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Retirement from orthodontics: Financial and psychosocial preparation and adaptation
ORIGINAL ARTICLE Retirement from orthodontics: Financial and psychosocial preparation and adaptation R. William McNeill, DDS, MSa Mammoth Lakes, Calif Retired members of the Pacific Coast Society of Orthodontists (n = 231) were surveyed with respect to their financial and psychosocial preparation for, and adaptation to, retirement. Statistical and subjective evaluation of the survey results established that the respondents used a variety of strategies in divesting themselves of their practices and other aspects of professional life. The respondents reported a relatively high level of accumulated wealth and general satisfaction with retirement as a result of a sense of financial security as well as continued active participation in diverse recreational, social, avocational, business, family, and community activities. Early anticipation of and planning for all aspects of the retirement experience enhanced the likelihood of a satisfactory outcome. (Am J Orthod Dentofacial Orthop 1999;115:283-7)
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or the older orthodontist, the transition to retirement has the potential to be one of life’s great challenges. It requires careful planning and a high level of adaptation to altered circumstances in virtually every aspect of life. Professional exposure is reduced. Earning power becomes largely passive. There is more time available for leisure activities than ever before. There is less structure imposed by work-related obligations, and many new personal choices to be made. In order to document the variety of ways in which this transition has been accomplished by diverse orthodontists, a survey of retired members of the Pacific Coast Society of Orthodontists (PCSO) was undertaken. In reporting the results of this survey, the objective is to provide active orthodontists with information that will aid them in planning their own retirement. SURVEY METHOD
A questionnaire, designed to explore a broad range of issues surrounding retirement, was mailed to members of the PCSO listed as retired in the 1995 American Association of Orthodontists Membership Directory (n = 432). Of these, 231 (53%) returned completed questionnaires. Thus the respondents represent a volunteer sample from the universe of all retired PCSO members. Basic demographic information, as well as data regarding preretirement and postretirement financial and psychosocial parameters were tabulated and evaluated staThis study was done in collaboration with H. Asuman Kiyak, PhD, Director, University of Washington Institute on Aging, Seattle, Wash. aRetired Professor, University of Washington, Department of Orthodontics. Reprint requests to: R. William McNeill, DDS, MS, PO Box 1477, Mammoth Lakes, CA 93546; e-mail: [email protected] Copyright © 1999 by the American Association of Orthodontists. 0889-5406/99/$8.00 + 0 8/1/90174
tistically by means of Chi-square tests, correlation coefficients, and analysis of variance. Because respondents were encouraged to give written answers to a number of open-ended questions, there was, in addition, a substantial yield of information that could be evaluated and reported only by subjective means. RESULTS Demographics
Of the 231 respondents, 227 were men and 4 women. Mean age of the subjects was 69.7 (range, 41 to 95) years; mean age of retirement was 62 (range, 38 to 85) years. Solo private practice was the predominant mode of work before retirement; 86.1% reported this. Smaller sample segments were in group or partnership private practice (11.7%) or had institutional careers (2.2%). The reason for retiring most frequently cited by the respondents (35.4%) was the desire for time to pursue a hobby, avocation, or other nonprofessional interest. A substantial segment of the sample (18.1%) cited a declining interest in orthodontics; another 17.7% were forced into retirement by illness or disability; and 5.8% left practice to pursue nonorthodontic business opportunities. A surprising number of the respondents stayed in the same community in which they lived before retirement (71.7%). Most (80.7%) reported that they were currently living in communities with a population of less than 500,000; the largest single group (30.3%) was in communities with a population between 25,000 and 100,000. Practice Disposal
Among noninstitutional retirees, 72.8% reported having sold their practices at a mean sale price of 65% 283
284 McNeill
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A
B Fig 1. Income sources in retirement: (A) orthodontists; (B)general population. (From American Association of Retired People. A profile of older Americans, 1994. Washington, DC, 1994.)
