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Tips for the Aspiring Physician-Scientist

Jeanie Park, MD, Emory University School of Medicine, Atlanta, GA

For most physicians, the pathway to a career in science often appears ambiguous and uncertain. Although the trajectory to becoming a practicing clinician is clearly defined, with well-demarcated milestones such as passing the USMLE step exams and completing residency training, the path to becoming a physician-scientist is not clear-cut. In fact, most physicians are unaware of the steps involved in fashioning a career in scientific research or the rewards and challenges involved in such a pursuit. In addition, unless one has dual MD and PhD degrees, a physician without PhD training may feel like a “late bloomer” when pursuing a career in science and not adequately trained or prepared. We may feel that our PhD counterparts have been preparing for years throughout graduate school and postdoctoral fellowships for a research career, while we have been training for an entirely different type of career in clinical medicine and patient care. These and other obstacles have led to a relative dearth in the number of young physicians pursuing academic research careers. However, physicians may evolve into successful scientists with some planning and foresight, and enjoy fulfilling careers that combine scientific research with patient care and teaching.

What is a Physician-Scientist?

A physician-scientist is a practicing clinician who spends the bulk of his or her time doing research. Like their PhD counterparts, physician scientists conduct all types of biomedical research, including basic, translational, clinical, and population studies. Physician-scientists also engage in clinical activities, teaching, service, and administration. Unlike clinician-educators that usually spend a minority of their time pursuing scholarly activities, physician-scientists typically devote at least 50% or more of their time in research activities as a principal investigator funded by federal and foundation grants. Research activities include a variety of specific endeavors, with some variation depending on the type of research program. These include writing grants and papers, performing experiments, training students and research fellows, collaborating with other investigators, serving on study sections, and presenting at national meetings. Although physicians may have relatively less experience in these areas, such skills can be developed during fellowship and as a junior faculty member. In addition, physicians have unique perspectives and backgrounds, which include scientific and clinical expertise, both of which can be leveraged when competing for grants and establishing a research program. Physician-scientists identify clinically relevant questions at the bedside, study these questions in the laboratory, and then apply that knowledge back at the bedside.

Do You Have the Desire for an Academic Research Career?

Given our relatively late start as MDs, you may wonder whether you have what it takes to become a physician-scientist. Several resources list various qualities that are necessary to becoming a physician-scientist, including being hard-working, self-motivated with perseverance, capable of problem-solving and multi-tasking with the focus and ability to see things through to the end. I believe that, for the most part, physicians possess these intrinsic traits, since these are also the qualities necessary for surviving the rigors of medical school and clinical training. In my opinion, the essential ingredient necessary for success as a physician-scientist is the desire to pursue this career path, and the commitment to make it your goal. This commitment is crucial because it will ensure that you apply your skills and talents to establishing a scientific career with the same fervor that has made you successful thus far. This level of commitment is akin to the commitment made when completing medical school and residency; if one’s mindset was open to giving up and opting for an alternative career if things got rough, then many of us may have given up medicine during our internship when working long hours on call under sleep-deprived and stressful conditions. However, giving up was not an option. When this same level of commitment is applied to pursuing an academic research career, then you have an excellent chance of successfully establishing a fulfilling and rewarding career as a physician-scientist.

There are many advantages of a physician-scientist career that make it a very attractive career choice. I particularly value the variety of the work. On any given day, I may be treating outpatients in the clinic, conducting experiments in the lab, rounding on hospital patients with residents, discussing grant ideas with my postdoctoral fellow, attending a scientific meeting, etc. This type of variety allows me to use my creativity and exercise different parts of my brain in interesting and stimulating ways, as well as eliminate any threat of a mundane work life. Many physician-scientists also appreciate the constant learning and opportunity for advancement. After completing training and becoming an attending physician, some physicians are left with a sense of “what next,” which can lead to long-term job dissatisfaction. In academic medicine, there are constantly new goals to be met, and endless ways to grow and evolve. Flexibility and autonomy are also important factors that enhance job satisfaction. Not only are the work hours more flexible in general than in private practice, but the type of work, including the types of clinical activities and research endeavors, is also more flexible and under my control. These advantages lead to a deeply satisfying sense that I am contributing on multiple levels: directly to patients through clinical work, broadly to scientific knowledge through research, and to the education of future physicians and scientists through teaching.

