A part-time retirement to rural medicine: When work becomes joy
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We are again privileged to have rheumatologist and author Chuck Radis, DO, grace the pages of Healio Rheumatology with his continuing observations on the life of those who are lucky enough to be in our little club of practitioners.
Rheumatology is a big profession globally but I still consider it to be, in reality, a small club. Clearly our international meetings are sizable, if not huge, but I am continually impressed and pleasantly surprised by how I constantly bump into familiar faces around the world and have made so many wonderful friends over my career.
Chuck, in this reflective piece, reminds us that while we are privileged to do what we do, our lives can also be complicated and at times attended by stress, uncertainty and burnout. His story is one of how service — which in this narrative describes the activities of several senior rheumatologists working to serve the underserved communities in rural Maine — can bring fulfillment to these practitioners.
Chuck is grounded, however, and does not proffer such volunteerism as a panacea for the plight of the underserved, but instead advocates for others to seriously consider such activities when the time is right. This lovely and true story proves to me that when we are allowed to work at our craft unencumbered by the business pressures of the day, then work is as it should be. Namely, not work at all but an effort of joy. Thanks, Chuck.
– by Leonard H. Calabrese, DO
On the second Sunday of each month, I drive 3 hours from my home in Portland to the 36-bed Maine Coast Memorial Hospital, and for the next four days, evaluate a steady stream of consults and follow-up patients for a catchment area stretching to the Canadian border.
Several weeks later, rheumatologist Dave Engelbrecht, MD, flies or drives from Brooklyn, New York, to begin his work week at Maine Coast. We are provided housing (complete with a kitchen to cook in!), as well as an outstanding rheumatology nurse and access to an oncology infusion center down the hall from our clinic.
Both of us have been working this “gig” for 9 years, rather than retiring completely or filling in as “locums” for one of the national rheumatology placement services. It’s a good fit. At the end of my work week, I am not burned out nor do I end each day frustrated with the demands of the EMR. Patients are grateful that they don’t have to travel several hours for rheumatologic care, and pleased that they see the same doctor year after year. In fact, my part-time practice in this medically underserved area of Maine may be my most satisfying yet.
What are the advantages of part-time work in a rural hospital? Similar to our previous full-time practices, we get to know and connect with our patients, month after month, year after year. In a recent letter to The Rheumatologist, Dr. Engelbrecht wrote that, “like many (older) physicians, I found working 5 days a week every week was becoming extremely fatiguing. Now that I am working part time, I have days to recover from my workdays and respond to emails, review labs and renew prescriptions ... which makes for a much better quality of life.”
Maine, like many states, has struggled to find rheumatologists interested in living and working in rural communities. Seven of Maine’s twelve rheumatologists work in Portland. This leaves much of the state’s patient population a several-hours drive from expert specialty care. Telehealth has a role in filling some of these gaps, but the American College of Rheumatology has recognized that this should not replace in-person visits out of concern for quality of care.
There is a colorful history to older rheumatologists practicing part-time in rural Maine. At age 68, rheumatologist Currier McEwen, MD, retired to South Harpswell, Maine, from New York University, where, among other notable achievements, he had been Dean of the School of Medicine and was instrumental in establishing the NYU medical center.
His retirement in Maine was short lived. Each month, McEwen, with his wife Katherine, drove to rural clinics in northern and down-east Maine where there were no rheumatologists. At 82 years old, he retired once again, ostensibly to devote more time to his passion for hybridizing iris flowers.
Sid Block, MD, who retired from full-time practice in Bangor, transitioned to a part-time practice in Belfast, Maine, providing much-needed rheumatologic care to residents up and down the coast. He retired in 2023 at age 80.
As Dr. Engelbrecht and I have found, our patients are grateful to have us, even on a part-time basis. For other physicians considering this option — who may have spent their entire practice lives in an urban practice — it provides an opportunity to practice in a different part of the country and enjoy a different culture. Engelbrecht has also suggested that “it also provides an income stream so physicians don’t have to dip too deeply into their savings to continue doing whatever it is they enjoy.”
Of course, rural clinics staffed by older rheumatologists are not the answer to the national rheumatology shortage, but from my perspective, they are part of the solution, and more rheumatologists who are weighing retirement should consider it. The long-term connections with our patients are a major reason we picked rheumatology in the first place. Why not consider part-time work instead of fully retiring?
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
- Chuck Radis, DO, is a board-certified rheumatologist and clinical professor of medicine at the University of New England College of Osteopathic Medicine, in Biddeford, Maine. He can be reached at cradis@maine.rr.com.
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