So to begin, we have Dr. Kathleen Bell, who is a professor and a former chair in the Department of Physical Medicine and Rehabilitation at the UT Southwestern Medical Center and holder of the Kimberly Clark Distinguished Chair in Mobility Research. Dr. Bell was on the faculty in the Department of Rehabilitation Medicine at the University of Washington for 20 years before moving to UT Southwestern in 2014. Her research interests and publications center on treatment and outcomes for traumatic brain injury. Current interests include late effects of COVID-19 infection and treatment, concussions, and autonomic nervous system function after brain injury. She has been funded or an investigator on several different grants since 1998. Dr. Bell is a past president of the American Academy of Physical Medicine and Rehabilitation, the co-director of the Texas Institute for Brain Injury and Repair, an investigator for the North Texas Concussion Registry, and co-PI for the North Texas TBI Model System. Moving on, we have Dr. Esselman. Dr. Esselman completed medical school in 1986, followed by residency in physical medicine and rehabilitation at the University of Washington. He joined the faculty of the Department of Rehabilitation Medicine at the University of Washington in 1990 and was promoted to professor in 2006. He served as chief of rehabilitation medicine at Harborview Medical Center, the level one trauma center for 20 years. He was appointed as acting chair for the UW Department of Rehabilitation Medicine in April 2006 and chair in October 2007. He has served in many roles of the American Academy of Physical Medicine and Rehabilitation, including as president in 2018 and 19. After serving as a department chair for 17 years, he will soon step down from that position. And then last but not least, we have Dr. Geringer. Dr. Geringer graduated from the University of Michigan Medical School in 1979 and completed his residency training in PM&R there as well. From 1982 until 1991, he remained on the faculty at Michigan, then joined Wayne State's PM&R faculty as an associate professor, reaching the rank of clinical professor in 1996. In 1999, as the Detroit Medical Center was in the throes of significant administrative and financial turmoil, Dr. Geringer started a solo private practice of acute and subacute musculoskeletal medicine, electrodiagnosis, and medical legal evaluations until closing the office and retiring in 2017. And without further ado, I'm going to pass it off to Dr. Bell. Here's a quick view of our agenda as well. Sorry, just unmuting myself. So are we on the first one? On the first slide? We are. Okay, great. So I was just going to just go through a few slides. This is going to be very interactive. I'm not going to be reading from slides all night. But I thought I would just go through a few things. This really has been an interest of mine over the last decade, looking at kind of winding down careers and figuring out next steps as a part of the developmental stages of being a physiatrist. So just in general, when do physicians retire? Somewhere between 60 and 90 years of age in general. So it really varies wildly depending on who the person is and what their circumstances are. There's very little information on the whole concept of full versus part-time retirement or kind of second careers, as it were. And there's basically no information at all on physiatrists per se. Now why do people retire early? We certainly read about that a lot these days of people being very unhappy about being physicians, et cetera. And really the drivers for early retirement are things like low job satisfaction, having a feeling of not having control over your situation, poor morale, and problems with the justice system of medicine in terms of the self-regulation versus external regulation of practices. A lot of stress and burnout, and of course that's something we've seen particularly coming to a fore through the COVID pandemic and afterwards. When they're experiencing either poor health, cognitive decline, and distress, which might be manifest by affective disorders or difficulty sleeping. Next slide. Now why do people delay retirement? I mean, many, many physicians are not retired at age 62 or age 65. Peter and I are not retired, although we have kind of different variations of what we're doing right now. The things that might help you delay retirement are being satisfied with your career, of having some flexibility about your career, of a feeling of responsibility either for your patients. There are a lot of people, for instance, who practice in underserved areas or practice in rural areas where there just isn't anyone else to take care of their patients. A desire to be healthy. For financial reasons sometimes, or because they don't have any other interest outside of medicine. They don't know what they'd do with themselves if they retired. Next slide. So there are similarities and differences between academic and non-academic practices. Both of them require planning. Both of them look towards both finances and legacy as part of the decision-making in terms of retirement. And I think in a lot of academic practices, again, this varies considerably depending on whether you're in a solo practice, for instance, like Steve was, and he can talk more to that, or whether you're in a large group practice, whether you're in a physiatric practice, whether you're a hospital employee. There's a lot of different things that go into non-academic practices. But a lot of times, if possible, people are looking at planning for either some retention or stepped retirement. There's a lot invested in physician practices. You all know when you bring on a physician to your practice, it takes a long time to get them up and running, get a full practice, really get them practicing at their peak. And so if you're in a solo practice or in a small practice, there's a lot of run-up to thinking about retiring, and there's a lot of run-down, as it were, on the other side in terms of letting