There are also a number of disadvantages that should be considered when pursuing this pathway. The salary of a physician-scientist is lower than that of physicians in private practice, which can be worrisome for those with large amounts of student loans. However, programs such as the NIH loan repayment program help to decrease the burden by paying a substantial portion of medical school debt for physicians engaged in research. Second, a career as a physician-scientist requires a great deal of troubleshooting. Unlike the clinical training years, your career as a physician-scientist may not follow the trajectory and timetable that you have set in your mind. Technical problems will arise, experiments may not go as planned, grants may take multiple attempts to get funded, and papers will be rejected. This kind of uncertainty and rejection may be difficult to deal with given that physicians are accustomed to achieving each expected outcome within an expected timeframe. However, science does not tend to work this way. Troubleshooting and adaptability are part of the scientific process. In short, failure is an essential part of the journey toward success in this line of work.

Tips for Preparing for a Physician-Scientist Career

1) Choose Your Scientific Niche

For physicians, research training often begins late in the game during residency or clinical fellowship. Therefore, it is crucial to think long-term when choosing a research area. Choose an area that you are passionate about, while leveraging the resources and expertise at your given institution, as well as your own strengths and talents. Given our late start in scientific training, you want to avoid switching fields during or after fellowship, and establish a foundation for a continuous line of research. For example, I became interested in autonomic regulation and its role in the pathogenesis of high blood pressure and kidney disease during my Nephrology fellowship. I became passionate about human physiology research and felt that there was a critical gap in our understanding and approach to treatment in this area to which I could devote my career long-term while continuing to treat patients.

2) Seek Mentorship

There is a consensus that good mentorship is a critical component of research training that can determine success or failure. However, mentorship is not a passive process on the part of the mentee. The mentee is not a receptacle into which a mentor pours his or her wisdom and guides each step of the way. Rather, the mentee will gain more by being an active player in the mentor-mentee relationship. It is best to understand your training needs and then actively seek out mentors who can fulfill those deficits. To that end, it is difficult to find a single person who can fulfill all of your training needs; therefore, you may have separate mentors for your science, career development, work-life balance, etc. Therefore, your mentors may be outside of your division, department, or even institution. However, one common characteristic of your mentors should be an interest in seeing you succeed, and the ability to offer honest advice with your best interests at the forefront.

3) Write a Fellowship Grant

Having the experience of writing a grant during your fellowship training will be an invaluable asset during your first faculty position. Even if you are fortunate enough to be supported on an institutional training grant or have other guaranteed sources of funding, I would still highly recommend writing a fellowship grant. Why? The process of writing a grant allows you to formulate your short-term as well as your long-term objectives, and will serve as a useful springboard for your career development award application as a junior faculty member. Writing a fellowship grant will provide experience with formulating research aims and approach, grantsmanship and scientific writing, organization and submission process as the principal investigator, and responses to a summary statement. Submitting the first grant application is an arduous process with a steep learning curve; therefore, you do not want your first grant-writing experience to occur as a faculty member. Writing a fellowship grant will set you up for writing a much stronger career development award application as a faculty member.

4) Practice Independence

Practicing self-reliance during your training period will increase your likelihood of success when you are indeed independent. Although it may be easiest to go to your mentor with each problem or unexpected result, try your best to solve the issue initially as much as possible on your own. Doing so will improve your technical proficiency and troubleshooting abilities. Understand the nuts and bolts of every aspect of performing research, including IACUC or IRB process, data management, and safety monitoring. If possible, set up a lab or a new experimental protocol on your own. This experience will be invaluable when you start your first faculty job and need to set up your own lab. And importantly, don’t rush it. This training period is a golden opportunity to gain as much proficiency as possible before embarking on your own. As such, it is in your best interest to continue training until you feel sufficiently prepared to develop your own program.

