When Should a Doc Retire? with Matt Harmody, MD, MBA

Many thanks to Matt Harmody, MD, for joining me today for Episode #168 of The Art of Medicine with Dr. Andrew Wilner. Matt was recently a guest on episode #158, where we discussed his donation of a kidney to a total stranger, his retirement, and his volunteer work with the transplant community.

Matt is also the author of “Ascending America,” the story of five living kidney donors who climbed the highest peaks in every state of the US in record time.

Matt’s here to discuss the dicey topic of physician retirement. He’s going to tell his story and share some humble advice.

To learn more about becoming a living kidney donor and Ascending America,  please go to https://www.kidneyregistry.com and  https://mattharmodymd.com.

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Transcript

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Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. I've planned a great program for today, but first, a word from our sponsor, locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a locum's one-on-one crash course. Learn about locums and get insights from real-life physicians, PAs, and NPs at locumstory.com. And now to my guest. Retirement is a dicey subject for physicians. When, if ever, should a doctor retire? That's the question we're going to explore today with Dr. Matt Harmody. Matt was recently a guest in episode number 158, where we discussed his donation of a kidney and subsequent work with the transplant community. He's also the author of Ascending America, the story of five living kidney donors who climbed the highest mountains in every state of the U.S. During our conversation last time, I learned that Matt was an ER doc and recently retired. Matt's thoughtful and articulate, and I can't wait to hear what he has to say about retirement. Welcome, Dr. Matt Harmody. Thank you, Andrew. I'm glad to be here. All right, Matt. So you were a regular ER doc. Along the way, you had this epiphany that you only needed one kidney, and you gave one away, and that went pretty well, right? And it got you involved with the, I don't remember which association, but one of the big transplant kidney associations. Yes, the National Kidney Registry. It's one of the largest parent exchange donation facilitator in the country. And you decided to retire. How long have you been retired? It's been a little over four years. You know, and I think, can I ask how old you are, just to put it in perspective? I'll be 65 in August, which brings with it its own retirement challenges. So you retired at 61? Yes. So probably, I mean, a reasonable age to retire for most people, maybe a little young for physicians, but maybe less so for the current generation. The idea, a lot of doctors in the old days used to just kind of work until they couldn't work anymore or dropped out, but that seems to be changing. All right. Well, I want to get the elephant out of the room. So we're just going to talk about how much money do you need to retire? Yeah, that's the $64,000 question. I would, that's right. Hopefully a little bit more. I would answer that question, Andrew, by highly recommending a couple of items, the most important being either yourself or probably preferred a professional take you through what's called a Monte Carlo analysis. So for those listeners that aren't familiar with that, just generally statistically, you're running frequent scenarios changing, usually one variable at a time and coming out with an output. And in most cases, that would beg to differ a bit on working with my financial planner. It yields a number that is the percent probability that you will not run out of money. So of course you want that high. And it's another question of how high is good. I found it to be maybe a little bit more helpful to be able to know how much money I could live on year to year. And that comes to my second point is I really think it's important to do a quick budget. I don't think you need to live by one tightly or do it every year, but I think towards the end of your working life, you probably should do a current budget and then a post-retirement budget. Some of those numbers change dramatically. Some don't. Right. So there was sort of a concept that, well, you're going to retire, you'll need less money. And then there's been a little pushback against that, that that's not necessarily the case. In your own situation, when you say you need less money now that you're retired, or now you have more free time, you got more time to spend money. That is true. I think my initial assessment was at least from year one of retirement to currently, we're spending a little bit more than we would have guessed. But I would say that we spend, I don't know, maybe 10% to 20% less. Okay. So pretty much work years. Not all that. I mean, 10% or 20% more or less is still in the ballpark. It's not like suddenly your expenses will be half. And presumably you've paid off the mortgage, children have graduated school. So those are two huge chunks of money. On the other hand, as you were mentioning, there's the new problem of health expenses, which in our country often end up being cash payments or private insurance or supplements to insurance. Now you're young enough that, or you were young enough anyway, at 61, where Medicare isn't going to pick up all your bills. So what did you do about health insurance? Yes. First, I would strongly discourage working just to pay for healthcare. I have had some of my former physician partners hang on. And I would even argue maybe hanging on a little bit too long. And we can talk about that, especially if you're a physician leader in administration or management of your group or within the hospital. But my wife and I have been on the exchange, what people euphemistically refer to as Obamacare. And a lot of the kinks have been ironed out. So it's a very efficient way to shop each year for health insurance. You won't get much of a subsidy. And likely, I guess, it depends on your circumstances. We've been doing Roth conversions for the past few years. So that's treated as income as the exchange is considered. So we've essentially had no subsidies. So yeah, we're paying full premiums. It is what it is. Knew that