Director’s Corner: When Should an ER Doctor Consider Retiring?

Last month, I went to a retirement party for an emergency physician colleague.  I’ve known docs who have retired, though this was the first retirement party I think I’ve ever been to for a doc who retired while working in the same ED as me.  It seems like I’ve seen docs step away from emergency medicine much more commonly than I’ve seen them truly retire as an emergency physician.

A few years ago, I received a question from a respected academic emergency department chair that stuck with me: “Should there be a mandatory retirement age in the ER?” It wasn’t meant to be provocative or discriminatory. It was a sincere inquiry rooted in concern for both patient safety and physician well-being. My last column answered this from a medical director’s perspective.  This month, let’s turn it around and ask: When should an individual ER doctor start thinking about retirement?

Emergency medicine is a demanding specialty. We pride ourselves on stamina, sharp clinical instincts, and the ability to thrive under pressure. But these qualities don’t always last forever. As medical directors and colleagues, we have a responsibility to ensure that our teams function safely and that our physicians are both supported and held to high standards. At the same time, we need to be thoughtful about what it means to age in our field, and what a healthy and dignified transition out of the clinical trenches can look like.

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So how do we approach this?

1. Health and Energy Check-In

The first and most obvious domain is physical and mental stamina. Emergency physicians need to be quick on their feet—both literally and figuratively. I haven’t run to a code since I was a third year medical student rotating at a Navy Hospital and we don’t necessarily need to be able to sprint across the department. But we do need to maintain enough energy and focus to manage the cognitive and emotional load of multiple critical patients, difficult families, electronic documentation, and team communication throughout our entire shift.

Fatigue, slower recovery between shifts, and declining mental sharpness are often gradual and subtle. They can manifest as more mistakes, more frustration, or simply a growing sense that the shift feels “harder” than it used to. These signs don’t mean someone should retire immediately, but they should prompt honest reflection.

A practical approach is to ask yourself these questions:

• How do you feel at the end of a shift?
• Do you need more time to recover between shifts than you used to?
• Are you noticing it takes longer to make clinical decisions or that multitasking is more challenging?

I am a huge fan of self-reflection and combining that with honest discussion and feedback from peers and/or your medical director, can be a very powerful way to help identify changes that might be addressed with schedule adjustments, wellness support, or in some cases, consideration of a step back from full-time clinical work.

2. Emotional Engagement and Fulfillment

Many of us entered this field because we love the adrenaline, the diversity of cases, and the camaraderie. But over time, some of that passion can fade. Burnout, frustration with the system, or simply a shift in personal values can cause emotional disengagement. One of my favorite attendings from residency said he knew it would be time to retire when he was driving home faster than I drive to work.  Work excited him and he was eager to be there. If you find yourself dreading every shift, avoiding eye contact with patients, or emotionally withdrawing from your team, that’s a sign something needs to change. Perhaps it’s as simple as considering your perspective as you look at your schedule—are these shifts something you “have to do” as opposed as something you “get to do.”

Retirement isn’t the only solution to emotional fatigue, but for some physicians, it may be the right one. Others may benefit from a sabbatical, a reduction in clinical hours, or a shift toward teaching or administrative roles.

Ask yourself:

• Do I still find meaning in patient care?
• Am I showing up with the same empathy and curiosity I used to have?
• Would I do this work even if I didn’t need the paycheck?

3. Professional Confidence and Competence

This is the most sensitive but perhaps most important issue: clinical performance. Most aging physicians remain excellent providers well into their 60s and beyond. But there comes a time when it’s appropriate to ask: Am I still performing at the top of my game?

This may be seen as a drop in productivity.  If you’re paid on an RVU format, this may mean you make less money.  From a department perspective, if you slow down, it may mean patients have longer waits or your colleagues that you’re working with are doing more than their share of patient care.  I don’t think we need to be the fastest in the group, but regardless of your age, if you’re among the least productive at your site, you may want to consider a change in venue.

Performance evaluations, quality reviews, and peer feedback all play a role. But self-awareness is key. If a physician is repeatedly struggling with new technology, slower in resuscitations, or demonstrating a pattern of near misses, these are red flags. Not necessarily for immediate retirement, but for reevaluation and support.

Medical directors should be proactive in creating a culture where it’s okay to talk about these things—where senior physicians are valued for their wisdom but also held to fair performance standards.

As a physician, reflect on:

• Have I received constructive feedback about my clinical performance, including productivity?
• Am I keeping up with CME, evolving best practices, and departmental workflows?
• Do I feel confident and competent on every shift?