5) Find the Right First Faculty Position

The criteria for determining the right first faculty position will depend on many factors, both professional and personal. For instance, you may be restricted to a certain city or state due to family reasons, or institutions with a specific patient population that you need for enrollment into your studies. There is not one single type of institution that will guarantee success, but rather many different institutions at which one has the potential to start a successful research career. What these institutions have in common is that the goals of the department align with your long-term career goals. For example, if the department’s goal is to recruit a clinician-educator but your goal is to establish an independent research career, then this is likely not a good fit, even if the institution is a top-tier research institution or promises you some degree of protected research time. If the department’s goal is to see you succeed in research, then it will be more open to providing resources and, importantly, protected time to develop your research program. At the same time, be sure to have a clear understanding of what you will need to be successful (lab space, clinical coordinator support, protected time, start-up funds, etc), and communicate those needs before you start the job. It is much more difficult to ask for these things after you have been hired.

Navigating the first faculty job and all of the new responsibilities will take time. Early on, invest your time into establishing your research career. You can always increase your clinical time later, but it is difficult to do the reverse. If possible, relate your clinical work and teaching to your research endeavors. In this way, your clinical work will inform your research, and your research will inform your clinical work. Moreover, you will further develop your scientific niche and your reputation as a leader (both clinically and scientifically) in your field. Be flexible and don’t give up. Remember that troubleshooting is part of the process. And lastly, don’t forget to enjoy your successes. They are well-deserved.

 

Author Bio

Jeanie Park received her BA in English from Rice University, and MD from University of Alabama at Birmingham (UAB). She then completed internal medicine residency at Washington University in St. Louis, and a nephrology fellowship at the University of Southern California, where she also received an MS in Biomedical and Clinical Investigations. She is currently an Assistant Professor of Medicine in the Renal Division at Emory University School of Medicine. She divides her time between caring for patients with kidney disease and conducting human physiology research in sympathetic nervous system regulation. She is a member of the Women in Physiology Committee for the American Physiological Society.

Further Recommended Reading

1. Cheung V. Vitalizing physician-scientists: it’s time to overcome our imagination fatigue. J Clin Invest 127: 3568–3570, 2017. doi:10.1172/JCI96939.
2. Eisenberg MJ. The Physician Scientist’s Career Guide. New York: Springer, 2011.
3. Feliu-Dominguez R, Medero-Rodriguez P, Cruz-Correa M. Women gastroenterologists in academic medicine: tradition versus transition. Dig Dis Sci 62: 13–15, 2017. doi:10.1007/s10620-016-4369-x.
4. Kalloo SD, Mathew RO, Asif A. Is nephrology specialty at risk? Kidney Int 90: 31–33, 2016. doi:10.1016/j.kint.2016.01.032
5. Kwan JM, Daye D, Schmidt ML, Conlon CM, Kim H, Gaonkar B, Payne AS, Riddle M, Madera S, Adami AJ, Winter KQ. Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers. BMC Med Educ 17: 115, 2017. doi:10.1186/s12909-017-0954-8.
6. Martin K. Tips for Young Scientists on the Junior Faculty/Independent Investigator Job Search. Neuron 93: 731–736, 2017. doi:10.1016/j.neuron.2017.02.012.
7. Mehta SJ, Forde KA. How to make a successful transition from fellowship to faculty in an academic medical center. Gastroenterology 145: 703–707, 2013. doi:10.1053/j.gastro.2013.08.040.
8. Melnick A. Transitioning from fellowship to a physician-scientist career track. Hematology 2008: 16–22, 2008. doi:10.1182/asheducation-2008.1.16.
9. Milewicz DM, Lorenz RG, Dermody TS, Brass LF; National Association of MD-PhD Programs Executive Committee. Rescuing the physician-scientist workforce: the time for action is now. J Clin Invest 125: 3742–3747, 2015. doi:10.1172/JCI84170.
You Beyond the PhD: Do You Have the Right Tools in Your Toolbox?