going in. It was in the budget. Somebody was paying for it before you retired, whether that was coming out of your group's budget or the hospital. It is a significant expense. I remember 10 years ago, I was self-employed, effectively, and had an HSA. And just for myself and my wife, I think we were paying about $20,000 a year for a pretty good plan. And I'm sure it's more now. So it's not negligible budget item. Right. And we've had an HSA as well for many, many years. And our monthly premiums this year have risen at $2,700 for the both of us. So that's over $30,000. Yeah, closer to $30,000. For just two of you. Okay. So that's a budget item that definitely needs to forget about that one when you're doing your calculations. Now, the other thing, at your age, I've done a lot of reading about this, and there are two very different views about Social Security. Some people say you should take it as soon as you can. And then if you don't need it, you can invest it, because who knows if it'll still be there. And then other people say you should wait as long as possible, and then you get more. Did you have an opinion on that? I would completely agree that the philosophy has changed. It had always been, wait as long as possible. I think it somewhat depends on your health to a degree, whether you have... One would hope as a physician retiring that you would have some type of savings retirement. Imagine most physicians probably don't have pensions, but there could be cases in which that would be true. I think you are more inclined to take it earlier if you're in need of it. I would agree with that general statement. But again, just like how much money do you need for retirement? A lot of these questions, Andrew, especially with your background, remind me of the saying, and you can fill in the diagnosis as you wish, but you've seen one MS patient, you've seen one MS patient, right? All right, well, let's talk a little bit about professionally. What do you think about at some point you say, well, this has been great. You mentioned that some doctors hang on too long. Do you think you should retire when you're at the peak? You had your best season ever at the NBA and I'm done, because it's just going to be downhill from there or phasing out. A lot of guys kind of hang on. Professor Emeritus, they're coming to Grand Rounds, they're shuffling in, falling asleep in the middle, but they're still there. You got a feeling about that? Yeah, there's a lot to impact there, Andrew. Just for your audience's sake, I've worked in a independent, what we call democratic physician group my entire career. So, we contract with a single hospital and a single hospital system, which there were four emergency departments. So, we all rotated through those departments, working shifts. And I think that we're not unlike professional athletes, quite honestly. Do you need to retire at the peak? I'm not necessarily suggesting that, but I will tell you, I was president of our group for the last few years, and there were a couple that would be considered, I think, hanging on and we're having trouble keeping up the pace in a very busy emergency department or departments. And it was hard. I think their identity was, especially in one case, was very much tied to being an emergency physician. And that's something to think about as you approach retirement. And I always felt, having been on the opposite side of that, having to help usher a couple of doctors out, that I didn't want anyone ever to have to do that to me, tap me on the shoulder and say, hey, Harmony, you ought to think about winding down or retiring. So, I think that, Andrew, coupled with board recertification was a little bit more challenging. I've heard that before also. It's like, I'm not going to do that one more time. And I think I felt like I forgot about as much information as I knew. Maybe that's a little harsh. And then finally, the young physicians that we were hiring were just unbelievably smart, unbelievably fast. And yeah, I wasn't still there. Now, I think there's an optimal point of many years where experience plus energy and knowledge base comes to make you the best that you can be. You can, of course, not have much experience and not be as good of a provider coming out of residency. And I think the final thing I'll say on that, Andrew, is every group's different. Every physician environment's different. We struggled with having a part-time role for a physician. Our group, my former group, has done a lot better with that since because it was, you know, for the good physicians that were getting up in their years but just wanted to work less, you need a spot for those folks. I mean, they're so gifted with their experience. They can help mentor younger physicians. And they're a known quantity as well. I mean, versus hiring someone from outside your group that maybe has some experience but is an unknown, I think you need to really work hard to keep those aging physicians working part-time if that's mutually agreeable. You mentioned identity, investment in identity as an ER physician. You know, when you reserve a table at the restaurant, it's like, well, it's Dr. Harmony. So is it still Dr. Harmony? How did you approach the identity thing? It's completely, as it always has been for me personally, it's completely dependent on the environment. So if, you know, the nurses, you know, which run the emergency departments and carry so much weight and really determines the success or failure of a department or a particular shift for that matter. Yes, it's Dr. Harmony in the patient room, maybe in front of other medical staff, but outside we run across each other in public. It's Matt. So now it's, you know, it's much more Matt, but I still have some roles with the hospital on the hospital board and the foundation board. So in those more formal meetings and settings, you know, I still go by Dr. Harmony, but otherwise, no. And it was a little difficult at first about losing that identity. But, you know, that happens in life. We go through phases and it's not necessarily a bad thing. Some identities you'll always have, whether you're a father, a husband, son, doll, what have you. But other identities come and go. I used to be an engineer. I used to be a business