(range, 7% to 200%) of annual gross income. Another 15.8% tapered off and terminated their practices, whereas 8.8% turned their practices over to an associate or to a family member. There was a significant relationship between age at retirement and mode of practice transfer (F = 12.01, P < .0001) with those in the latter two groups being older (68.4 years and 67.6 years, respectively) than those who sold their practices (60.2 years). The majority of buyers (52%) were known personally by the seller before the transition, and 14.8% were identified through graduate orthodontic programs. Almost half (49.7%) of the respondents reported financing the buyout through a combination of down payment and a note held by the seller; 19% of sellers carried a note for the entire purchase price, whereas 20.9% were cashed out at transition. Financial Preparation and Adaptation
One of the most common subjective comments made by respondents addressed the important role that advance financial planning plays in a successful transition to retirement. Almost half (49.8%) of the subjects reported preretirement net worth between $1 million and $3 million. Another 35.4% had a net worth less than and 14.8% greater than the above. The level of net worth was found to be significantly higher for respondents who retired to pursue other business interests than for those who retired because of disability or declining interest in orthodontics (χ2 = 37.6, P < .05). Likewise, net worth was significantly higher in those who sold than in those who tapered off and terminated
their practices (χ2 = 30.8, P < .01). For most respondents postretirement income was derived from a variety of sources (Fig 1A) and was characterized by 91.6% of respondents as being adequate for their needs. As might be expected, distribution of retired orthodontists’ income sources differs substantially from that of the general population (Fig 1B). Judgment by the retired orthodontists of the adequacy/inadequacy of their postretirement income was not significantly related to net worth. Even those who retired because of disability and declining interest in orthodontics, and as a group reported the lowest level of net worth, perceived their income to be adequate. Those with the highest net worth at the time of retirement reported deriving the greatest percentage of their postretirement income from active, as opposed to passive, sources (F = 3.53, P < .008). A small number (5.3%) of orthodontists were forced to curtail spending primarily due to lower than anticipated investment returns or ill-advised investment decisions, but most (63.1%) respondents had sufficient income to enable maintenance of their preretirement lifestyle. Smaller segments of the sample were either able to spend more freely after than prior to retirement (15.6%) or chose to curtail spending (16%) in their retirement years. As might be expected, those with lower net worth were most likely to curtail postretirement spending (χ2 = 29.7, P < .01). Subjects forced into retirement because of illness or disability more commonly maintained or curtailed spending, while the respondents most likely to increase spending were
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Fig 2. Aspects of professional life missed by retired orthodontists.
those who chose to retire in pursuit of other interests (χ2=28.1, P < .002). Reliance on sheltered and nonsheltered savings and investments as principal (53.1%) income sources is in sharp contrast to the small portion of income derived from the proceeds of practice sale (6.7%). That the latter serves as a source only in the early years of retirement is supported by the observation that longer term retirees are less likely to be dependent on it ® = –.26, P < .0002) and more likely to be supported by preretirement savings and investments ® = .18, P < .01). Respondents reported that they had sought information and advice about retirement strategies from a variety of sources, with 70% naming personal advisors (attorney, accountant, financial advisor), 39% their spouses, and 49% previously retired friends, relatives, and orthodontic colleagues. It is of interest that only small numbers of respondents relied on retirement organizations such as AARP (6%) or on the American Association of Orthodontists (7.5%) for retirement advice. Postretirement Professional Involvement
An overwhelming majority (66.1%) of retired orthodontists reported having no active interest or participation in professional matters, whereas the balance of the sample continue to attend meetings, participate in study clubs or remain active in specialty organizations. Because it might be assumed that those who did not respond to the survey were most likely those who had the least interest in professional matters, this percentage might be considerably higher in the retired orthodontist population at large. More than half (54%) of respondents maintain a relationship with their former practice either through casual contact or by their successors seeking their counsel. A small number (8.1%) of retirees indicated they would prefer to have maintained some role in their former practices, but their successors declined their participation. The
remaining 37.5% chose to have no practice connection after the transition in ownership. Those with no ongoing involvement with their practice successor were also most disengaged from other professional activities (χ2 = 25.1, P < .003). Emotional Preparation and Adaptation