Maria L. Urso
BTG International

This contribution to the Mentoring Forum covers topics that I presented during a “Mentoring for Diverse Careers” symposium at Experimental Biology in 2015. The goal of my talk was to highlight pivotal actions that were made as my nontraditional career unfolded. I opened my talk with the statement, “this is not a story of adversity, but rather a story of opportunity and finding a ‘good fit.'” I opted to be particularly candid in my talk, since, although I always touted that every stage of my career was the best phase of my career, each was not without internal and external conflicts. I felt that the best way to inspire and educate others on these difficult career decisions was to be transparent, since then one would be empowered with the appropriate tools to take on the adversity associated with the path less traveled.

In a nutshell, I had an extremely successful PhD with a fantastic team of mentors, most notably my advisor and friend, Dr. Priscilla Clarkson. One thing that I will never forget about my mentor was that she took a chance on me. I showed up in her lab lacking a lot of the basic skills that one would hope their graduate students would have, which prevented any immediate contribution to the productivity of the laboratory. Dr. Clarkson noticed one thing about me, and that was all it took. Rather than deny me entry into her lab because I had not yet published as a master’s student or because I was not well-versed in the muscle-damage literature, she asked me what I wanted to do and how I thought I would go about doing it. Although I did not have a past pedigree, I had a vision that was tethered to a realistic plan and enough passion to guarantee that complacency would never be an issue during my tenure. Accordingly, I left Dr. Clarkson’s laboratory with a toolbox full of skills that would guarantee a prosperous career if I continued to develop and refine them as I matured. In addition to my full toolbox, I had several publications in notable journals, successful grant applications, molecular biology laboratory skills (that were self-taught following an initiative by Dr. Clarkson to bring our laboratory up to speed), and a direct commission from the U.S. Army.

As any mentor or mentee could imagine, the final aspect of my departure from my PhD created a few waves and hushed discussions among my colleagues and mentors (not to mention my mother, but that’s a different column). However, this was not a rash decision by any means. I had spent my entire research career up until that point doing research in humans related to skeletal muscle breakdown, whether it was a consequence of exercise-induced muscle damage, injury, immobilization, or aging. As I interviewed for postdoctoral positions in notable laboratories across the country, I just could not see myself transitioning away from the line of research that I had established. Additionally, although I had academic mentors providing advice, I was fortunate to have a mentor since the day I was born in my father. He was a physician and spent many years providing medical support in the U.S. Army Reserves. Since I was young, a career in medicine was always something I wanted to pursue. So, I joined the military to follow some life dreams and personal motivations, and to continue to do skeletal muscle research in humans, particularly military-relevant research. I entered the military as a commissioned officer with a military operational specialty (MOS) of 71B, or Research Biochemist. In this role, I would not only serve my country as a scientist, but my research would provide answers to military-relevant problems such as blast injury, rhabdomyolysis, inflammation, and spinal cord injury.

After 7 successful years as a military-scientist at the U.S. Army Research Institute of Environmental Medicine (USARIEM), I decided to use the skills that I had developed to transition to a clinical research and medical science team in industry. Remarkably, despite the notion that you can only be hired in industry if you have industry experience, the transitions were not only seamless, but I was able to make significant contributions within a relatively short time of being hired. I can only attribute this steady trajectory to the tools that were placed in my toolbox throughout my career: tools that were collected from my mentors, peers, adversaries, and experiences.

Although my nontraditional career decisions tended to be cautioned against rather than lauded, I have continued to grow as a scientist, and each day I am more fulfilled by the opportunities that have presented themselves. I am convinced that the only way to produce fantastic work is to have the right tools for the battle and to love what you do. I want to use this column as an opportunity to highlight the essential tools for the battle that I emphasized in my talk.

