My primary-care doctor is retiring and it feels a little too much like a break-up. I’m sad. I’m worried. I tried to guilt him into staying.

I’ve been with Eliot Nierman at Penn Internal Medicine since 2002, when I moved to Philadelphia. It’s one of the longest relationships in my life, and it’s not just that I trust him, he trusts me. And when things got bad, really bad, he was there for me when other doctors bailed.

I was in a hospital in Kansas, where I was working as a visiting professor. One day, I came home from class and suddenly couldn’t see. My blood pressure was in the stroke range, although I’d had a checkup two weeks earlier and been fine.

No one could figure out what was going on. The Kansas doctor I’d seen refused to return calls, and her nurse told me I needed to speak with the hospitalist. I was terrified. So I called Nierman, although he was 1,165 miles away. He called me back within an hour, answered my questions, and also reached out to the Kansas hospitalist. He helped me connect with the Mayo Clinic, reaching out to a former Penn doctor whom he knew there. A year later, when I came home to Philly, Nierman sat down with me for more than an hour, went over all the tests, and we figured out a way forward.

Now I have to forge a new path with a new doctor, who doesn’t know me at all. I’m not the only one dreading this journey. According to a 2020 survey from the Association of American Medical Colleges, two out of five physicians will be over 65 in the next decade. Although one survey found that the vast majority of doctors (96%) said they won’t leave medicine because of the pandemic, another said 22% are thinking about retiring early.

At least I had some warning. Often caregivers have just left, and I found out when I called to make an appointment. But in May I received a retirement head’s up from Nierman, saying that he was planning on retiring at the end of June.

Nierman grew up in a suburb of Boston, graduated from Harvard College in 1971 and Harvard Medical School in 1976 before joining the first tiny class of four residents to specialize in general internal medicine at the Hospital at the University of Pennsylvania. He first planned on majoring in physics, but overheard a doctor on the phone at a student health clinic and thought he’d enjoy helping people in a similar way.

“I was drawn to primary care,” he wrote in one alumni letter, “because I liked helping people and feeling their gratitude toward me. This emotional reward, rather than medicine as a science, which has never appealed to me as much as the physical sciences do, was and remains my motivation.”

In an interview, Nierman said he hadn’t changed much over the last decades, but medicine had. When he started practicing medicine at Graduate Hospital, internal medicine doctors visited their patients in the hospital, before and after their regular office visits, even serving as the primary attendings in the ICU unit.

Although some aspects of medicine have become more advanced, there is less time with patients, and more reliance on tests and specialists, which makes him feel a bit like a “dinosaur,” he said. One daughter carries on the tradition as an internal medicine doctor in New York City, another daughter works for a high-end travel agency, he said.

The choice to retire was not an easy one, even at 72, he said. A majority of his patients have been with him for decades, and he cares for some of their adult children. The ones who stay with him, he said, have to be comfortable with his “style” of medicine, which Nierman describes as preferring to be the first point of care, and less reliant on consultants. He also is open about his own experiences with the health system, particularly when he had prostate cancer four years ago, and living with a chronic allergic cough.

I would describe his “style” as direct but kind. Some doctors get defensive when their patients ask questions, and as a medical reporter, I tend to have quite a few. Nierman never seemed bothered when I pulled out my notebook, and when I needed major surgery to remove a tumor, he told me to reach out to him if I couldn’t get ahold of the surgeon (who was not always thrilled with my questions).

The idea of retiring came up around his 60th birthday, he said, telling his family he’d probably stop by the time he turned 70. He dropped to an 80% schedule in 2020, and stopped doing 14-day rotations at the hospital. It was a hard decision, he said, because he enjoyed working with the medical students and residents, but it was physically exhausting.

When the pandemic hit, as an older doctor, he felt a little sidelined, the last to see patients face-to-face because of the COVID risks. Having been on the front lines of the AIDS pandemic, it was an adjustment to switch to telemedicine, but also a wake-up call that maybe it was time to move on.

He plans on seeing a lot of his four grandchildren, traveling as COVID allows, and, as written in his letter to patients, inviting them to reach out for coffee or a game of pickleball.

“It has been such a pleasure to be your primary-care physician. I will miss you and the opportunity to share so much of your lives,” he wrote. “I wish you all the best for your future health and happiness. I will never forget you.”

Tips for choosing a new doctor

Although some practices will assign a new doctor when one retires, Nierman emphasized that it’s important to find someone who is a good fit.

  • Don’t be afraid to move practices.

  • Ask your doctor for a referral to someone who would be a good fit for your personality and medical situation.

  • Ask for referrals from friends. People who love their doctors are not hesitant to recommend them.

  • Be honest with your new doctor about what you’re looking for. Oversight of an ongoing condition? How does the doctor like to be contacted, if at all?

  • Don’t hesitate to show gratitude toward the medical professionals who take care of you. That doesn’t mean gifts, Nierman said, but sometimes simply saying “Thank you for taking the time to answer all my questions.”

Dawn Fallik is an associate professor of journalism at the University of Delaware, and is a former Inquirer health reporter.