The great majority (88.9%) of respondents indicated that their emotional accommodation to retirement was easily accomplished. Those who retired to pursue an avocation or other business interest adapted most easily while those who retired due to illness or disability had the most difficult emotional transition (χ2 = 22.2, P < .001). More than half (55.2%) reported that their ability to contribute to the well-being of others remained about the same as before retirement; 37.2% found it more difficult. A majority (50.9%) have achieved this sense of contribution as community, religious, and service organization volunteers, 14.4% as formal or informal mentors, and 33% through family involvement. Subjects with high levels of savings and investment income were more likely to be well adapted emotionally than those who were less financially secure (F = 4.52, P < .04). Although not statistically significant, the retirees with the highest percentage of income derived from active sources had a tendency to higher levels of emotional adaptation (F = 3.27, P < .07). When asked to quantify the degree to which they missed various aspects of professional life, respondents rated personal contact with patients and collegial relationships as most missed, and business and staff management and practice promotion as least missed (Fig 2) (Table I). Respondents who had been retired longer were least likely to miss their former earning power (F = 3.26, P < .01) and the clinical challenge of patient care (F = 2.36, P < .06). No significant relationship was noted between years retired and the other tested aspects of professional life. Those who reported having the greatest difficulty with emotional adaptation
286 McNeill
Table I. Quotes
American Journal of Orthodontics and Dentofacial Orthopedics March 1999
from retirees
• Be prepared to have your insignificance validated. Know yourself and what is important to you; the yin and yang of retirement is no different from any other pursuit. Kick back and enjoy it. To hell with other people’s values! George Newton, Kailua, Hawaii • Think carefully about your feelings of self-worth and the extent to which they come from your own understanding and appreciation of yourself versus the need to see yourself reflected favorably in the eyes of others. The latter can result in some negative feelings after retirement and the loss of professional prestige. Merritt Major, Tracyton, Washington • The greatest sense of loss I have experienced could not have been prevented by any type of planning. I miss the patient and parent contact, the community sense of prestige, the sense of daily accomplishment, and all of those intangibles that are associated with conducting a successful practice. I don’t think this can be anticipated and planned for. Bob Campbell, Stockton, California
were most likely to miss personal contact with patients (χ2 = 14.3, P < .006), the challenge of clinical patient management (χ2 = 13.5, P < .01), practice promotion (χ2 = 2.8, P < .001), and prestige and community recognition (χ2 = 22.7, P < .001). Adaptation to retirement was easiest for those who least missed their earning power (χ2 = 26.8, P < .001). Timing of Retirement
Most of the respondents (76.1%) and their spouses (85.6%) reported feeling that the decision to retire had come at the right time. Fully 29.7% of spouses have had a career outside the home from which he or she is also retired; a relatively high (15.8%) number of spouses continue in a career after retirement of the orthodontist spouse. The group of retirees who reported difficulty in achieving a sense of contribution to others’ well-being were most likely to wish they had retired later while those who contributed at the same level were generally satisfied with the timing of their retirement (χ2 = 11.2, P < .02). Supporting evidence from other retirement studies, we found that respondents who indicated they should have deferred retirement were most likely to feel that their postretirement income is inadequate for their needs (χ2 = 9.7, P < .008) and that their emotional adaptation to retirement has been difficult (χ2 = 50.5, P < .001). Postretirement Activities
In their open-ended comments, many respondents indicated that the freedom from a structured schedule
was the best part of retirement because it afforded flexibility to pursue leisure activities in a way that was not possible while working. They cited participation in a wide range of recreational, business, intellectual, and avocational pursuits in their retirement years. Travel was noted with the highest frequency (32%), while involvement in nonorthodontic business interests and investment management was the second most prevalent (31%), followed by golf (27%) and skiing (16%). As noted above, retirees also rate volunteer work, mentoring, and family involvement as important sources of satisfaction. A substantial number of respondents (11.2%) have embarked on second careers including the ministry, law, real estate development, financial planning, investment brokering, ranching/farming, interstate trucking, charter sailboat skippering, television acting, and timber hauling. DISCUSSION
Advances in modern medicine and a whole range of healthier life choices continue to result in increased human longevity. Over recent generations, the span of years spent in retirement has been greatly extended so that persons retiring now or in the future may enjoy as many or more years after closure of their professional life as they did during their careers. The broad range of responses to this survey is indicative of the variety of experiences retired orthodontists have in transitioning from an active career to retirement. It can be fairly concluded from both the objective and subjective data that orthodontists generally accomplish this transition successfully, and their years of retirement are satisfying and fulfilling. There seems to be an extension into retirement of the generally high level of selfworth, self-esteem, and security that orthodontists enjoy during their practice years. To be sure, there are those who suffer an element of identity crisis as they no longer command the status, prestige, and recognition that is bestowed almost automatically on health care professionals. However, the high level of satisfaction among retired orthodontists, in spite of the strong tendency for them to completely disengage from professional involvement, in all probability indicates that their preretirement identity is broad based. This is further supported by the fact that their retirement years tend to be active ones with the former orthodontists either continuing to participate in recreational, avocational, and voluntary service activities that they enjoyed before retirement, or in many instances pursuing entirely new interests or carving out a second career. Such efforts extend the sense of personal competence and productivity that are a significant part of the career experience, provide a milieu in which new
