Men Still at Work: Professionals Over Sixty and on the Job (15 page)

Neil’s advice for men considering working beyond conventional retirement age derives from his parenting philosophy and personal experience. “The messages too many guys learn about masculinity at an early age fosters a selfish ‘I win–you lose’ approach to problem solving. Young men, particularly gang members and boys who grow up without fathers in their lives, need messages that move them away from ‘win-lose’ and help them to make healthy life choices. Older men serving as role models for younger men can make a real difference. By mentoring and teaching younger men about healthy behaviors, they can leave the kind of legacy a granddad wants to leave for his grandkids. You’re never too old to affect the way you will be remembered!”

Professional men need to be well educated, and the survey respondents certainly prove that point. Nearly every one (94 percent) has at least a bachelor’s degree. Three-quarters of the men have a master’s, doctorate, or other advanced professional degree, such as an MD or JD. This is also true of the women I surveyed. While both genders are highly credentialed, I did detect an interesting difference in the type of advanced degree attained. Nearly one-half of the women have a master’s, two master’s, or credits beyond the master’s compared to 22 percent of the men, whereas more than half of the men have a doctorate or other advanced professional degree compared to one-third of the women. That men earned far more doctorates and advanced professional degrees than women does not mean they are brainier. It is no doubt associated with the time women gave to bearing and raising children, the lower-paying occupations open to them when they finished college, and the challenges they faced when attempting to break into fields (and graduate programs) where men once predominated.

Times have changed and the gender gap in educational attainment discussed earlier has been reversing in recent years. According to the US Department of Education’s National Center for Educational Statistics, female attainment has been surpassing male attainment at each educational level since 1980.
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In addition, on average, younger adults in the United States are completing more bachelor’s degrees today, whereas older adults have earned more advanced degrees:

Adults sixty-five and older with a bachelor’s degree or higher: 22.1 percent

Adults sixty-five and older with a graduate or professional degree: 9.8 percent

Adults twenty-five to twenty-nine with a bachelor’s degree or higher: 32 percent

Adults twenty-five to twenty-nine with a graduate or professional degree: 7 percent

Then again, times have not completely changed in some respects. When it comes to taking time out from work or schooling to provide family care, the current US Census tells us that women in the twenty-five to sixty-two age bracket still do most of it: 93.1 percent of women versus 6.9 percent of men. They interrupt work to care for children most often (94.7 percent), or an elder relative (3.8 percent), or a disabled relative (1.5 percent).
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So when I saw that merely three of the 156 older men I surveyed had taken some time out for childrearing, I was not surprised that they completed more advanced degrees than their female counterparts, who, in contrast, had taken time out for childrearing (58 percent). As to adult caregiving, the percentage of respondents who had provided or were still providing it was low for both the men and women I studied (3 percent and 4 percent, respectively) and did not necessarily entail a career interruption if other family members pitched in or paid help was available.

Educational attainment usually is an important consideration but not the sole factor in salary decisions. A professional’s income can depend on many factors besides education, notably part-time versus full-time job status, career field, rank or title, experience level, length of service, job performance (skills and ability), and more. Although several of the main indicators of economic expansion have started to trend upward—for example, increases in construction, manufacturing, and consumer confidence—companies are keeping wages and salaries in check and remain cautious about hiring. A pervasive feeling of anxiety about the economy lingers. One sixty-three-year-old businessman shared a long list of his concerns with me: rising health-care costs, the cost of implementing “Obamacare,”
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potential changes in the tax rates, the worldwide economic climate and its effect on the United States, the US debt structure and its effect on the economy and retirees, and the solvency of Social Security and Medicare.

To find out how well older men are faring salary-wise in the workforce, my survey asked respondents to indicate current personal income in one of three categories: “modest” (under $30,000), “middle” ($30,000 to $79,000), or “higher” (more than $80,000).
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All but four of the full-time and part-time workers were willing to share information about their salary range. Regardless of age or field, nearly three-quarters of the senior men (71 percent) have incomes in the higher category, 13 percent have modest incomes, and 16 percent have incomes in the middle range. Since the average annual earned income for American men ages sixty to seventy-four is approximately $50,000,
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most of my respondents appear to be well above average. Across all the older age groups, the majority—just shy of two-thirds—are working full time. Nearly half of the men who are working part time appear to be doing very well in terms of personal income, despite working fewer hours.
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This is true of Steve Schoenbaum, who made a smooth transition to foundation work from medicine and health-care management and is now working part time. After distinguishing himself as a clinical epidemiologist and then a health-care administrator with a focus on health policy and high performance delivery of care, Steve moved to a different arena—national grant-making. He spent a decade overseeing programs for the Commonwealth Fund before accepting a part-time position in 2010 with the Josiah Macy Jr. Foundation. At the foundation, he works on grant making, organizes meetings, and prepares talks and papers on medical education. Steve loves the intellectual stimulation of new challenges and has no idea how long he will continue working. “I’m seventy-one, semi-retired, and feeling great!” he enthuses.