4. Fear

As a close cousin to concerns about competence and clinical sharpness, many physicians experience anxiety about simply working a shift. I’ve seen it across all age groups and levels of experience. Some of the most confident and capable doctors I know have admitted to feeling uneasy about certain types of cases—particularly ones involving procedures or conditions we don’t routinely manage.

This isn’t unique to emergency medicine. In talking with colleagues from other specialties, it’s clear that developing a healthy sense of anxiety or fear around unfamiliar or high-stakes scenarios is more common than we admit. In the ED, for instance, few cases raise anxiety levels like a critically ill newborn or an unexpectedly difficult airway. Most emergency physicians experience a significant spike in stress when managing these outlier situations.

And that’s not necessarily a bad thing. Awareness and heightened vigilance in unfamiliar territory can make us more careful and thorough. But it’s a problem when the anxiety becomes paralyzing—when the fear of what might walk through the door starts long before you badge in. At that point, the discomfort begins to impact team dynamics and patient care. It can delay action, shift burdens to colleagues, or in some cases, drive excellent clinicians away from the field entirely.

We all understand that emergency medicine requires being comfortable with the uncomfortable. But as we age and accumulate difficult experiences and outcomes, it’s not unusual to begin avoiding that discomfort. That avoidance, especially when unchecked, can quietly undermine both individual performance and team resilience.

Ask yourself:

• What am I afraid of at work?
• Is the fear present before I even get to work or is it a particular clinical scenario?
• Is there additional training, simulation, or peer support that will help restore confidence and reduce anxiety so I can do my job.

5. Financial Readiness

I know I’m close to retirement based on my age, but I’m not quite there.  I also feel like I’m too young to retire and have more to give.  But let’s be honest—for many of us, the decision to retire is as much about financial security as anything else. Have you saved enough? Do you understand your pension, 401(k), or partnership payout? Can you afford your lifestyle without clinical income or can you adjust your lifestyle (i.e. monthly costs) and still be happy.

If the answer is no that doesn’t mean you should keep working indefinitely. It might mean it’s time to talk to a financial advisor and map out a realistic transition plan. And if the answer is yes, then the decision becomes a bit more liberating.

Ask yourself:

• What would my monthly income be without working?
• What are my monthly expenses, and can I reduce them if need be?
• Do I want to work part-time or fully retire?
• Have I built a financial plan that supports this next phase?

6. Legacy, Identity, and Purpose

Emergency medicine is more than a job. For many of us, me included, it’s part of who we are. Stepping away from the bedside can feel like losing a part of your identity. That’s normal. But it also opens the door to a new kind of purpose.

Think about how you want to be remembered. What wisdom do you want to pass on? Who could benefit from your mentorship, your experience, your leadership? Retirement isn’t an ending—it’s a shift.

Options might include: Teaching medical students or residents, Volunteering in underserved communities, Taking on administrative, consulting, or coaching roles, Writing, speaking, or leading in a professional society

Ask yourself:

• What would I do with my time if I didn’t work in the ER?
• Who can I help or mentor? What brings me fulfillment outside of clinical care?

Find an Executive Coach to Help

Just like you’d call your financial planner when you’re thinking about retirement, it might be worth talking to an executive coach, too. My wife spent her career in government and retired about 18 months ago. She worked with a coach for about six months and found it incredibly helpful in figuring out her priorities, values, and what came next.

Executive coaching isn’t therapy or consulting—it’s more like guided reflection. A good coach will ask thoughtful, sometimes uncomfortable questions that help you clarify what you really want. They won’t give you the answers, but they’ll help you find your own.

Coaching can be especially useful when you’re trying to sort through questions like: Am I leaving on my own terms? What do I want the next few years to look like? And maybe the hardest one: What am I retiring to, not just what am I retiring from?

If you’re wrestling with some of these questions—or even if you’re just trying to make a more intentional decision about your future—talking to a coach might help bring things into focus.

Conclusion: A Personal and Professional Journey

There is no one-size-fits-all answer to when an ER doctor should retire. It depends on health, engagement, skills, finances, and purpose. But avoiding the question altogether is a disservice to us, our teams, and our patients. Fortunately, the emergency medicine skill set lends itself well to multiple other clinical jobs if the decision is to transfer to a different clinical environment or role.

As department leaders, we need to create structures that allow for these conversations—annual self-assessments, peer coaching, flexible scheduling, and respectful performance evaluations. And as individual physicians, we owe it to ourselves to reflect regularly and honestly about where we are in our journey.

Retirement isn’t about stepping down. It’s about stepping into a new phase—with dignity, intention, and the same commitment to excellence that brought us to emergency medicine in the first place.

Photo by mohamad azaam on Unsplash