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goals can be set and met, and imbue life with an all important element of challenge.1 The complex nature of orthodontic practice with its requirement for a broad range of mechanical, biologic, managerial, communication, and interpersonal competencies ultimately serves the retiree well. Orthodontists invariably have a rich reservoir of experience to apply to new endeavors or to fuel the expansion of preexisting ones in contrast to those individuals retiring from careers that require less responsibility or are more circumscribed in their demands.2 In addition, the freedom afforded by self-employment and the relative affluence enjoyed by orthodontists makes it feasible for them to “practice” at retirement during their working years by pursuing a variety of nonprofessional interests. A high degree of financial security is clearly central to the successful retirement transition. That orthodontists enjoy levels of income and accumulated wealth that places them in the upper echelons of the general population is no small factor in their successful adaptation to retirement.2 And yet, in concert with the concept of relative deprivation, retirees accommodate to their asset level irrespective of net worth. The orthodontists for whom adaptation to and satisfaction with retirement were most problematic were those forced into retirement by illness or disability before having had an opportunity to adequately prepare emotionally or financially. In their written comments, these individuals universally expressed frustration with their circumstances. They emphasized the importance of considering the possibility of incapacitation by carrying appropriate disability insurance coverage and by early wealth accumulation through systematic savings, elimination of debt, and conservative spending. Involuntary retirees often bear the additional burden of an abrupt career termination that denies them the sequential separation most often chosen by voluntary retirees. The usual period of associateship before and after practice transition not only offers the new orthodontist a scaled introduction to the demands of proprietorship but allows the prospective retiree to gradually reduce active earning power, to test various retirement strategies, and to sample the inevitable life style changes on a part-time basis. Adaptation is most likely further enhanced if retirement is viewed as a process rather than as an event.3 Many of the survey respondents qualified their expression of satisfaction by noting that in the early stages of retirement its positive aspects were compromised by feelings of inadequacy, purposelessness, boredom, and frustration, and that some time and considerable effort were required
Table II. Suggestions
from survey to assist orthodontists to plan their own retirement • Start retirement planning early and seek sound investment and savings advice. • Don’t succumb to inactivity; stay busy with a variety of interests. • Be cautious in selection of a practice successor, particularly if postretirement income is to be derived by installment payments on the practice sale or you are committed to an ongoing relationship. • Be well prepared mentally, physically, economically, and emotionally before retiring. • Control spending and be debt free as early as possible in order to assure the building of adequate wealth.
before a new balance was achieved. The continuity theory of aging holds that patterns established in one stage of life tend to be carried over into subsequent stages. Thus, it is probable that in general the relative degree of satisfaction with retirement among these respondents is reflective of their life satisfaction before the transition.4,5 CONCLUSION
This study establishes that orthodontists approach retirement in diverse ways (Table II), but from the perspective of both financial security and psychosocial well-being, they generally experience a satisfactory transition out of their professional lives. The survey results substantiate that the probability of a successful retirement can be enhanced by financial planning that protects against the exigencies of disability and ensures adequate wealth accumulation, by emotional preparation that anticipates the change in public and professional status of the retiree, and by involvement in diverse activities that provide for ongoing mental and physical vitality. Recognition of the importance of these factors and early incorporation of them into individual and family life styles offer the orthodontist the opportunity for gratification and fulfillment well beyond the years of active professional life. REFERENCES 1. Jackson JB, Kart CS, Wagner KS, Rowe AR. A survey of retired dentists in the United States. J Am Dent Assoc 1984;201:151-4. 2. Hooyman N, Kiyak HA. Social gerontology, 4th edition. Needham Hts, MA: Allyn and Bacon; 1996. 3. Schultz R, Ewan, R. Adult development and aging, Chap 9, work and retirement. New York: Macmillan; 1992. 4. Neugarten B, Havighirst RJ, Tobin SS. Personality and patterns of aging. In: Neugarten BL, editor. Middle age and aging. Chicago: University of Chicago Press; 1968. p. 173-7. 5. Atchley RC. A continuity theory of normal aging. The Gerontologist 1989;29:183-90.