analyst. I was a medical student. And now I'm an advocate for living kidney donation. Can I ask, is that a paying job or are they just doing it out of the goodness of your heart for your kidney, your remaining kidney? Yeah. So everything I do, I think that's a safe statement. Everything I do advocacy wise is uncompensated. I have a small role with doing some innovation work with our hospital system here. And that's as a consultant. And it's, you know, kind of showers a month, you know, it's very minimal, but it's fun. It's some work I can take off the hands of some of our very busy executives. And of course, you know, there's the book, but if anyone wants to retire and write a book, which I really would not have been able to without retiring and earn a decent living at it. You think medicine's challenging, become a full-time author. Right. Good luck with that. I have four books. There you go. It hasn't made a big dent in my taxes every year. I'm still waiting. Maybe book number five, but yeah, I think it's a tough, that's a tough road for sure. But it is a wonderful book. I'll just mention it again, Ascending America. It's an incredible story. I, the point was that here, you got all the, right. These five guys between them, they've only got five kidneys, right. And, but it didn't slow them down too much, mountain climbing. And it would, they set a time record too, right? It was the number of peaks per, in the shortest period of time. There's a Guinness record for a lot of things, including climbing the highest point in each of the 50 States. And the record was set back in the eighties, 43 days and change. And it took us about a little over 41 hours. So yes, we did set the record and yeah, it, it again, retirement allowed me to do that. They were looking for a fifth teammate and of course it helped that I was a physician so I could help, you know, take care of everybody. But the criteria where you had to be a kidney donor and you had to have a month off, there are not too many people running around meeting that criteria. So. And you just happen to be an extreme athlete. We have to put that in there. This wasn't a new thing for you to be exerting yourself. Yeah. The climbers on the team were, yeah, they're, they were experienced, you know, by no means am I a technical climber. I, you know, I have climbed Mount Kilimanjaro, but yeah, that's not to minimize it, but that's a hike. And it's a hike at very high altitude and, and a hundred percent of people are not successful. But yes, that experience was also helpful on the adventure. So do you find that now that you're retired, that there's a lot of opportunities like that, that are presenting themselves like before? Well, I can never get a month off, but Hey, I could do a month. Yes. I, as a physician and leader in our group, I'd never said no to anything the hospital asked us to do. And we had a single contract and we protected that by our reputation, doing as many things as we could do in the community, just to make us so integrated into the healthcare system. But I had to kind of change that perspective, Andrew, when I retired, because I think you need to leave some free time to be able to evaluate things that come your way. So when people find out you're retired, they automatically assume you have plenty of time and you'll do stuff for free. So you'll quickly, at least that was the case in my situation, find yourself just kind of batting off things that, as I put it, if it's not hell, yes, it's no. Well, I think that's very important that your time gets sucked up. I agree. When you're home, I have a home office and everyone assumes I'm in a home office. I got nothing to do. And it's like, I work very hard here and no interruptions, please. But the rest of the world doesn't understand that. Right. So, yes. But yeah, it has allowed me to, especially in the advocacy world, I'm taking on more speaking engagements. The book's given me a little bit more of a platform to be able to do that. And right now I'll speak to any group or individual, for that matter, anytime, anywhere. And I've had travel expenses paid for. But again, that's not a retirement income stream by any stretch. Have you, was that important for you to create, you know, other than stocks and bonds? And do you have any other, you know, real estate or side business going on that's going to, working wife, I don't know, some other way to make some money? Actually, no, I've kind of gone the full gambit. A little bit of background. I have an MBA. I got that while I was an engineer and it's a concentration in finance. And I loved investing. In fact, I used to do all my own individual stock purchases. I even traded in commodities and options. And I think through time and talking with more experts in the area, I actually even invested in startup companies, you know, that had non-registered stock, you know, somewhat of a high risk and occasionally high return. But I learned that through some wisdom that I'm competing with people that do this full time and have a lot more resources than I do. So I handed off all of our family's personal investments to a financial planner, probably mid-career. And it really just kind of took a weight off my shoulder. And I really haven't missed it that much. It, you know, it's gone well. Of course, you know, the conservative nature of the investing has increased with time as I've approached and entered retirement. So, yeah, no real estate. I get the bug every now and then to start a business. And I just have to talk to my friends that, you know, run their own businesses, especially dealing with the public, you know, and the hassles and, you know, the really important attention that is needed. And I quickly talk myself out of it. Well, I think when we talked last time, you mentioned retiring to something versus from something. You want to talk about that for a minute? Absolutely. I think we talked briefly about playing golf and I am trying to play a little bit more golf. I grew up playing golf and have played a little bit on and off most of my life for that matter. And we live in the Pinehurst area. So people realize you don't play golf and you live here. They kind of roll their eyes. But yes, I probably worked a little bit longer than I would have