The TAP-IN Blog

Encore Careers Announces 2008 Purpose Prize Winners

Encore Careers is a new initiative of Civic Ventures.  "The Encore Careers campaign aims to engage millions of boomers in encore careers, providing personal fulfillment doing paid work and producing a windfall of human talent to solve society's greatest problems."

Yesterday, Encore Careers announced its 2008 role models for those of us looking to recreate ourselves in new careers for this new stage of our lives. Each of these six entrepreneurs over 60 receives a $100,000 grant to support their new work. Nine others receive $10,000 each.

All of the winners are engaged in socially beneficial activities, from inventing new technologies for poor farmers to helping war refugees to reducing toxins in household products.

As I approach the big Six Oh, I understand what has driven these people to start new careers with new purposes. We learn through our first rounds of career what it is that we'd really like to be doing, and recognizing the needs of others - and our abilities to address those needs - is one of the greatest things we learn.

This weblog contains many examples of medical professionals who - after long careers in offices and hospitals - describe whole new experiences as they practice as volunteers in clinics.

Primary Care Doctors Planning to Quit or Cut Back

Almost half of U.S. doctors surveyed by the Physicians' Foundation responded that they feel overworked to the point that they're ready to reduce their patient load or leave their practice completely. Sixty percent of the 12,000 doctors surveyed said they would not recommend medicine as a career. As the Reuters story reported:

"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.

The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.

Health care reform is near the top of the list of priorities for both Congress and president-elect Barack Obama, and doctor's groups are lobbying for action to reduce their workload and hold the line on payments for treating Medicare, Medicaid and other patients with federal or state health insurance.

Adding to their frustration, more than 90 percent of the respondents said that they've had to devote more time to non-clinical paperwork has increased in the last three years. Almost two-thirds of them blamed that for their having to spend less time with each patient.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked".

"It's not a job to anyone; it's a mission."

From Cityview Magazine of Knoxville, Tennessee

Debbie Allen believes that people’s lives can be altered, that someone can reach out to another person in need and positively impact that life forever.  It’s a notion that has inspired her as a volunteer physician at Interfaith Health Clinic, providing affordable health care to individuals without health insurance. After fourteen years regularly volunteering with the clinic, Allen chose to leave her practice and accept the fifth offer to become medical director at Interfaith Health Clinic. She has been a physician since 1981, and with the support of family, children and friends, her first day as director will be September 22, 2008.

“It’s purely about helping people who need to be helped. The other day a nurse practitioner worked overtime to make sure a man received treatment,” Allen said. “She had to go to the UT medical center and beg for help and because of her that man received care at 10 percent of the total cost. That’s what people do here. They go the extra mile. It’s not a job to anyone; it’s a mission.” Allen is only one of many health care practitioners who provide their services at no cost, she said. She treats people who have slipped through the cracks at other social service organizations; some have been sick for years without treatment, and others have undergone catastrophic events, she said. As a volunteer physician, it is rare that she sees the people she treats after they leave the clinic, but she still feels that her work has been appreciated.  “They have thanked me. They have made me feel that I did something, and it has been utterly rewarding,” Allen said.  Her hope is that the work provided at Interfaith Health Clinic creates better life opportunities for those in need.

Life Options Institute Promotes Encore Careers

"To do other things" is the response given by 70% of people asked about why they were about to retire. This article from the Life Options Institute presents the results of several studies on the coming wave of Baby Boomers reaching retirement age.

With the economy in flux and 401-K plans losing value every day, more and more baby boomers realize that they will need to continue working much longer than they ever expected, and they're rethinking how they want to spend those years, according to Joan Strewler-Carter and Stephen Carter, co-founders of the Life Options Institute, an organization dedicated to helping people plan for life after age 50.

"During this economic downturn, boomers should take pause and reflect on what they plan to do with the rest of their lives, and ask whether it's time to reinvent themselves by pursuing their dreams and turning their passion into 'encore careers'," says Mrs. Strewler-Carter.

Even the Insured May Struggle to Find Doctors

While the uninsured are challenged to find any medical care at all that they can afford. those with insurance do not necessarily face smooth sailing. Not only are many physicians opting out of treating those dependent on Medicare or MediCal, but fewer new physicians are choosing to fill the role that we've come to depend on for most health services.