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or the older orthodontist, the transition to retirement has the potential to be one of life’s great challenges. It requires careful planning and a high level of adaptation to altered circumstances in virtually every aspect of life. Professional exposure is reduced. Earning power becomes largely passive. There is more time available for leisure activities than ever before. There is less structure imposed by work-related obligations, and many new personal choices to be made. In order to document the variety of ways in which this transition has been accomplished by diverse orthodontists, a survey of retired members of the Pacific Coast Society of Orthodontists (PCSO) was undertaken. In reporting the results of this survey, the objective is to provide active orthodontists with information that will aid them in planning their own retirement. SURVEY METHOD
A questionnaire, designed to explore a broad range of issues surrounding retirement, was mailed to members of the PCSO listed as retired in the 1995 American Association of Orthodontists Membership Directory (n = 432). Of these, 231 (53%) returned completed questionnaires. Thus the respondents represent a volunteer sample from the universe of all retired PCSO members. Basic demographic information, as well as data regarding preretirement and postretirement financial and psychosocial parameters were tabulated and evaluated staThis study was done in collaboration with H. Asuman Kiyak, PhD, Director, University of Washington Institute on Aging, Seattle, Wash. aRetired Professor, University of Washington, Department of Orthodontics. Reprint requests to: R. William McNeill, DDS, MS, PO Box 1477, Mammoth Lakes, CA 93546; e-mail: [email protected] Copyright © 1999 by the American Association of Orthodontists. 0889-5406/99/$8.00 + 0 8/1/90174
tistically by means of Chi-square tests, correlation coefficients, and analysis of variance. Because respondents were encouraged to give written answers to a number of open-ended questions, there was, in addition, a substantial yield of information that could be evaluated and reported only by subjective means. RESULTS Demographics
Of the 231 respondents, 227 were men and 4 women. Mean age of the subjects was 69.7 (range, 41 to 95) years; mean age of retirement was 62 (range, 38 to 85) years. Solo private practice was the predominant mode of work before retirement; 86.1% reported this. Smaller sample segments were in group or partnership private practice (11.7%) or had institutional careers (2.2%). The reason for retiring most frequently cited by the respondents (35.4%) was the desire for time to pursue a hobby, avocation, or other nonprofessional interest. A substantial segment of the sample (18.1%) cited a declining interest in orthodontics; another 17.7% were forced into retirement by illness or disability; and 5.8% left practice to pursue nonorthodontic business opportunities. A surprising number of the respondents stayed in the same community in which they lived before retirement (71.7%). Most (80.7%) reported that they were currently living in communities with a population of less than 500,000; the largest single group (30.3%) was in communities with a population between 25,000 and 100,000. Practice Disposal
Among noninstitutional retirees, 72.8% reported having sold their practices at a mean sale price of 65% 283
284 McNeill
American Journal of Orthodontics and Dentofacial Orthopedics March 1999
A
B Fig 1. Income sources in retirement: (A) orthodontists; (B)general population. (From American Association of Retired People. A profile of older Americans, 1994. Washington, DC, 1994.)