go of a practice. There are things like flexible hours, sabbaticals, that people often think about as they're looking towards retirement, managing the bureaucracy, maybe moving into administration as opposed to clinical care to help get some arms around their hours, developing or changing their work content. It's certainly an opportunity sometimes to build knowledge, to take a different step, go in a different direction than you've been in before, build different knowledge, maybe be able to volunteer and give back at that point. If you've been in a private practice, that may be the time when you're financially capable enough of stepping back and saying, I can give something back to my specialty or my patients at this point in time. Next slide. In academic practices, again, it depends on where you are within an academic practice, but usually by the time you're hitting retirement, you're in some sort of a leadership position, whether that's a departmental leadership, like a chair or division leadership, or whether you're in charge of some educational component or research component, but you're probably in some sort of a leadership position. This often means, again, that you're looking very carefully about trying to groom someone to be able to step in and take over whatever type of leadership position you've been doing. For instance, if you're looking at a department leadership, Peter and I have both been department chairs. The five-year retention rate for academic chairs is 70%. Both of us have made it past what the average is for academic chairs. Peter's been a chair for a long time, and I was a chair for eight and a half years. You always have to have a plan in the background in case there's an emergency. We could get hit by a bus any day. This is something that you need to think about from day one of being in a leadership position, but really start planning well, well before you reach that point of looking at retirement. Next slide. One of the things that you want to do, and I will say that this is true whether you're in academics or you're in private practice, is to really develop leadership and skills in others. In order, you spent many years developing your practice or many years developing your department. You really want to make sure that things don't just fall apart when you retire. Really developing administrative and leadership skills in younger physiatrists to help move up to take over, that takes years. That's not something that happens right away. In fact, the day I started as a chair, I started planning on leadership development. That was one of my very top goals, was to have leadership development going on, looking at internal and outside candidates. You really want to know your bench. You want to know a lot about who you've got, who might really be able to have that budgetary knowledge, who has the talent maybe to get an MBA, how you can get people into networking either within your institution, within your medical society, national committees, et cetera, depending on what kind of a practice you're in. Next slide. Identifying potential leaders is a job for us to do as we're looking at retirement and looking for people who have emotional stability, have good communication skills. People who want to be a leader or think they want to be a leader or maybe don't know but have great skills and that conversation can happen about whether they want to lead. There are a lot of people that want to lead who perhaps don't have the personality to lead. You want to consider things like diversity and equity. You want to make sure there's a fit with your organization. Whoever is going to be stepping into a leadership position of any kind, whether it's in your practice, whether it's in your institution, whether it's in your academic department, you want them to want to develop other people and have good mentoring skills because that really is the mark of an excellent leader. Next slide. One of the things that we can talk more about this, I think, more casually after I finish with these slides is what do you do when you retire? If you're a chair, if you're a leader in your group or in your institution, do you just kind of stop? This requires some thought. Most of us are pretty hard-driving people. Most of us have enjoyed our work. Most of us just work hard. That's just what we do. It's pretty hard, and I think people would warn against just stopping without thinking a little bit about what do you do at that point. Do you take a different role in your institution or your group? Do you go back to clinical work? Some people have done that. I know Greg Gortzowitz has gone back to clinical work, has left administration entirely. Do you look at your personal and family goals? What are they at this point? What kind of value do you bring to your organization, and how can you parlay that into work towards retirement that's going to be fulfilling to you and fulfilling for your organization? I think the other thing is, again, having your own strategic plan for at least a five-year strategic plan on how you're going to transition and how you're going to transition everyone around you into retirement. These include things like not only the leadership development, but your finances and financial planning as well. Next slide. There's the good, the bad, and the ugly about retirement. This is particularly looking at finances. Let me tell you that this year, I stepped down to a part-time position, which is below where I'm supported with health insurance. I had to go on to Medicare this year. This has been an interesting year to go through thinking about money and how that money flows out. Obviously, retirement's not all about money, but money plays a role. Typically, if you're looking at annual spending, people say you should look at something like a 3% to 4% withdrawal from whatever you have in terms of your retirement savings. You'll run out of money if you spend 6% to 8%. Work that out with some numbers and see where you stand. You are, of course, forced