Fellow NPs: What's your strategy for retirement?

Jules A, MSN · Jun 13, 2017

I never plan on retiring as long as I have a sound mind and body.

This isn't just directed at you because I know a lot of people feel this way but how does one know when their own mind is no longer sound enough to safely practice?

I don't think its so cut and dry and it is a fact that we decline both reflexively and cognitively as we age. Even if still fairly mentally astute is a physician or NP in their late 70s fit to safely practice? Is there any way their knowledge could be current? I've known a few in their early 70s but no one past 75 that has remained at work and is still what I would consider capable of caring for one of my family members. Worth adding it seems in psychiatry they tend to stick around longer possibly due to the reduced physical rigors as compared to other specialities although as above I have seen several who were flat out incompetent at that point.

How do we navigate that possibility? Do we wait until someone gets hurt, our care is so subpar that reluctant peers confront us or report us to the board?

cyc0sys · Jun 13, 2017

I'm not an NP but I've thought on this topic long and hard. My biggest concerns are the raising cost of taxes, medical costs, and the devaluation of the dollar in the US. I'm not counting on Medicare or Social Security for retirement. I plan to work as long as I'm capable to do so.

I've scaled back my investment portfolio and have decided to divert that money into purchasing property in Central America for the construction of a medical tourism clinic. The clinic will offer pro bono medical services to the local population and host 'guest' doctors who engage in alternative and complementary medical services not offered in the US.

guest416560 · Jun 13, 2017

I assume that annual physicals and MMSE would be a good starting point. One's primary care provider along with one's trusted peers can make recommendations as to your ability to practice safely.

I work along with 80 year old dermatologists and primary care physicians who are still practicing and doing it well. These guys works because they love the job. They are still teaching at the university and precepting students and training residents. Age is just a number.

FWIW, my personal dermatologist is 83 and my primary care physician is 81. I actually prefer to be seen by older practitioners as their 40 to 50 years of experience are priceless.

Jules A, MSN · Jun 13, 2017

I assume that annual physicals and MMSE would be a good starting point. One's primary care provider along with one's trusted peers can make recommendations as to your ability to practice safely.
I work along with 80 year old dermatologists and primary care physicians who are still practicing and doing it well. These guys works because they love the job. They are still teaching at the university and precepting students and training residents. Age is just a number.
FWIW, my personal dermatologist is 83 and my primary care physician is 81. I actually prefer to be seen by older practitioners as their 40 to 50 years of experience are priceless.

Do primary care docs routinely do MMSEs or MOCAs, which I believe to be superior for mild cog deficits? Funny that you mentioned derm because there is one in this area who graduated over 40 years ago. Talk in town is no longer flattering.

My personal preference is physicians

guest416560 · Jun 13, 2017

I found this interesting

Advanced practice registered nurses (APRNs) are especially likely to work past 65, according to a national workforce survey conducted in 2013 by the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers. Eight percent of registered nurses (RNs)â€”but 17 percent of APRNsâ€”are 65 or older, it found. About one in four clinical nurse specialists (25 percent) and certified nurse-midwives (23 percent) are 65 or older, and about one in 10 nurse practitioners and nurse anesthetists are 65 or older.

FNP_Lifer · Jun 13, 2017

I think that they probably do so because they don't want to lose their FNP licenses so early. MDs can always jump back into the game, but FNPs need to maintain their practice hours. And the only way to do that is... practice.

LadysSolo · Jun 14, 2017

I don't know about the rest of you, but I (at age 62) still regularly read (several articles/week) practice updates, new drug updates, new guidelines, etc. I feel I keep up to date on new things, and don't forsee that changing anytime soon. I believe I owe my patients this.

FNP_Lifer · Jun 14, 2017

I'm not an NP but I've thought on this topic long and hard. My biggest concerns are the raising cost of taxes, medical costs, and the devaluation of the dollar in the US. I'm not counting on Medicare or Social Security for retirement. I plan to work as long as I'm capable to do so.
I've scaled back my investment portfolio and have decided to divert that money into purchasing property in Central America for the construction of a medical tourism clinic. The clinic will offer pro bono medical services to the local population and host 'guest' doctors who engage in alternative and complementary medical services not offered in the US.

Interesting choice. I'm doing index funds right now (60/40 stock/bond ratio) and hoping to one day crack 6 figures for my nest egg (preferably with digits >1 or 2 for the leading number). I don't know how America will turn out in the next 20-30 years. But I speak several languages, so there is the option to live as an ex-pat in a foreign country and make the retirement dollar stretch much farther. South America and some less-developed Asian countries such as Thailand come to mind.

TicTok411 · Jun 15, 2017

Retire?? I imagine I will stroke out one day yelling at a patient who tells me she doesn't believe in vaccines!!