(range, 7% to 200%) of annual gross income. Another 15.8% tapered off and terminated their practices, whereas 8.8% turned their practices over to an associate or to a family member. There was a significant relationship between age at retirement and mode of practice transfer (F = 12.01, P < .0001) with those in the latter two groups being older (68.4 years and 67.6 years, respectively) than those who sold their practices (60.2 years). The majority of buyers (52%) were known personally by the seller before the transition, and 14.8% were identified through graduate orthodontic programs. Almost half (49.7%) of the respondents reported financing the buyout through a combination of down payment and a note held by the seller; 19% of sellers carried a note for the entire purchase price, whereas 20.9% were cashed out at transition. Financial Preparation and Adaptation
One of the most common subjective comments made by respondents addressed the important role that advance financial planning plays in a successful transition to retirement. Almost half (49.8%) of the subjects reported preretirement net worth between $1 million and $3 million. Another 35.4% had a net worth less than and 14.8% greater than the above. The level of net worth was found to be significantly higher for respondents who retired to pursue other business interests than for those who retired because of disability or declining interest in orthodontics (χ2 = 37.6, P < .05). Likewise, net worth was significantly higher in those who sold than in those who tapered off and terminated
their practices (χ2 = 30.8, P < .01). For most respondents postretirement income was derived from a variety of sources (Fig 1A) and was characterized by 91.6% of respondents as being adequate for their needs. As might be expected, distribution of retired orthodontists’ income sources differs substantially from that of the general population (Fig 1B). Judgment by the retired orthodontists of the adequacy/inadequacy of their postretirement income was not significantly related to net worth. Even those who retired because of disability and declining interest in orthodontics, and as a group reported the lowest level of net worth, perceived their income to be adequate. Those with the highest net worth at the time of retirement reported deriving the greatest percentage of their postretirement income from active, as opposed to passive, sources (F = 3.53, P < .008). A small number (5.3%) of orthodontists were forced to curtail spending primarily due to lower than anticipated investment returns or ill-advised investment decisions, but most (63.1%) respondents had sufficient income to enable maintenance of their preretirement lifestyle. Smaller segments of the sample were either able to spend more freely after than prior to retirement (15.6%) or chose to curtail spending (16%) in their retirement years. As might be expected, those with lower net worth were most likely to curtail postretirement spending (χ2 = 29.7, P < .01). Subjects forced into retirement because of illness or disability more commonly maintained or curtailed spending, while the respondents most likely to increase spending were
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Fig 2. Aspects of professional life missed by retired orthodontists.
those who chose to retire in pursuit of other interests (χ2=28.1, P < .002). Reliance on sheltered and nonsheltered savings and investments as principal (53.1%) income sources is in sharp contrast to the small portion of income derived from the proceeds of practice sale (6.7%). That the latter serves as a source only in the early years of retirement is supported by the observation that longer term retirees are less likely to be dependent on it ® = –.26, P < .0002) and more likely to be supported by preretirement savings and investments ® = .18, P < .01). Respondents reported that they had sought information and advice about retirement strategies from a variety of sources, with 70% naming personal advisors (attorney, accountant, financial advisor), 39% their spouses, and 49% previously retired friends, relatives, and orthodontic colleagues. It is of interest that only small numbers of respondents relied on retirement organizations such as AARP (6%) or on the American Association of Orthodontists (7.5%) for retirement advice. Postretirement Professional Involvement
An overwhelming majority (66.1%) of retired orthodontists reported having no active interest or participation in professional matters, whereas the balance of the sample continue to attend meetings, participate in study clubs or remain active in specialty organizations. Because it might be assumed that those who did not respond to the survey were most likely those who had the least interest in professional matters, this percentage might be considerably higher in the retired orthodontist population at large. More than half (54%) of respondents maintain a relationship with their former practice either through casual contact or by their successors seeking their counsel. A small number (8.1%) of retirees indicated they would prefer to have maintained some role in their former practices, but their successors declined their participation. The
remaining 37.5% chose to have no practice connection after the transition in ownership. Those with no ongoing involvement with their practice successor were also most disengaged from other professional activities (χ2 = 25.1, P < .003). Emotional Preparation and Adaptation