to make withdrawal from your retirement savings as soon as you hit a certain age. I believe it's 72 with retirement. Calculate that in that you're going to be taxed on those withdrawals at that point. Labor is not free by any means. If you have a higher forced income because of these age-linked saving sources, you will be paying a much higher rate than you think you will for Medicaid services. Think about that as well. What you do have on the good part, you have decreased income tax. You don't have any payroll taxes. You don't have to save for retirement at this point. Hopefully, you don't have a giant mortgage at this point. You don't have to pay for life insurance. You probably don't need disability insurance at this point, although long-term care insurance is something you should be thinking about. You don't have work-related expenses. You can get rid of all those suits and fancy dresses and hopefully no child care. You will receive some Social Security between $40,000 and $60,000 because you're going to max out on Social Security. Next slide. You do have to save at a much earlier age than you think you do. I don't know how old everybody is who's joining in here, but you absolutely need to start saving in that first five years that you're out of your residency or even in your residency, start putting away small amounts of money for saving because a quarter of physicians at age 65 to 69 do not have a million dollars in savings. You think, oh, these people have all sorts of money. They don't. They don't. You really have to think about that ahead of time. As I mentioned, health insurance can be ugly, so you have to really think about that as you're going along. If there's a way for you to stay on and optimize your institutional health care support after you retire, you should think about doing it. There's all sorts of side gigs that one can do when one reaches retirement. One can do, for instance, locums. One can do medical surveys. One might be able to do some part-time telemedicine, asynchronous medicine, some sort of medical writing and editing, medical legal consulting, health coaching. There's a number of things that you can be kind of creative about if you think that you want to continue in health care. Next slide. This is part of my retirement plan here. There's a lot of little kitties here who are my grandchildren, and that was one of my real goals for retirement was to be able to spend some time with my grandchildren. I also, however, am still dedicated to participating in research, which you can see on the upper right-hand side. I'm still working in some of those areas, and I still am very dedicated towards mentoring and education. These were all the things I had to think about when I put my package together for retirement. I think that's the last slide. That is my last slide, and now we're kind of into ... I hope that that just set the stage for us to think a little bit about maybe some questions and maybe what's in our minds at this point. Thank you so much, Dr. Bell. Now we will move on with our panel discussion, so we really can just go down these lists of questions here, and I can just open up the conversation. We can start with Dr. Esselman, and just talk about your retirement timeline a little bit. Thanks, Kathy. Nice set of slides. Nice overview to set the stage here, and as I think people mentioned, I've been chair now 17 years with the first year and a half as interim chair or acting chair for that. It really is a long ... You have to have a long timeline. You kind of have to have that five to 10-year approach to timeline, to thinking about your goals in your career, what you want to accomplish, and how are you going to wind down. I guess I'll probably jump maybe into the second question a little bit, too, if I can. It's so key when you're in a leadership position, certainly Kathy and me as a department chair, that succession planning is to have that bench of people who can kind of step in and take over responsibilities, and that's just not easy. As you say, Kathy, it's an eight to 10-year approach. I always think the people we're hiring today are gonna be the leaders of our specialty in 15 years. It's really the, for me, it's the people that we hired 10 to 15 years ago are at the point where they're ready to step into leadership positions or be candidates for chair positions. And if you don't have that early bench, it's hard to recruit into that senior leadership bench and to try to develop that. So it's a matter of delegating responsibilities, my retirement plan is getting more and more things off my plate and having other people take responsibility to a little bit of being comfortable with that and realizing that there are things that I used to do, used to think that I used to know really well how things ran in the department that I just don't know anymore because I'd given that job to somebody else. And I'm a step removed from it and then it has to be okay to allow people to grow into leadership. So that's my initial thoughts and Kathy, I think your point was really well taken on kind of the succession planning and having that bench. Maybe I'll ask Steve, a very different perspective on kind of your retirement timeline and thoughts. Well, I spent the first half of my practice career thinking I was in academics and I thought that's the way it would always be. And I saw myself taking what I called a starter chair, like a starter home and then moving to another one, another one and in my fantasy, moving back to Michigan as the chair of Michigan, where I've been associated with most of my life. But it didn't happen that way when the Detroit Medical Center fell apart for family and other reasons. My wife was a professor at U of M in the business school and for other reasons, I just wasn't gonna move away. So I started a solo practice and that was the second half of my career. In terms of winding it down, I retired when I had just turned 64, six years ago. And my practice was, the private practice was about half