Winding up to wind down: designing the end of one's medical career with intentionality.

Background: Physicians are planful beings, spending much time imagining and trying to design their ideal careers. Yet, despite actuarial expectations that physicians may spend almost two decades in retirement, it is paradoxical that little attention is generally given to designing an ideal retirement.

Methods: The coauthors are physicians in the latter parts of their careers who both teach leadership to physicians and have thought deeply about physician transitions, including retirement. This perspective narrative is based on their observations, actual experience of colleagues who have retired well and their review of relevant literature.

Results: Several forces restrain physicians from imagining an ideal retirement: first, as with people in general, physicians may be averse to change, and second, thinking about retirement may be framed through a deficit-based lens (eg, "I am retiring because I want to avoid some unpleasant features of my current career.") Though physicians are predisposed to deficit-based thinking by virtue of their longstanding practice of developing differential diagnoses in clinical reasoning, appreciative or asset-based thinking about retirement (eg, "I am retiring because I am attracted to activities that have not otherwise been possible in my career.") offers richer possibilities and is encouraged. A rubric for navigating retirement regards being intentional about identity, relationships and purpose in the new state. A taxonomy for types in retirement is offered, recognising that physicians may exemplify more than one type or migrate among them. Finally, several examples of successful retirement by the authors' colleagues are offered.

Conclusions: We endorse physicians' being as planful and intentional about retirement as they are about designing their careers. Our hope is that the described issues and approach enhance physicians' likelihood to achieve the fulfilment and impact in retirement that they seek.