The primary care physician - the internal medicine specialist who serves as the first line of health defense and referral for all - may become a rare resource if trends continue for incoming medical students. A survey published in the September 10 issue of the Journal of the American Medical Association found that internal medicine is the last option chosen by the sample of 1,177 students at 11 U.S. medical schools. Only 2% of the respondents chose that path for their careers. A similar survey from 1990 found 9% choosing internal medicine.

“It’s getting increasingly difficult to find a (family medicine) doctor especially in rural areas. It’s a tenuous situation as students look to careers that are financially rewarding because they have a lot of debt and they’re looking away from primary care,” Dr. Mark H. Ebell, the study’s author and a primary care doctor at the University of Georgia, said.

For example, medical students owe a median of $140,000 in student loan when they graduate.

There are many reasons for which medical students look away from primary care, starting with the long hours they have to work and the low pay they get for what they work. Many medical students are simply turned off by the amount of paperwork general internists have to deal with, a situation that doesn’t offer them a chance to a personal life. Many students today seek careers that offer them the chance to balance their work life with their personal life. And the thought of dealing with elderly patients with complicated diseases is another thing these medical students consider when choosing internal medicine.

Survey Finds Millions Working in "Encore Careers"

The 2008 MetLife Foundation/Civic Ventures Encore Career Survey (PDF) estimates that between 5.3 and 8.4 million Americans have already launched "encore careers,"" positions that combine income and personal meaning with social impact. The survey, conducted by Peter D. Hart Research Associates, Inc., provides some clues about what 78 million retiring Baby Boomers will do as they extend their working years into what have become known as "retirement age."

The press release summarizes the study's finding that between 5.3 and 8.4 million citizens already describe themselves as working in "encore careers," where continued income combines with personal meaning and social impact. This bodes well for the future as the larger waves of Boomers breaks on the shores of retirement age.

"This is the first national survey to uncover evidence that the encore career is more than an appealing idea," said Marc Freedman, founder and CEO of Civic Ventures, a think tank on boomers, work and aging. "Unexpectedly large numbers of boomers are looking for purpose-driven jobs that provide them with both means and meaning. That’s great for them and great for the rest of us, too. As this research shows, they are applying their skills and passions to the very public interest fields that need them most."

The report finds that a majority of Americans in this age bracket express a desire to use their skills and experience to help others. Of those currently in encore careers, 84 percent report a high level of satisfaction and 94 percent say they see the positive results of their work and know they are making a difference.

"The people who are pursuing encore careers are true pioneers," said Sibyl Jacobson, president and CEO of MetLife Foundation. "They are blazing not only their own path but also one for those just behind them – workers who share their aspirations but have not yet taken the plunge. Their message is clear: social purpose careers are fulfilling and worthwhile."

Concerns of those seriously considering encore careers matched those of people already following the encore career path. The need for continuing education and recertification looms as a worry for over a third and the loss of seniority bothered about the same percentage. Addressing these issued, the report recommends changes in workplace practices and policies that will make it easier for experienced seniors to offer their services.

Is the encore career a trend? "The millions of people now in encore careers constitute a new social phenomenon with promise for individuals and society," said Allan Rivlin, a partner at Peter D. Hart Research Associates, Inc., and director of the report. "The tens of millions interested in joining them could add up to one of the most unexpected and significant consequences of an aging America."

States Can Ease Burden on Volunteer Retired Doctors

Jennifer Bunn, RN, writes articles about health care ethics in the impressively syndicated Web log Brain Blogger. Her latest essay is titled "Charity Begins at Home - U.S. Physicians Volunteer." It describes the challenge of providing care to our 47 million uninsured citizens, but its main points are that retired doctors are a key element in responding to that challenge, and we need to lower the barriers that discourage them from volunteering.

One way to help those patients who cannot afford healthcare would be to take advantage of retired doctors who want to serve the poor. States could pay licensing fees for these volunteer doctors, and could also provide insurance coverage in return for a minimum number of hours of service.

Some states have taken the initiative in offering licenses free of charge to volunteer physicians who serve only indigent patients or who serve in areas that are underserved. Some states offer licenses at a reduced fee. Some states have adopted legislation to limit liability of volunteers. The Volunteer Protection Act, passed in 1997, sets a minimum national standard for immunity laws for volunteers. Although it sets limits on awards, it still does not provide full protection and physician volunteers, or the organizations they work for, are still responsible for medical liability insurance.