treatment of acute musculoskeletal and subacute musculoskeletal issues and then electrodiagnosis and then medical legal stuff, IMEs. And as the years went by, the demand for the medical legal got more and more. In the maybe three years before I retired, I deliberately started cutting back on my slots that I had for new patient evals for treatment and opened up more based on demand for the medical legal. And in fact, in the last year I was in practice, which coincided with my presidency year in the academy, I had by then essentially cut out all treatment other than those people who I had been seeing for many years. And I had by then gone from five to four to three in that last year, two days a week at the office because the medical legal stuff, the forensic stuff took a lot of homework. Files that could be 20 pages, but it could be 4,000 pages for the cases I was seeing. So I was still working 50, 60 hours a week, but not in the office, it was most of it at home. And so that's how I transitioned out. I had planned on retiring at 63, but I thought it probably wasn't a good look to be the president of your National Practitioner Society and being retired. So I worked the extra year, which was fine. That was a pretty busy year looking back on it. So yeah, so that was it in terms of how I started reducing the time in the office. And then I let people know way ahead of time, obviously, for both the treatment and the medical legal that I would be, I gave my specific dates, but I would be quitting. I did a little bit of work in that first year afterwards on the medical legal side, file reviews and things like that for cases I had already been involved with, business follow-up. Otherwise, nothing in the direct medical care. I've been involved otherwise in medicine and to some extent. So soon after I retired, I started doing interviews for file reviews and interviews for the med school here, for Michigan's med school. And they get about 10,000 applications a year. And it's an awful big job to do not just the file reviews, but then later the interviews, which are all remote. I volunteered in a free clinic and that until my, I'm a type two diabetic, great control, but my endocrinologist couldn't believe that I was going into a clinic where they didn't require vaccination and stuff like that. And so she yelled at me and I had to quit. She was just very concerned. I think a little conservative, but I took her advice. And afterwards, now that COVID is a little more relaxed, that opportunity just isn't there with that clinic. So it's really, that was for a while, but the med school takes a lot of time, the interviews. That's all I'm doing in the medical world, really. I'm watching the chat a little bit here and can speak to my plans and answer some of the questions in the chat. And my plan, once I stepped down as chair within the next month or so, as the new chair is named, is to continue at 50% time, mostly clinical work, but a little bit of administrative work. One thing that does that keeps my benefits at 50% time, the University of Washington, I'm eligible for benefits. So I don't have the Medicare decision. I could delay that a bit and that's variable depending on the institution you work for and how much you have to work to continue your healthcare benefits has to be part of the decision. And I'm sure Kathy, you're the same that you- Yeah, so it's like 60% for University of Texas. And what I did when I first, when I stepped down from chair position, I went to 60% initially and I was still doing clinical work, et cetera. And then I think what happened is a few months after I stepped down and went to 60%, I fell while hiking and got a tibial plateau fracture. And so I was down in a wheelchair for three months. I continued to work, sold patients, sold everybody. I just was non-weight bearing for three months. And so it changed my perspective a little bit. I also had two friends who unexpectedly died over the prior 12 months. And so it changed my perspective a little bit through that six or seven months. And I thought, maybe I wanna move back to where my family is because I was living in Dallas to work 60% time. And I decided that I would work out a deal which the university accepted so far that I would work 25% FTE and most of it would be remote. So I closed my clinic, which I'd been seeing patients in one way or another for 50 years at that point. I started as a nursing assistant and went all through this. And at 50 years, I decided that's enough. I've enough patients. And so I've worked out that I'm still funded for research on a number of research grants. I still teach virtually. I'm doing a lot of work with the academy right now. Actually, other than this, I'm working on a number of courses and just a number of things. So I'm keeping very involved with that. I do a lot of mentoring for young people, particularly young physiatrists and others who are in trying to make their way in research and in academics. So I'm really very busy. I'm probably working more than 25% time, but that's kind of the way life is. But I'm able now to take on other things as well, like things that I haven't done for 10 years. I'm playing the piano every day, which is really nice. I found a nice partner to do duets with in my neighborhood. I have a garden for the first time in 10 years. I can do nothing as a chair. That's all I did was work. So I'm making bread. I'm getting a little bit involved in some community activities. So it's allowing me to kind of spread myself. And I'm babysitting every once in a while for my grandkids and seeing them all a little bit more frequently. So as long as I, right now, this is pretty nice. I go down, like I said, and cover for people once in a while and go down and meet with my research team in person, all that sort of thing to kind of keep up those relationships. Yeah, I'm on a data safety monitoring board for a big research thing. I still do some scientific advisory work. So, like Steve said, there's some things that you can do that are