Essential Tool #1: Knowing What Drives You
The best mentor in the world cannot give you this tool; this one must be acquired on your own. In an effort to achieve favor while working on our doctorates, the vision of the laboratory becomes your own. As important as it is to contribute to the overall success and productivity of your laboratory, it is absolutely critical that you do not lose sight of who you were before you began this adventure. Many of you are also athletes, musicians, bakers, artists, etc. As best as you can with the responsibilities that you must juggle, do not let your side passions go. To remain creative and productive, you will need something that is yours. The benefit of maintaining something that you are passionate about outside of the laboratory is that it will always give you a chance to do an inventory and examine your current engagements from an outside perspective. When you look from the outside in, ask yourself: Are you still excited? Are you making decisions because they feel good and motivate you, or because you feel pressured to? Have you been pressured to do something that might seem unethical when you look at it from the outside? Are you truly managing your time properly, or are you getting lost in busy-work? Asking yourself these questions is important for not forgetting who you are and sticking to your convictions when making difficult decisions.

Essential Tool #2: Having a Blueprint
A blueprint is essential to your career because it will consistently remind you of your vision, particularly when your plate is so full you cannot look beyond the next 4 months of tasks. Write down where you want to be in 6 months, 1 year, 2 years, and 5 years. Revise your plan as necessary. Do your homework. Learn about other career opportunities outside your laboratory and read career descriptions of the job that you want. Modify what you are doing to obtain the skills and experience required. If others try to persuade you to think differently, you will have a solid plan in place that may help you to navigate difficult discussions.

As a start to some nontraditional career opportunities, here are some links:

Put your plan on paper, do your research, and follow through, despite persuasion.

Essential Tool #3: Honing Your Fundamental Skills
Make sure you practice your writing daily. Clear writing is a skill that should be easy, but oftentimes we are determined to make our writing sound as impressive as our research. This tool is critical in grant applications and manuscript preparation. Your goal should not be to impress the reviewer with your vernacular. Your goal is to clearly explain what you plan to do (grants) or did do (manuscripts) concisely. In scientific writing, you will be amazed at the elegance that comes with simplicity. You should also be able to write or speak persuasively. Although we are scientists and not salespeople, we are always selling something. It may be an idea, a research finding, a proposal, or a hypothesis. Become the best scientific salesperson you can be. When making a transition away from the benchtop, the ability to express yourself and your work clearly is of utmost importance. You will no longer be speaking to like-minded scientists but to clinicians, businesspeople, policy-makers, sales teams, patients, etc.

Essential Tool #4: Your Elevator Speech
Many of you are working on niche projects in a laboratory. You have spent months immersed in the literature and running experiments. It is important to remember that you are now an “expert” in this domain and that others may only have a cursory knowledge of your research area. You will lose their interest if you begin to go into the intricate details of your work. It is always a good idea to prepare a two- to three-sentence overview of what you do. This is not an easy task. You need to make two to three impactful sentences that explain the following: the tissue/organism you work with, the research question you are answering, how you are going about answering it, and why it matters. These sentences should be understood by everyone from your mentor (for accuracy) to the officer at passport control who asks what you do as a scientist. This elevator speech is going to be your first impression as you navigate nontraditional career opportunities, and it needs to be perfect.

Essential Tool #5: Managing Projects and People
We are all going to manage projects and people differently. The key point here is that you devise a formula that is reliable. Having a reliable formula to produce quality work ensures that, when you are part of a team that is in an up-tempo production mode, you will deliver. This is how you become an asset to any team and sought after by employers. Whether your project is big or small, your formula should apply (albeit with a few tweaks). Oftentimes, when you are in a leadership positon and managing people, you will not have the luxury of first devising a plan to manage a task.