Profile: Stephen C. Schoenbaum

According to a September 2012 report from an Institute of Medicine expert panel, an estimated $750 billion or approximately thirty cents of every dollar spent on health care is squandered because of unnecessary services, inefficient delivery of care, excess administrative costs, inflated prices, prevention failures, and fraud. The report goes on to compare health-care inefficiencies to several major industries, such as banking: “ATM transactions would take days”; home building: “carpenters, electricians, and plumbers would work from different blueprints and hardly talk to each other”; shopping: “prices would not be posted and could vary widely within the same store, depending on who was paying”; and airline travel: “individual pilots would be free to design their own preflight safety checks—or not perform one at all.” And the panel concludes that “American health care is falling short on basic dimensions of quality, outcomes, costs and equity.”
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These are the very issues that have preoccupied Dr. Stephen Schoenbaum for most of his forty-six-year career. With a master’s degree in public health and a medical degree from Harvard, in 1967–68 Steve trained in communicable diseases at the Centers for Disease Control (CDC) in Atlanta under the tutelage of noted epidemiologist Dr. Alex Langmuir, founder of the CDC’s Epidemic Intelligence Service. “Alex took me under his wing, trained me, and became my professional father figure and a friend.” Steve’s specialization in infectious diseases first landed him a clinical position at the Brigham and Women’s Hospital in Boston. He went on to help establish the Department of Population Medicine at Harvard Medical School, then served as deputy medical director at Harvard Community Health Plan from 1981 to 1993.

During this period, Steve worked closely with his colleague Dr. Donald Berwick to increase the value and quality of health care. Berwick was the plan’s vice president of quality-of-care management and an advocate of practices that improve care and reduce cost. He drew attention to waste in health care, for example, overtreatment, failure to coordinate care, and fraud. (Berwick later served as administrator of the Centers for Medicare and Medicaid Services from 2010 to 2011 through a highly contentious Obama administration recess appointment.) The two colleagues wanted hard evidence to show how the vast amounts of money spent on health care could produce better outcomes. “Health care professionals always
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they were delivering the very best care, but there was no measurement of it until we, along with others, created the tools collectively called HEDIS, the Healthcare Effectiveness Data and Information Set.” Now further expanded and maintained by the National Committee for Quality Assurance, HEDIS is used by more than 90 percent of America’s health plans and other providers to measure and compare performance on important dimensions of care and service.

Steve went on to become the medical director and then president of Harvard Pilgrim Health Care of New England from 1993 to 1999. As it turned out, he was the
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president of that organization. Harvard Community Health Plan of New England had started as Rhode Island Group Health and later was taken over by Boston-based Harvard Community Health Plan. Although the Rhode Island component ran an efficient operation, it was bleeding red ink. Even though expenses were relatively lean, revenue did not match those expenses. Steve was “up to his eyeballs in alligators.” He “saw the end coming” but chose not to jump ship. In late 1999, Harvard Pilgrim Health Care jettisoned the Rhode Island entity, which went into receivership and was liquidated. A few months later, the attorney general of Massachusetts put Harvard Pilgrim Health Care itself into receivership but helped to save it.

By late 1999, it was necessary to move on. Steve considered returning to clinical medicine, but chose instead a job that tapped not only his management skills and experience but also his interest in health policy and delivery of care. From 2000 to 2010 he was executive vice president for programs at the Commonwealth Fund, as well as executive director of the Fund’s Commission on a High Performance Health System. The Commonwealth Fund is a national grant-making foundation based in New York City that supports independent research on health-care issues and makes grants to improve health care practice and policy.

At the end of 2010 Steve left the Commonwealth Fund and full-time employment, accepting a new position as special advisor to the president of the Josiah Macy Jr. Foundation, where he works two days a week. Macy is a national foundation dedicated solely to improving the health of the public by advancing the education and training of health professionals. At Macy he works on grant making, organizes meetings, and prepares talks and papers on medical education.

Like most private foundations, Macy saw the recession take a bite out of its endowment but continued to support existing commitments and make new grants. Instead of the just passively responding to grant-seeking appeals from organizations, Macy’s staff is increasingly proactive, reaching out to potential grantees and advising on the development and functioning of projects.

When I asked Steve how long he plans to continue working, he confessed that he has no idea. “I’m seventy-one, semi-retired, and feeling great! Living and working in New York City, I have to walk a lot. My schedule is flexible and I can work from practically anywhere.” Most of Steve’s friends in medicine and in academe are still working. “Frankly,” he says, “I don’t know many people who think in terms of conventional retirement age.” At the same time, he points out, there are so many new developments in medicine, it is hard for older professionals to keep up. Their clinical skills may be pretty good, but not cutting edge. Still, there are other ways to stay involved, and they need not retire. “Personally speaking, I need something new to learn every five years or so.” He loves the intellectual stimulation of a new challenge, even if he’s simply changing positions within the same organization. “I tend to burrow into the work and make changes until I’ve solved the problem,” he notes.