not necessarily taking care of patients if you're interested in that. We are getting some great questions via the chat as well. So I will just run through some of these as well. But one question, do you have tips on how to start the conversation between you and your employer when you decide to retire? I thought, how much notice do you give like a medical director or leadership position? And I personally, I told the dean last July that I was going to step down once a new chair was chosen. And it takes about a year to do a national search and do all of that. And I did not want the department to be in the position of having an interim chair. So I kind of timed my retirement with thinking, okay, I announced now in about a year or so, new chair will come in. But it kind of depends on your position. The leadership position, like you don't want to leave your organization in the lurch too much and give them time to try to backfill and recruit to cover patients and other administrative responsibilities that, heck, I'd like three to six months notice from my faculty, ideally, if they're going to move on and to be able to adjust and fill the gaps. At least certainly in an academic sense, I don't think you can go wrong by doing it sooner rather than later. I mean, because in an academic setting, it often takes a year or a year and a half to replace somebody. So, and even, honestly, in private practice, depending on when somebody leaves, it could easily take a year to replace somebody, again, to get the right person at the right time with the right skills. So the further you are in leadership, the more responsibility I think you have to give some prior notice. And again, this has to do with not only fairness to your institution, your employer, but you want to leave. You've worked so hard on whatever it is you're doing. You want to leave it at top notch in somebody's hands and you don't want to leave it in this valley where nobody's taking care of it. There's a note in the chat just now about retiring when you're still healthy enough to enjoy life. And boy, do I agree with that. At an academy meeting six months before I retired, so early 2017, it was the bold kickoff, the bold initiative kickoff. But I was sitting next to somebody a few years younger than me, and I told him, you know, I'll be retiring in six months. He said, boy, Steve, when I'm 90, if I'm still able, I'll still be working. I said, well, you know what? That's why they make wallpaper because we're not all the same, we're all different. And that's very different than what I wanted to do. But if that's what turns you on, my preference would be exactly what I did, which is to retire, I think, pretty young, 64, and essentially 100% retired at that point. Well, I'm 69 years old, and I can't cut it off like that. I just, I'm just not that, I'm not that personality. And I am, by the way, I'm back to hiking. I can hike seven to eight miles an hour. So my knee hurts sometimes, but I can hike. Yeah. And Kathy and I, we're, I'll disclose, we're the same age. So there's, has not been early retirement for us. We've just kind of dragged this out. Well, as it happens, we're all three the same age. I'll be seven in a couple of weeks. Well, you know, I think, I think what I did though, I decided that, you know, at a certain age that I wanted to have a different experience in my career. And so that's when I decided to move into a chair position. And I had not decided before then. And I thought, you know, I'm gonna, I'm gonna leave kind of with a bang. And I also, I wanna do, and this sounds so cheesy every time I say it, but it's honestly was true. I wanna do one more thing for physiatry, you know, before, before I leave a specialty, I wanna do one more thing. And so that's why I made that decision to kind of go for another extra few years than I otherwise would have, Steve. Mm-hmm. Yeah. Steve, there's a couple of comments in the chat from fellow practitioners or people in small practices like yourself, or maybe your primary concern is not succession planning, but being financially ready and doing that. Did you look to someone come in to work with you and take over your practice, or did you feel comfortable just closing the doors and walking away? My practice was not sellable because of the nature of it. It was, by the time I finished, it was essentially a hundred percent medical legal and they were retaining me as the expert. And so there was no way it could have been sold. So there was that, and in terms of finances, we haven't talked, you know, money at all. And my old chairman at Michigan used to say, well, no matter what they're talking about, they're talking about money. And Kathy alluded to this some in her slides. And it is really, really important to, first of all, do what Kathy said. The minute you start making, you know, any money at all, put some away. The compounding over the decades is the single most important factor in what you'll have when you retire. My advice for finances, if we'll segue there, honestly is to have a financial advisor. So my wife, I mentioned earlier, she's the one who takes care of our finances. She's a Michigan MBA and she's a Michigan PhD in business. And she's a smart gal. But together we did a lot of research on investments. There are some books I would recommend. There's a lot of books out there, but there's a couple that we used with some basic principles. A couple of basic principles are these. If you are in stocks, which most people are mostly early in their careers, you can take any date, any day of any year since the depression almost a century ago. And from that point to 10 years later, your investments in stocks will have increased. You'll have appreciated. There's no 10 year period where stocks have gone down. How much they go up varies, but that's number one. They therefore say, when you do retire, figure that anything 10 years out, if you're 64, hopefully I'll live a few more decades. From 10 years out, my stocks will appreciate. They will because