As an example, when I was writing the literature review for my dissertation, I accomplished very little the first 2 weeks. The enormity of the task was so daunting, I avoided it. One day I realized that if I wrote two pages per day, I would have a literature review completed in advance of my deadline at the end of the semester. The rule was that I could not get caught up in small details; I just had to put pen to paper for two pages per day, and I would go back and edit when I was done. Each day I started by writing two pages of text—it was so easy! I found that once I started I did not want to stop after just two pages of writing. I ended up finishing a month in advance of my deadline. My formula is to take a large task with a far-away deadline and break it up into smaller tasks with daily deadlines. I have relied on this formula for everything, from work to house projects.

Essential Tool #6: Accept Challenges and Live Outside Your Comfort Zone
Once you know what you can accomplish when you put your mind to it, start accepting new challenges. I recall thinking my plate was full during my first year of my PhD program. By the second year, I was handling twice as many tasks, and I still had time to do things that I enjoyed. If I accepted the first “full plate,” I never would have taken on new challenges. Allow yourself to fill the plate with more than you planned. You may surprise yourself with what you can accomplish when you take new risks and live outside your comfort zone (n.b., see section below on expecting to fail). Despite the expectations around you, design your own constantly evolving expectations. Say yes and get involved. Ask questions at conferences. When it is your turn to be front and center, give the best front and center that you can give.

Essential Tool #7: Conference Attendance and Interactions
When I attended my first national conference, I did not know a single person there except for my master’s advisor. He had friends and colleagues that he needed to meet with, so I was on my own. I went to symposia, met people at the poster sessions, and exchanged e-mail addresses with people whom I still collaborate with today. When I went to my second national conference, I was with my peers, and we spent the entire conference together. I went home without meeting a single new person. After that, I began to avoid the “conference pod.” Break away from your home team at conferences. Go to the sessions that pertain to your work, but also to those that excite you. Attend the career seminars. Start discussions at the poster sessions. You are much more approachable on your own, and you will not feel pressured to step away from a conversation prematurely. Do not be afraid to step away from the crowd on the small things, it will make stepping away for the bigger things easier.

Essential Tool #8: Get Involved in Professional Organizations
Aside from the “village” that raised me during my years in school, the single greatest contributor to my growth was my involvement in professional organizations. I began by volunteering for small things at regional conferences (e.g., manning registration booths), then national conferences (introducing speakers), then serving on committees. These opportunities allowed me to work on projects with scientists whom I had previously idolized from afar. All of a sudden, I not only had a seat at the table, but we were exchanging ideas on how to bring a new concept to life. These professional relationships will give you a platform for everything from research advice to visibility.

Essential Tool #9: Expect to Fail
Human nature: we all want to earn an A. Nobody takes on a research project or activity with the intention of earning an F. However, it is when we earn those Fs that we learn more. Most of us will attempt the project again in an attempt to turn that F into an A. Others will use that experience as a learning experience for the next project, perhaps refining the experimental design and approach. Take big risks and expect to fail. This will prevent complacency or an inability to start something new in fear of receiving an F. Get the F, learn how to make it an A. In the long run, the failures will shape you more than the successes. Become an expert at uncertainty and build resiliency. One of my favorite quotes is from Arianna Huffington (co-founder of the Huffington Post): “We need to accept that we won’t always make the right decisions, that we’ll screw up royally sometimes—understanding that failure is not the opposite of success, it’s part of success.”

Essential Tool #10: Find a Niche
People will tell you to follow your passion. How many of you have just one passion? Following your one passion may be a dead end. It is better to identify which skills you have that may be valuable to others. Once you do this, hone those skills until you have career capital. Constantly determine whether and how you are distinguishing yourself from the thousands of individuals with the same major or degree.

Essential Tool #11: Have a Hobby That Overlaps With Your Career
Once my mentor taught me how to write, it became one of my favorite things to do. I was also an athlete, so I was continually exposed to trends and fads in the fitness world. As a side project, I started writing columns and blogs for different periodicals incorporating scientific evidence and human performance and nutrition. While doing this, I established connections and relationships from industry to private organizations. As my skillset improved, I was invited to serve as a scientific consultant, speaker, and writer for these different organizations. Suddenly, I was getting paid to do something that I considered a hobby. At the same time, I was refining the skills that I used every day in my professional life.