The great majority (88.9%) of respondents indicated that their emotional accommodation to retirement was easily accomplished. Those who retired to pursue an avocation or other business interest adapted most easily while those who retired due to illness or disability had the most difficult emotional transition (χ2 = 22.2, P < .001). More than half (55.2%) reported that their ability to contribute to the well-being of others remained about the same as before retirement; 37.2% found it more difficult. A majority (50.9%) have achieved this sense of contribution as community, religious, and service organization volunteers, 14.4% as formal or informal mentors, and 33% through family involvement. Subjects with high levels of savings and investment income were more likely to be well adapted emotionally than those who were less financially secure (F = 4.52, P < .04). Although not statistically significant, the retirees with the highest percentage of income derived from active sources had a tendency to higher levels of emotional adaptation (F = 3.27, P < .07). When asked to quantify the degree to which they missed various aspects of professional life, respondents rated personal contact with patients and collegial relationships as most missed, and business and staff management and practice promotion as least missed (Fig 2) (Table I). Respondents who had been retired longer were least likely to miss their former earning power (F = 3.26, P < .01) and the clinical challenge of patient care (F = 2.36, P < .06). No significant relationship was noted between years retired and the other tested aspects of professional life. Those who reported having the greatest difficulty with emotional adaptation
286 McNeill
Table I. Quotes
American Journal of Orthodontics and Dentofacial Orthopedics March 1999
from retirees
• Be prepared to have your insignificance validated. Know yourself and what is important to you; the yin and yang of retirement is no different from any other pursuit. Kick back and enjoy it. To hell with other people’s values! George Newton, Kailua, Hawaii • Think carefully about your feelings of self-worth and the extent to which they come from your own understanding and appreciation of yourself versus the need to see yourself reflected favorably in the eyes of others. The latter can result in some negative feelings after retirement and the loss of professional prestige. Merritt Major, Tracyton, Washington • The greatest sense of loss I have experienced could not have been prevented by any type of planning. I miss the patient and parent contact, the community sense of prestige, the sense of daily accomplishment, and all of those intangibles that are associated with conducting a successful practice. I don’t think this can be anticipated and planned for. Bob Campbell, Stockton, California
were most likely to miss personal contact with patients (χ2 = 14.3, P < .006), the challenge of clinical patient management (χ2 = 13.5, P < .01), practice promotion (χ2 = 2.8, P < .001), and prestige and community recognition (χ2 = 22.7, P < .001). Adaptation to retirement was easiest for those who least missed their earning power (χ2 = 26.8, P < .001). Timing of Retirement
Most of the respondents (76.1%) and their spouses (85.6%) reported feeling that the decision to retire had come at the right time. Fully 29.7% of spouses have had a career outside the home from which he or she is also retired; a relatively high (15.8%) number of spouses continue in a career after retirement of the orthodontist spouse. The group of retirees who reported difficulty in achieving a sense of contribution to others’ well-being were most likely to wish they had retired later while those who contributed at the same level were generally satisfied with the timing of their retirement (χ2 = 11.2, P < .02). Supporting evidence from other retirement studies, we found that respondents who indicated they should have deferred retirement were most likely to feel that their postretirement income is inadequate for their needs (χ2 = 9.7, P < .008) and that their emotional adaptation to retirement has been difficult (χ2 = 50.5, P < .001). Postretirement Activities
In their open-ended comments, many respondents indicated that the freedom from a structured schedule
was the best part of retirement because it afforded flexibility to pursue leisure activities in a way that was not possible while working. They cited participation in a wide range of recreational, business, intellectual, and avocational pursuits in their retirement years. Travel was noted with the highest frequency (32%), while involvement in nonorthodontic business interests and investment management was the second most prevalent (31%), followed by golf (27%) and skiing (16%). As noted above, retirees also rate volunteer work, mentoring, and family involvement as important sources of satisfaction. A substantial number of respondents (11.2%) have embarked on second careers including the ministry, law, real estate development, financial planning, investment brokering, ranching/farming, interstate trucking, charter sailboat skippering, television acting, and timber hauling. DISCUSSION
Advances in modern medicine and a whole range of healthier life choices continue to result in increased human longevity. Over recent generations, the span of years spent in retirement has been greatly extended so that persons retiring now or in the future may enjoy as many or more years after closure of their professional life as they did during their careers. The broad range of responses to this survey is indicative of the variety of experiences retired orthodontists have in transitioning from an active career to retirement. It can be fairly concluded from both the objective and subjective data that orthodontists generally accomplish this transition successfully, and their years of retirement are satisfying and fulfilling. There seems to be an extension into retirement of the generally high level of selfworth, self-esteem, and security that orthodontists enjoy during their practice years. To be sure, there are those who suffer an element of identity crisis as they no longer command the status, prestige, and recognition that is bestowed almost automatically on health care professionals. However, the high level of satisfaction among retired orthodontists, in spite of the strong tendency for them to completely disengage from professional involvement, in all probability indicates that their preretirement identity is broad based. This is further supported by the fact that their retirement years tend to be active ones with the former orthodontists either continuing to participate in recreational, avocational, and voluntary service activities that they enjoyed before retirement, or in many instances pursuing entirely new interests or carving out a second career. Such efforts extend the sense of personal competence and productivity that are a significant part of the career experience, provide a milieu in which new