of what I just said. But for those next 10 years, and especially as you get older, you wanna have something a little more conservative. So for most people it's a 30, 70 and it was conservative versus stocks, 40, 60. It just depends. But my main thing is become educated and don't, honestly, don't try to think that you can do it yourself. It's not easy. And people who try to time the market, do their own investments, some do okay. But on average, they do about 40% as well with appreciation as people who don't do that. Yeah, we certainly, Steve, have done a lot of that. And I have to say, my husband has been really the driver with this, but we've met with a number of financial advisors. And I would say we started doing that some years ago, not now, we started doing that probably 10 years ago when I moved to this position where we knew that he was going to retire right away and that I was X number of years from retiring. At that point, I thought I was five to seven years from retiring. It turned out to be eight and a half years, but nonetheless. But we spent a lot of time really looking at where we were and figuring out what we thought we needed and getting housing and things like that kind of in order before we kind of made that final jump. But I think that's the whole mantra here is start early and get a plan for yourself. It's not gonna happen without you planning for it to happen. I mean, it'll happen. You don't want it to happen suddenly beyond your control with no planning in place. And as you get to our age, we're starting to roll the dice a little bit. We have another great question in the chat and this question has a few parts, but I'll go ahead and read it. Please share any books, podcasts, or resources you used in planning for retirement, specifically as one figures out a new sense of purpose or meaning, if not taking care of patients, our whole career. How do you transition into this new phase in your life and not lose your identity after you retire? I'm right now typing two books into the chat. Let me say before I post them that these are not brand new. And one's from 2005, one's from 2012. So a lot of those, a good portion of those books have to do with specific funds. The, you know, Fidelity Magellan Fund versus Vanguard versus whatever. And you can forget all that stuff, but the basic principles, some of which I alluded to a few minutes ago is what I would suggest you look at these books. Excellent, very excellent for that. And hopefully will convince you to try not to do it yourself, to be a money manager yourself, unless you or somebody you know, or your partner has very specific expertise in money management. And there's a million books out there. These were recommended to us by the person who still does our money management. And they were very helpful. Thank you. I think it's, sorry, go ahead, Peter. Go ahead, Peter. Okay, I think the key to that question, how do you not lose your identity after you're tired? You talk, Cathy, like being a physician is who we are. It's our life. And certainly being a department chair, it just consumes your life seven days a week. But then how do you keep that identity? And, you know, I'm really in that transition phase. So you could ask me in a year or two how it's gone. I'm not totally sure how it's going to go other than through a gradual slide and work 50% time and to do that. And the other part of that is being engaged with people. And I'll just tell a little story. And Cathy will know what I'm talking about. I ran into one of our neuroradiologists at Harborview, who's retired, is there forever. And she asked me about retirement. And her comment was, and it rang so true with me, that she misses being engaged with younger people. And she said, oh, I hang out with my kids' friends and doing that. And we're in the cafeteria. I look around the cafeteria and go, you're right. Every day I come to work, I'm engaged with younger people and a very diverse population of people. And my personal social circle is not super diverse and it's older. And so one thing to think about, how do you stay engaged with the world and younger people as part of that? Yeah. Yeah, no, I think that's really, that's so true. I'm in this transition right now as well. We moved, had moved to Dallas, lived there for nine years and then had moved back up to Washington State, which is where my children are. And that certainly was a driver for us, was being around children and virtually lifelong friends who are there that we knew we wanted to be around. But that is a great point. I mean, one thing about being a physician, you see lots of people. And even if it's not your trainees or whatnot, you see lots of people. And so, and then all of a sudden you find you're, you know, you're spending time with your husband. I love my husband, but you guys know my husband well. Lovely guy. I am seeing for sure that we're going to have somewhat diverging lines of what we're going to be doing in retirement because I'll kill him if I have to stay in the house with him every day, all day. So. So Kathy, for 20 bucks, I won't tell Larry what you just said. This is being recorded though. No, I'm really, I'm delighted to be spending more time because, you know, again, I think that having this opportunity to reconnect with your spouse is a great thing and really to find some things to do with your spouse again or your partner to kind of change your relationship. It's an opportunity, your last opportunity. So it's a great thing to do. But I think also, I am also looking at some community activities that I can get involved with where I will have a bigger array of patients, I mean patients, bigger array of people that I deal with other than the folks I live around who are all, you know, like me. Yeah. Yeah. Yeah, so one thing Karen and I always did was travel a fair amount. And that's actually one thing a solo practice allowed me to do. She retired 12, 13 years ago, but she'd been busier than ever in doing nonprofit administration and all sorts