3ringnursing, BSN · Jun 15, 2017

I'm not an NP, an RN only, but I had to medically retire four 10 years.

I had renewed my license right before I did so, but thought I would never work again. In fact I believed pretty strongly I was headed for the eternal dirt nap.

When renewal time came around again I was going to just blow it off, but my husband encouraged me to fork out the money and renew - I still had the necessary amount of hours worked to do so, so I did. I still thought death was a possibility and I would never work again, but I just couldn't let go of my license. I'm not ridiculous enough to think my license is me, but at the time it sure felt like it.

The next time I started thinking about when my license would be up for renewal I was still pretty sick, but no longer heading for the Big Sleep just yet. I also was not ready to say good bye to my RN license. I no longer had the hours to renew, but I knew couldn't survive a refresher course with my now chronic health condition if it lapsed either (I worked my fanny off getting my RN, and did it on financial aid, grants and scholarships ... we scraped by on a wish and a prayer and I will never forget the financial hardship of where I came from or what I endured getting there).

I realized hours "worked" don't have to be paid - volunteering fills the requirement (I was on disability too, so I also couldn't have any earned income then without raising a red flag).

My PCP graciously allowed me to volunteer at his office any time I felt up to being there - I had a specific number of hours to fulfill, but I could do it at my own leisure. I literally had to drag myself in on some days, and sometimes went a week or more without going in due to illness. He was in his 80's and still working for reasons of his own, so he understood a great many things back then that I didn't figure out until later on. He was a great man, and eventually became a dear friend too.

He didn't think he had anything for me to really do at his office, but I was soon doing his Medicare gaps in care paperwork - the precursor for HEDIS measures - that had been deemed unimportant and left undone for years. This ended up generating an extra $50,000/year for his practice.

Three years later I completed my hours. My PCP died suddenly not long after I got all my hours for licensure renewal, still with a full time practice. A small injury snowballed into a PE. Even though I got my hours a few months prior I never left, and had stayed volunteering. I loved being there. It was the best job I ever had in my life up to that point - and I was paid nothing. Go figure.

Two years later I got better enough to return to work as an RN full time after a 10 year hiatus. Scary. After a trial work period I got off of social security and medical disability retirement. My health is better now - not perfect, but good enough.

I got majorly lucky that I got the break I did to get the hours I needed to remain active. I also gained a dear friend that was literally right under my nose for years: my then PCP. He was one of the greatest men I've ever known.

He helped me when others may not have. I am grateful for the help he offered me (and even though I couldn't accept cash as payment for my work, he made sure to "pay" me in other ways).

My long rambling story boils down to this: you could volunteer somewhere that means something to you that could use your help, while remaining untethered to the commitment of a job and still generate hours to keep a license active. That way if you ever really needed it you still have it, and you don't have to say good bye to your hard earned licensure.

It's one of many options open to you when the time comes. I hope my story helps.

Advanced Practice Columnist / Guide · Jun 15, 2017

I'm nowhere near retirement age but I'm planning on staying where I work right now and hope to take advantage of the fact that I work for an entity that still provides a pension to retirees on top of optional tax sheltered annuity which I have as well. My spouse and I already own a property we're going to retire in and that's going to be more simple, smaller space, and affordable to live in if we were to live on a fixed income but yet still get to do some things we enjoy. It's also within the state so we don't have to move away. By that time I could also rent out the property we live in now, keep it as a place we visit from time to time, or maybe sell it.

babyNP., APRN · Jun 15, 2017

I plan to go to part-time status (0.6) as soon as I can after I save enough in my nest egg (likely 10-15 years). That would equal 4 24 hour shifts a month which sounds peachy to me. I feel like I could do that for a very long time- there are a couple of colleagues of mine who are in their 60s. They say they still feel great- just sometimes need a longer nap after the shift if they've had to stay up (we are essentially just on call for issues with the NICU babies and any high risk deliveries on the night shift, so we can sleep if it's quiet).

That would allow me to have a lot of free time off while keeping insurance benefits and I could easily live off of 60% of my current income (which I'm also expecting to rise) if I didn't have a mortgage.

After a couple of years, my facility also puts in 7% of my salary into retirement which is a hugely nice bonus. I've been maxing out an IRA and 403b for the past few years and it's exciting seeing the numbers rise up and up.

Of course, who knows where we will all be in 20-30 years with the rise of automation. One of the neos I work with told me that he fully expects our jobs to be replaced by a machine. When I asked him what he would be doing, he said that he'd be doing prenatal consults as that takes a more human approach than a machine, lol. With CHOP starting human trials on bio-bags full of fetuses in a couple of years- who knows? Maybe I'll be managing a row of babies in a bag determining when to "deliver" them :)