Final Thoughts
As you traverse your career, you will find many more tools to add to your toolbox that you find are essential. The key focus is to never stop adding tools to your toolbox. Build bridges instead of burning them, never pass up an opportunity to be assessed, and listen to what goes on around you. Take chances constantly, but be prepared to accept that not every decision will be the right one. Only you can choose the career that is right for you, and, with the proper planning, you beyond the PhD will be exactly the right fit.

Maria Urso is a Medical Science Liaison (MSL) for BTG Pharmaceuticals, a specialty pharmaceutical company that offers therapies for patients with COPD, vascular disease, and cancer. She received her PhD from the University of Massachusetts, Amherst. Prior to BTG, Maria was the Director of Clinical Research at Arteriocyte, and a scientist at the U.S. Army Research Institute of Environmental Medicine (USARIEM). While at USARIEM, Maria served on active duty as an Army Major.

Maria is a Fellow of the American College of Sports Medicine, a member of the MSL Society, and previously served on APS’s Women in Physiology Committee. In 2012, she was a recipient of the Presidential Early Career Award for Scientists and Engineers (PECASE) from President Barack Obama.

Carpe Emeritus: A Physiologist Does Retirement

Gerald F. DiBona
Professor Emeritus
Departments of Internal Medicine and Molecular Physiology & Biophysics, University of Iowa College of Medicine, Iowa City, Iowa

It may seem a bit strange to have an article on retirement in a forum devoted to all aspects of mentoring relevant to today’s trainees at all stages of their careers (graduate, postdoctoral, early career). However, the importance of early planning for retirement is not limited to various financial aspects. An equally, if not more important, aspect is coming to grips with the free time (often 40-80 hours per week) you will have and what you plan to do with it.

Since there are multiple sources for information concerning financial planning for retirement, I will not comment on this aspect. Rather, I will comment on planning for the free time that will become available. This is certainly not meant to be a template or a how-to piece but rather a telling of my own personal experience, which emphasizes some of the steps that might be found useful. To keep things in perspective, I have always considered vacation time as a short-term look at what retirement could be like; I have preached to those who would listen that you don’t get paid extra for not taking all your vacation time. The reader might also consider the fact that, when I told some of my closest colleagues about my retirement plans, some of them said, “How will we know the difference?”

Plan Ahead

“If one does not know which port one is sailing to, no wind is favorable.”
— Lucius Annaeus Seneca

I had known too many colleagues whose work was their sole activity and who had not developed outside interests. They worked hard until close of business on their last day and awoke the next day facing the prospect of having nothing to do. They felt isolated, were bored, and became depressed in the absence of their usual professional activities and interactions. For some individuals, given the dropping of mandatory retirement ages in many universities, a satisfactory solution has been to continue to work under various contractual arrangements. However, at some point, these arrangements come to an end.

My major outside interest had always been sailing, and by retiring at an early age I could enjoy this while physical mobility was good as opposed to a later time when it might not be so good. My plan was that the retirement year would be divided between summers sailing in Maine and winters living somewhere else.

Clear message here: figure out what you are going to do with all the available time when you are no longer working…do it early! For many, the decision about what you want to do can be coupled to where you want to live. This adds another important dimension to the planning activity.

Recognize Opportunities

“If your ship doesn’t come in, swim out to it.”
— Jonathan Winters

Sailing summers along the Maine coast facilitated the identification of a harbor town in which we would like to live for part of the year. A chance opportunity during a favorable period in the local real estate market enabled the purchase of a summer vacation home. Lucky perhaps, but luck is a matter of “preparation meeting opportunity” (Lucius Annaeus Seneca).