of stuff. But she was able to travel too. Well, since I retired, we've been traveling an awful lot more. Even during COVID, we traveled quite a bit. For us, that's a huge thing. We're gone on probably nine or 10 trips a year and big ones. And so that's been a thing. I have started my Romeo Club, which is retired old men eating out. So I'll go out with buddies, usually just one at a time and just chat about stuff. I'm reading an awful lot more. I love reading. So I'm reading an awful lot more. I also putz around the garden a lot. Karen wants to get rid of this house. It's way too big for us, but I still like putzing around, so I do. Yeah, so you'll find things to fill your day. You guys will too, once you're more retired. Yeah. It is amazing how you can go through a day almost without thinking of medicine at all, with a lot of different things that go on. So- And I'm not sure why, but I still read the journals. I do too, I read everything. Yeah, I mean, several different sources. Can't say that I know why I do that. I still have my license. But- Just in case. Just in case. Like someone just put in the chat that their wound physician, the retired age 72 and was back at work after the weekend. That's not gonna be me. Yeah. And of course- We have another great question here for the group. If you could rewind the clock 10 to 15 years, what, if anything, would you have done differently? I would have had grandkids sooner. Unfortunately, that wasn't quite my choice. But yeah, Kathy alluded to this. If you happen to have children, just make sure that you have grandkids. I mean, there's nothing. But in the practice, I would have done nothing different. Me, absolutely nothing. That's funny. Grandkids is a game changer. They're just something special and changes your whole look on life. I'm not sure I would have done anything special other than kind of trying to start that succession planning in my job a little bit earlier. And there's many things that got in the way of that from time and finances and people and everything else. And I think I accomplished that more over the last five years than 10 or 15 years ago. I think that I would have maybe had the confidence in myself to make some changes a little earlier or start this planning a little earlier than I did, perhaps. I have always dealt with imposter syndrome throughout my entire career. And it certainly had still there. So I think that in retrospect, that would have been something. I think I've been able to hold on to enough. We also love to travel. So we've managed to keep some traveling up even through the peak of my career, which has been great. And so we're going to be doing that. But right now, I guess we're in the throes of kind of being an old married couple, which we haven't gotten the chance to do that yet. So part of it is we're just being old geezers, I guess, and kind of enjoying puttering and bake. I love to bake. I love to cook. And I haven't cooked or baked since I became the chair. I mean, just didn't do it. So now I'm kind of back to it. I've gained a few pounds. So I think I might have thought about all of this a little earlier. And like I said, it's become a real interest of mine of this kind of whole career development and how just like there's a developmental stage for individual development, there is for your career as well. And it's something to start thinking to be aware of and be cognizant of. It's not the initial you need to do anything, but it's a good thing to step back periodically and either by yourself or with some sort of a career coach or something and say, this is where I am. Where do I wanna go? Am I happy with where I am? So be kind of directional about it, I think rather than sort of letting things happen. There's a question here in terms of how much should you have in your retirement, in terms of how many dollars? And the first thing to think about, and again, ahead of time, is what do you think your life will look like? If you're planning on traveling as much as Karen and I do, I think it's a lot of money. How about inheritance? If you have kids or others you wanna leave money to, and then whatever that turns out to be, you won't come up with an exact number. You probably will spend a little less money as years go by as you get older and older, especially on the travel side of things. But to have a ballpark figure, what's your budget gonna be, estimate. And then go back to what Kathy had said, which is very basic and very important information. 4% to 5% of your corpus is about what you can spend every year to keep the corpus intact. You don't necessarily need to keep the corpus intact if it's gonna shrink bit by bit, but you don't wanna be spending 10% of it every year, obviously, or even 8%. So you need to have some idea of what you're spending money on once you retire. The things that were in that slide of Kathy's, maybe you won't have a mortgage anymore. We haven't had one for over a decade. Maybe you won't have school supplies to buy for kids. Maybe you've already paid for whatever you're gonna pay by then for college and maybe grad school for your kids, et cetera. So you need to have some general ballpark feel of what your budget's gonna be like. And that's gonna be different for everybody, right? Because hopefully, God willing, if you have children, your children are independent and doing okay, but sometimes that's not the case. And again, grandchildren, I mean, what do you wanna be able to, again, as Peter said, grandchildren are a game changer. What is it that you want for your grandchildren? What do you want for your community? I mean, do you have philanthropic goals? We haven't talked about that a lot, but if there's something very meaningful to you, your family, you might wanna make sure that you're building in something for that philanthropic goal to, again, give back in a meaningful way. And make sure you do talk to somebody, a tax advisor or a financial advisor, that would be more like a tax advisor. So we have a small foundation, the two of