otherwise because of COVID. I retired probably 18 months or maybe closer to probably two years into COVID. It had kind of settled and it clearly hadn't resolved. But I think the worst of it was far behind us at that time. I just couldn't leave my partners and the rest of the group. Well, E.R. was front lines. Yes. And we were a little shorthanded and all the challenges that came with COVID. I stayed down longer than I actually did administrative work for the group just to help lessen the burden. And then did some hospital administration work for another 12 months or so. So I think one of the things we were going to talk about was whether you wind down gradually or just go cold turkey. I think that's somewhat personality dependent. But if someone asked me, I think winding down would be important consideration. And whether that's locum's work or administrative work, there's expert witness work. There's all kinds of avenues to pursue there. But just the shift work, the nights, the weekends, the holidays, I just really needed to take a break from that. I didn't really have a desire to continue the work at a lower level or even a lot of emergency physicians move to urgent care or something a little less critical or hectic. Right. Locum tenens, as you mentioned, that's an option. Yes, I think that's even a great speaking of locum's. I always think of my good friend growing up. He went into family practice. He actually did locum's for his first five years of his career out of residency. And there's a book called Die with Zero. I think it's Bill Perkins that wrote it. It'll change your perspective a little bit if you kind of are a traditional thinker about working hard, accumulating wealth to then enjoy in retirement. Now, it's probably a little bit difficult for physicians to take that approach. But I loved his. He worked in some great places when he was young and able to enjoy. He was a Yellowstone National Park physician. He worked in Hawaii and just had a great time doing that. And then he settled in and been at the same practice since. So, yeah, I think flexibility, having something to retire to is important. I would highly recommend working that out before you retire. And for me, it was kidney donation advocacy. I just wanted to do more than a full time emergency medicine career would allow. So that was what I retired to. Well, that's a real passion because they're not paying you. You're just an advocate. Yes, it's a solvable problem. That being the 93,000 plus people on the kidney transplant waitlist, of which half will die before they receive a kidney. So, yeah. And it still harkens back to my father and what he went through. He was on dialysis for several years. And, you know, fast forward many decades and eventually donated a kidney to a stranger in 2017. And yeah, it's just great work. It's great people. There's just not enough of it. And my hope is to change that over time. All right. Here's a question. Are you happier now that you're retired? Yes. Okay. How are you going to handle that? All right. I miss the people and I miss the challenge, especially in the hectic, busy emergency departments. But a lot of it I don't miss. I'm glad I did what I did. I really enjoyed the variety. I did enjoy, you know, punching a clock, which is a lot of what emergency medicine is, though I did have a lot of administrative responsibilities that had me on call for some things, but, you know, clearly not clinical call. But, you know, there just comes a time when it's reasonable enough to move on and try not to be too attached to that identity, which I think made it a little bit easier. But yeah, now I don't, you know, I make all the family events and everyone's not planning their schedules around me. We have a nine-month-old grandson, our first. So that really changes your perspective. And I might also add, interestingly enough, one of our two sons is a first-year emergency medicine resident. So he's... So he's taking your place. I mean, it's, you don't want to be missed. I think that's perfect. All right. So to wind up, any advice, you know, a lot of doctors our age out there, it's like, well, so first thing they ought to do when this question comes up? I would say first thing to do is a budget and a Monte Carlo analysis and get comfortable with those numbers. And secondly, it's a little bit more deeper and subjective thought, but decide what you're going to retire to and not just retire from something. Dr. Matt Harmody, thanks for appearing as a guest on The Art of Medicine. My pleasure, Andrew. Glad to be here. And now a final thanks to our sponsor locumstory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory exists to answer your questions about the how-tos of locums on their website, podcast, webinars, and videos. They even have a locums 101 crash course. At locumstory.com, you can discover if locum tenens make sense for you and your career goals. What makes locumstory.com unique is that it's a peer to peer platform with real physicians sharing their experiences and stories, both the good and bad, about working locum tenens. Hence the name locumstory. Locumstory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free. Thanks again to locumstory.com for sponsoring this episode of The Art of Medicine. I'm Dr. Andrew Wilner. See you next time. This program is hosted, edited, and produced by Andrew Wilner, MD, FACP, FAAN. Guests receive no financial compensation for their appearance on The Art of Medicine. Andrew Wilner, MD, is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee. Views, thoughts, and opinions expressed on this program belong solely to Dr. Wilner and his guests and not necessarily to their employers, organizations, other group, or individual. While this program intends to be informative, it is meant for entertainment purposes only. The Art of Medicine does not offer professional, financial, legal, or medical advice. Dr. Wilner and his guests assume no responsibility or liability for any damages, financial or otherwise, that arise in connection with consuming this program's content. Thanks for watching. For more episodes of The Art of Medicine, please follow on YouTube or your favorite podcast player. Please share with your friends and subscribe. www.andrewwilner.com