient
safety and increasing quality of care. And it occurs to me that there is no
better qualified person to speak to this than someone who has been in practice
for 20 or 30 plus years. They have seen how important that the role of
physician anesthesiologists plays in the OR for patient safety. And there's no
other group of people who have a better depth of experience, a pool of
connections, social and professional, and also have the time and resources to
be able to go to their state capital or go to the national capital to promote
our specialty and patient safety. So again, I would point out that the late
career and retired members have the highest Net Promoter score of any cohort in
the ASA.
And so some specific
ways to advocate for people who may have been on the sidelines, I would
encourage the same way that I walk down that pathway. Go to your state society.
Get involved. Introduce yourself to the leadership. Tell them you want to be
engaged. I guarantee they will be delighted to see you and love to get you
plugged in. Go to the ASA Legislative Conference. Speak with your senators and
representatives. It's amazing when you have a chance to talk to them and get to
sit with them face to face and realize they're real, living people whose family
and even themselves have had anesthetics. They understand and they get that
this is an important issue.
So the other thing I
would encourage our late career and retired members to do is think about, in
your life, all of the social connections that you've made. Some of them, I
suspect, have been with national and state leaders. Reach out to these people,
have a connection with them. Let them know who you are. The importance of your
specialty. Um, remember, you know, the time to prepare for a flood is before it
starts raining. The next time we run into political advocacy challenges, if
you've got those relationships, they will reach out to you to ask questions.
And finally, if you're an ambitious sort, you can run for a political office.
There's nothing better than having a physician in political leadership to help
with one of the largest budget line items, which is always health care.
DR. DEUTCH:
Well, I think that's
that's well said. And what's interesting is, as you were talking, I was
thinking about what Jay Epstein, who's kind of our Florida advocacy and
legislative guru for many years, had said: when you meet with legislators and
you meet with health aides and legislative aides, you're definitely the expert
in the room. And so don't be intimidated because they need your knowledge to
understand. And I think, who better to impart that knowledge than people that
have been in clinical practice for 25, 30, 35 years and are veterans of all
sorts of clinical, political, economic and social situations. So very well
said. And it's nice to see that that group of people would play a very strong
role in terms of, you know, pushing our the future of our specialty forward.
Um, we're coming to the
end here. But I have one last question for both of you. And we'll start with
Aaron, and then we'll go to Aletha. Um, both of you have worked on this issue,
and I'm just wondering what might have surprised you or made you think differently
about hanging up the scrub cap and retirement. Anything particular that stands
out that you want to share with our listeners while we have a moment?
DR. TEBBS:
Yes. I would point out
that retirement is a relatively recent phenomenon. I hadn't considered this,
but our great grandfathers and mothers, retirement was not even in their
vocabulary. So this is really a unique thing in human history, and it requires
some unique consideration and preparation. Just like we plan our anesthetics,
we have to plan for one of the most stressful, normative life change events
that we will face, which is retirement. The Committee on Late Career and Retired
mnember is working hard to support and meet this fastest growing cohort of the ASA.
And this is the cohort that has built the ASA that we know it today. These late
career and retirement members have this tremendous clinical, administrative,
research, leadership and life experience. And I personally have been impacted
greatly with being around these committee members, working on these projects
together on presentations, and their mentorship to me, um, I've gained from
their hard won wisdom that comes from a life of service in medicine. And it's
my opinion that the ASA needs this experience and wisdom to pass down to the
next generation of ASA leaders and fortunate for us, the late career and
retired members, they want to engage. They want to mentor and share their
wisdom with us.
So the other thing that
really struck me is I looked at this is that I am about 2900 weeks into my 4000
weeks, if I'm lucky, on this planet, and I am not immune to aging and
retirement. Again, if I'm lucky enough, I will face this event. And it's
important for me to plan for it. So another important finding from the Harvard
Adult Development Study, and I would encourage everyone to look at that--it's
really got some very interesting points--is that people tend to become happier
as they age, and which some researchers attribute this increased happiness to
an awareness of our finitude or our impermanence. This awareness or mindfulness
may allow us to more fully enjoy all the positive things in our life right
here, right now, in the present moment. So there's strong evidence supporting
the ideal that the best is yet to come.
DR. DEUTCH:
And Lalitha, you get the
chance for your last comments here. It gives you the last word, literally and
figuratively.
DR. SUNDARARAMAN:
Well, uh,. thanks, Zach.
I think, uh, retirement has to be on everyone's threshold. You have to keep it
at the back of your mind because it creeps up on you when you're inadequately
prepared. It takes sometimes many years, many decades to plan for it properly
because of life changing events, not only in your own life, but in those of
your loved ones, which might affect your own decision to retire and when and
how. And hence you often end up procrastinating it. And sometimes along the way
you take physical, emotional hits and at the end it becomes a rocky course. So just
like you planned for your entry into medicine, plan for your exit as well. Give
yourself time to plan for a proper exit, and the path thereon will be much
smoother and more satisfying.
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DR. DEUTCH:
Well, thank you both for
being with us tonight. It's really been a nice treat to have two very
knowledgeable and articulate interviewees here who can kind of share their
wisdom, and I think that reading this issue will be of great interest,
certainly to me and to other ASA members as well. So thank you all for joining
us on the Central Line Podcast. And remember, for extra information or
background, you can always go to asamonitor.org. We'll see you next time.
DR. SUNDARARAMAN:
Thank you Zach. Thank
you, Dr. Tebbs.
DR. TEBBS:
It was a pleasure. Dr.
Deutch. Dr. Sundararaman. Thank you.
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