us, from which we do all our philanthropic giving. And we have, and there's some tax advantages doing it certain ways. And the same with our, so far, three grandkids putting money aside for their college, which at this point, we're more able to than their parents are. But again, there are ways to do that that are more tax advantageous. Yeah, yeah. So you really, you need to be serious about sitting down with people. And I don't know many people that can do this on their own. Maybe Steve's wife is about the only person I know who could do this. Yeah, she's smart enough to, but you know what? As much as anything, it was the time and the stress checking things all the time and didn't wanna do it. I absolutely, totally agreed with her. Well, we have just about five more minutes left in the hour and I'm seeing some great questions, but I'll just ask kind of a two-part question. This person says, I'm mid-career and have, and I've never had a mentor. Is it too late to get a mentor? How do you go about, how do you find a career mentor? And then, you know, closing out, I'll also just ask, you know, how are you staying involved in the PM and our community? And do you have any great areas or resources you'd like to share with the group? I volunteer, Peter, for you to be anybody's mentor. Yeah, never too late to have a mentor. You can always benefit from mentorship. And I think the Academy may have something, I know the AAP has a mentorship program I've been involved in too. And so through national organizations can do that or your peers or people that you work with. You know, if there's somebody that you really want to talk to, ask them. You know, we look at people sometimes, oh, they wouldn't want to talk to me. Well, people are generally very flattered, actually, if you ask them. And, you know, you might, if there's somebody that you think you want to talk to, whoever that might be, you know, ask them, can I have an hour of your time to kind of talk about some thoughts I have with my career planning? And I cannot imagine that most people will say no. And it's, you know, the problem with those programs are they kind of match people up. And sometimes that works, but mostly it works when you know yourself and you have, you know, your questions and you can maybe choose a little better. But don't be afraid of asking. I will double down on that, Kathy. Over the decades, I've learned that, you know, when people are a little skittish about asking, in this case, you know, mentorship, but whatever it might be, something that seems like it's, you know, encroaching, for the most part, whoever you're asking is going to be delighted to say yes, unless they're, you know, for some reason, some kind of curmudgeon. And that can, even an initial contact can then turn into that. Or I happen to have two young women right now, one of whom is already in practice in PM&R. Good friends of ours, their daughter, he's a cardiologist, she's a dentist, but she thought about PM&R. I had lunch with her several times before she was even applying to residencies, but she's in PM&R now here in Ann Arbor. And another one, a gal that I worked with at Wayne, her daughter was in the service and wanted to think about PM&R. And right now she's starting her PM&R at Walter Reed. And those two, I think will, it'll be an ongoing mentorship type of thing. And it's delightful to see young people like that. You can incidentally also look for a coach. So that's another thing that you can do is you can get a professional coach. And so, you know, if you're, I know that the American Medical Women's Association, they have professional coaches. I know other organizations also have professional coaches. So that, and at one point in my career, I did have a professional coach for at least, I don't know, six or seven meetings just to kind of talk about things. Or somebody who, you know, I wasn't connected to. And so there's that also. Yeah, if you don't have a specific person in mind, maybe a good place to start would be the communities within the academy. Aren't there like five or 50 different communities now? And whether it's based on ethnicity, based on political interest, a certain procedure, that might be a place to find somebody. There's a name you recognize because they published or because they've spoken, you've heard them speak. And yeah, like Kathy said, just give them an email and wouldn't be surprised if they say sure. So, you know, staying involved in the PM&R community, I mean, I'm still involved with academy efforts in a variety of things. We're working on leadership and directorship courses and stuff about concussion. And, you know, just helping out wherever I can. I interview medical students, applicants as well, which is just delightful, absolutely delightful. And I get my reading list kind of filled out for the rest of the year by asking what they're reading. And so that's great. So, you know, I think there've been a lot of opportunities with the organizations to volunteer a little bit and stay up with all the young folks. So I don't know if our emails have been published otherwise. Brian put mine up there when I said to people, if you have specific questions not related to retirement, feel free to email me. But if we're out of time here, I'm happy to stay on. But if we're out of time, if anybody could email me about any questions they might have, feel free. Yep, likewise, yeah. In here. That would be great. So what we can do is save the chat from the recording so we can refer back to any questions. And I'm happy to share that with you so we can share that with the group as well. But we just wanna thank you so much for your time and your expertise. And we truly, truly appreciate it. Thank you so much. This was fun. Thank you. Everyone take care. Have a good evening. Thank you so much. Have a great evening.

retirement planning

physicians

early retirement

succession planning

financial considerations

transitioning into retirement

finding purpose

mentorship

professional coaches