Some years prior to retirement, a research sabbatical evolved into the opportunity to live and work in Sweden. Initially, this was Karolinska Institute, Stockholm, and currently, Gothenburg University, Gothenburg. This involved teaching renal physiology to medical students and clinical nephrology to nephrology trainees, as well as collaborative research with former trainees and long-term colleagues. Not long thereafter, the university’s implementation of a retirement earlier than age 65, with minimum financial or fringe benefit loss. This permitted a stepwise decrease in effort over a period of 3 years prior to full retirement and allowed adjustment to the increased amount of free time as well as to living and working in Sweden. Currently, the year is divided into a winter period in Gothenburg, Sweden, a summer period in Maine, and shorter intervals between these periods in Iowa, our long-term home.

Pivotal Circumstances

“Circumstances are the rulers of the weak; they are but the instruments of the wise.”
— Samuel Lover

The wishes, interests, and needs of spouses, partners, children, and other family members have a clear bearing on the planning activity and eventual choices. Retirement aspects of a spouse’s or partner’s current employment and both financial and nonfinancial aspects of their retirement planning require careful consideration. Having a partner who is a renal physiologist, a native of Gothenburg, Sweden (where she received her doctoral education), and a long-term sailor and lover of the sea is easily identified as a pivotal circumstance in the final definition of our retirement life.

Details

“Success is the sum of the details.”
— Harvey S. Firestone

One needs to consider the basics of financial management and oversight as well as health status and care. Most of these issues can be managed electronically or during the short visits to home or by making suitable arrangements in the other living place. Similarly, developments in caretaking and property management provide peace of mind and security when we are living in different places.

Overall

“Life is like a sewer: what you get out of it depends on what you put into it.”
— Tom Lehrer

While not knowing exactly how this would all work out, it has played out to be much better than anticipated. Initially, I thought I would be challenged by having to adjust to living in three different locations, one international, and all very different from each other. Aside from adjustment to time-zone change, this has not been a major issue. Would the teaching and collaborative research involvement in Sweden (part-time by the clock) be sufficiently fulfilling and stimulating? Far more than expected as these enjoyable activities replace the time that was previously occupied by some of the less-enjoyable activities of academic life. Learning Swedish and being in a country where the natives speak excellent English has made adjustment to a different society and culture relatively easy and pleasant. Sailing has always been a free time endeavor. Previously, some of my best experimental ideas came while at sea, whereas now I enjoy the luxury of endless reading time. The time in Iowa provides an opportunity to catch up with friends and colleagues as well as manage regular health maintenance and financial activities.

When I am asked what would I have done differently, I say I would have done it sooner. The initial plan was to fully retire at age 60, but an unexpected (but most gratifying) election to APS Presidency (a 3-year commitment) delayed this plan. One might put this event under the above category of Pivotal Circumstances.

Currently, career and family issues are likely the dominant ones for most of the readers of this article. View this article as a plea to consider various aspects of retirement planning along the way. This will serve to ensure overall flexibility at the time of retirement rather than being confronted with a situation constrained by many factors that could have (should have) been dealt with earlier.

Gerald DiBona received the AB from Harvard College and the MD cum laude from Tufts University School of Medicine. Following training in internal medicine at University of Pennsylvania and nephrology and renal physiology at Harvard Medical School/Peter Bent Brigham Hospital, he moved to University of Iowa College of Medicine in 1969. Rising through the ranks, he served as Professor and Vice Chairman of the Department of Internal Medicine and Chief, Medical Service, Iowa City Veterans Administration Medical Center from 1977 to 2001. From the APS, he received the Starling Lectureship Award, the Walter Cannon Lectureship Award, the Robert Berliner Award, and the Ray Daggs Award. He served as President of APS from 2000 to 2001. From the American Heart Association, he received the Dahl Award and the Novartis Award. From the Veterans Administration, he received the Middleton Award. Following retirement, he has served as Foreign Adjunct Professor at the Karolinska Institute, Stockholm, Sweden, and Guest Professor in Renal Physiology at Goteborg University, Goteborg, Sweden.