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American Journal of Orthodontics and Dentofacial Orthopedics Volume 115, Number 3
goals can be set and met, and imbue life with an all important element of challenge.1 The complex nature of orthodontic practice with its requirement for a broad range of mechanical, biologic, managerial, communication, and interpersonal competencies ultimately serves the retiree well. Orthodontists invariably have a rich reservoir of experience to apply to new endeavors or to fuel the expansion of preexisting ones in contrast to those individuals retiring from careers that require less responsibility or are more circumscribed in their demands.2 In addition, the freedom afforded by self-employment and the relative affluence enjoyed by orthodontists makes it feasible for them to “practice” at retirement during their working years by pursuing a variety of nonprofessional interests. A high degree of financial security is clearly central to the successful retirement transition. That orthodontists enjoy levels of income and accumulated wealth that places them in the upper echelons of the general population is no small factor in their successful adaptation to retirement.2 And yet, in concert with the concept of relative deprivation, retirees accommodate to their asset level irrespective of net worth. The orthodontists for whom adaptation to and satisfaction with retirement were most problematic were those forced into retirement by illness or disability before having had an opportunity to adequately prepare emotionally or financially. In their written comments, these individuals universally expressed frustration with their circumstances. They emphasized the importance of considering the possibility of incapacitation by carrying appropriate disability insurance coverage and by early wealth accumulation through systematic savings, elimination of debt, and conservative spending. Involuntary retirees often bear the additional burden of an abrupt career termination that denies them the sequential separation most often chosen by voluntary retirees. The usual period of associateship before and after practice transition not only offers the new orthodontist a scaled introduction to the demands of proprietorship but allows the prospective retiree to gradually reduce active earning power, to test various retirement strategies, and to sample the inevitable life style changes on a part-time basis. Adaptation is most likely further enhanced if retirement is viewed as a process rather than as an event.3 Many of the survey respondents qualified their expression of satisfaction by noting that in the early stages of retirement its positive aspects were compromised by feelings of inadequacy, purposelessness, boredom, and frustration, and that some time and considerable effort were required
Table II. Suggestions
from survey to assist orthodontists to plan their own retirement • Start retirement planning early and seek sound investment and savings advice. • Don’t succumb to inactivity; stay busy with a variety of interests. • Be cautious in selection of a practice successor, particularly if postretirement income is to be derived by installment payments on the practice sale or you are committed to an ongoing relationship. • Be well prepared mentally, physically, economically, and emotionally before retiring. • Control spending and be debt free as early as possible in order to assure the building of adequate wealth.
before a new balance was achieved. The continuity theory of aging holds that patterns established in one stage of life tend to be carried over into subsequent stages. Thus, it is probable that in general the relative degree of satisfaction with retirement among these respondents is reflective of their life satisfaction before the transition.4,5 CONCLUSION
This study establishes that orthodontists approach retirement in diverse ways (Table II), but from the perspective of both financial security and psychosocial well-being, they generally experience a satisfactory transition out of their professional lives. The survey results substantiate that the probability of a successful retirement can be enhanced by financial planning that protects against the exigencies of disability and ensures adequate wealth accumulation, by emotional preparation that anticipates the change in public and professional status of the retiree, and by involvement in diverse activities that provide for ongoing mental and physical vitality. Recognition of the importance of these factors and early incorporation of them into individual and family life styles offer the orthodontist the opportunity for gratification and fulfillment well beyond the years of active professional life. REFERENCES 1. Jackson JB, Kart CS, Wagner KS, Rowe AR. A survey of retired dentists in the United States. J Am Dent Assoc 1984;201:151-4. 2. Hooyman N, Kiyak HA. Social gerontology, 4th edition. Needham Hts, MA: Allyn and Bacon; 1996. 3. Schultz R, Ewan, R. Adult development and aging, Chap 9, work and retirement. New York: Macmillan; 1992. 4. Neugarten B, Havighirst RJ, Tobin SS. Personality and patterns of aging. In: Neugarten BL, editor. Middle age and aging. Chicago: University of Chicago Press; 1968. p. 173-7. 5. Atchley RC. A continuity theory of normal aging. The Gerontologist 1989;29:183-90.