With a large number of retired physicians who are civic-minded, states could go a long way towards easing the burden of the uninsured by making it easier for retired physicians to do what they do best.

As Tap-In explains on its Web site:

All TAP-IN participating clinics will facilitate malpractice protection for any volunteer recruited by the TAP-IN program whom they decide to engage in active volunteer service. Virginia clinics offer coverage through the state's "Good Samaritan" law, which is administered by the state Division of Risk Management. North Carolina clinics offer coverage through low-cost private insurance (Medical Mutual) and/or the Federal Tort Claims Act (FTCA). Georgia clinics offer coverage through the Georgia Volunteer Health Care Program administered by the Georgia Department of Community Health. Ohio clinics offer coverage through state-reimbursed private insurance or the FTCA. Texas clinics provide coverage through the FTCA.

New Jersey Assembly Considers Volunteer Physician Immunity Bill

One of the greatest obstacles to expanding the ranks of volunteer doctors is the lack of protection from the costs of malpractice insurance. So, every time another state moves closer to providing that protection, a whole new wave of retired physicians takes a fresh look at the option of volunteering their skills and experience for the benefit of the uninsured.

The New Jersey bill, sponsored by a doctor, Assemblyman Herb Conaway, MD, "would protect physicians who provide volunteer patient care and the clinics or federally qualified health center (FQHC) where they serve from civil liability."

"Across New Jersey, there is a shortage of doctors to provide medical services to low-income residents," said Conaway.  "As a practicing physician who volunteers at a clinic I realize that the threat of liability is great and must be reduced.  It is vital that we do all that we can to attract quality doctors to donating their time to improve access to health care for the many underinsured New Jerseyans."

Conaway's bill (A-2861) would provide immunity to volunteer physicians and the nonprofit clinics or federally qualified health centers where they volunteer their services.  The measure was designed to encourage more retired doctors to volunteer their time to increase access to affordable quality health care.

"By providing immunity to physicians and the health care centers they serve at New Jersey will boost the overall health of many underserved residents," said Conaway, chairman of the health panel. 

The measure would require volunteer doctors to be licensed to practice and would make them immune from liability for care reasonably provided in good faith.

Conaway said the influx of doctors volunteering their services means citizens will have access to medical care much sooner which increases the likelihood that they will be diagnosed and treated earlier for health conditions. 

The bill was released 11 to 0.  It now heads to the Assembly Financial Institutions and Insurance Committee for further consideration.

"...because practicing medicine is lots of fun."

So says Dr. Robert Duncan about his working retirement at The Sulzbacher Center's clinic and once a month with We Care Jacksonville clinics in Jacksonville, Florida. Besides treating patients, he also teaches

"We need more retired doctors to do this," Duncan said. "It makes me want to read more about medicine, and keep up with things."

The article in the Jacksonville Business Journal describes how retired physicians retain malpractice insurance coverage as volunteers in Florida.

Retired physicians retain some form of medical malpractice coverage to cover the possibility of a retroactive claim being filed. Once a retired physician begins to practice again and get compensated for practicing, the coverage is void.

"You can't work for money, but you can volunteer," Duncan said. "I'd prefer to work as a volunteer" at this point.

"Tail coverage" is optional protection that allows a physician to report malpractice claims after a policy has ended for alleged injuries that occurred during the time the physician's policy was in force.

"My patients weren't getting the good care that I wanted to give them "

In a story featured on CNN, we meet a true hero of the uninsured. Dr. Lorna Stuart, frustrated by the paperwork and insurance issues that had begun to dominate her work hours, quit her practice and opened a free clinic. The video piece is very uplifting.

She confided her desire to start a clinic in the Rev. Marie Swayze, her friend whose parish property was home to a Victorian-style rectory that had become dilapidated from disuse.

The two concocted a plan to restore and remodel the mansion into a place that anyone would be happy to visit for quality medical care.

Then, leaving private practice, Stuart sold her house and set out to raise $400,000 in donated funds, materials and services. In 2002, these efforts resulted in "The Clinic: Medical Center for the Uninsured," a charitable, sun-filled clinic that has since received more than 40,000 patient visits.

Individuals receive free or low-cost primary medical care across eight specialties, regardless of income or locality.