Physician Retirement Research Articles

Medical School Admissions: Focusing on Producing a Physician Workforce That Addresses the Needs of the United States.

The aging population, burnout, and earlier retirement of physicians along with the static number of training positions are likely to worsen the current physician shortage. There is an urgent need to transform the process for selecting medical students. In this Invited Commentary, the authors suggest that to build the physician workforce that the United States needs for the future, academic medicine should focus on building capacity in 3 overarching areas. First, medical schools need to develop a more diverse pool of capable applicants that better matches the demographic characteristics of health care trainees with those of the population, and they need to nurture applicants with diverse career aspirations. Second, medical schools should recalibrate their student selection process, aligning criteria for admission with competencies expected of medical school graduates, whether they choose to become practicing clinicians, physician-scientists, members of the public health workforce, or policy makers. Selection criteria that overweight the results of standardized test scores should be replaced by assessments that value and predict academic capacity, adaptive learning skills, curiosity, compassion, empathy, emotional maturity, and superior communication skills. Finally, to improve the equity and effectiveness of the selection processes, medical schools should leverage innovations in data science and generative artificial intelligence platforms. The ability of ChatGPT to pass the United States Medical Licensing Examination (USMLE) demonstrates the decreasing importance of memorization in medicine in favor of critical thinking and problem-solving skills. The 2022 change in the USMLE Step 1 to pass/fail plus the exodus of several prominent medical schools from the U.S. News and World Report rankings have exposed limitations of the current selection processes. Newer approaches that use precision education systems to leverage data and technology can help address these limitations.

Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021

Physician work hours are an underexplored facet of the physician workforce that can inform policy for the rapidly changing health care labor market. To examine trends in individual physician work hours and their contribution to clinical workforce changes over a 20-year period. This cross-sectional study focused on active US physicians between January 2001 and December 2021 who were included in the Current Population Survey. Outcomes for physicians, advanced practice professionals (APPs), and nonphysician holders of doctoral degrees were compared, and generalized linear models were used to estimate differences in time trends for weekly work hours across subgroups. Physician and APP workforce size, defined as the number of active clinicians, 3-year moving averages of weekly work hours by individual physicians, and weekly hours contributed by the physician and APP workforce per 100 000 US residents. A total of 87 297 monthly surveys of physicians from 17 599 unique households were included in the analysis. The number of active physicians grew 32.9% from 2001 to 2021, peaking in 2019 at 989 684, then falling 6.7% to 923 419 by 2021, with disproportionate loss of physicians in rural areas. Average weekly work hours for individual physicians declined by 7.6% (95% CI, -9.1% to -6.1%), from 52.6 to 48.6 hours per week from 2001 to 2021. The downward trend was driven by decreasing hours among male physicians, particularly fathers (11.9% decline in work hours), rural physicians (-9.7%), and physicians aged 45 to 54 years (-9.8%). Physician mothers were the only examined subgroup to experience a statistically significant increase in work hours (3.0%). Total weekly hours contributed by the physician workforce per 10 000 US residents increased by 7.0%, from 13 006 hours in 2001 to 2003 to 13 920 hours in 2019 to 2021, compared with 16.6% growth in the US population over that time period. Weekly hours contributed by the APP workforce per 100 000 US residents grew 71.2% from 2010 through 2012 to 2019 through 2021. This cross-sectional study showed that physician work hours consistently declined in the past 20 years, such that physician workforce hours per capita lagged behind US population growth. This trend was offset by rapid growth in hours contributed by the APP workforce. The gap in physician work hours between men and women narrowed considerably, with diverging potential implications for gender equity. Increasing physician retirement combined with a drop in active physicians during the COVID-19 pandemic may further slow growth in physician workforce hours per capita in the US.

Implementing leading practices in regional-level primary care workforce planning: Lessons learned in Toronto.

Investment in capacity for implementation of leading practices in regional-level health workforce planning is essential to support equitable distribution of resources and deployment of a health workforce that can meet local needs. Ontario Health Toronto and the Canadian Health Workforce Network (CHWN) co-developed and operationalized an integrated workforce planning process to support evidence-based primary care workforce decision-making for the Toronto region. The resultant planning toolkit incorporates planning processes centred around engagement with stakeholders, including environmental scanning tools and a quantitative planning model. The outputs of the planning process include estimates of population need and workforce capacity and address challenges specific to Toronto, such as patient mobility, anticipated rapid population growth, and physician retirement. We highlight important challenges and key considerations in the development and operationalization of workforce planning processes, particularly at the regional level.

Engaging Retired Physicians as Educators: Motivations and Experiences of Participants in a Novel Educational Program.

Physician retirement has important impacts on medical learners as well as retiring physicians themselves. Retiring physicians take with them a wealth of knowledge, wisdom, and expertise and can feel a loss of identity, lack of fulfillment, and reduced social connectedness after leaving the institution. To address this, a novel educational program providing retired physicians with renewed educational roles was implemented in 2018 within a university-associated pediatric department. This study sought to explore the retired physicians' experiences in this new intergenerational program, including their motivations to reengage as educators after retirement. The authors designed this study using qualitative description. Semistructured interviews were conducted in the Department of Pediatrics of McGill University in 2019 with retired physicians who participated in the educational program's inaugural year. Role theory and psychosocial development theory were used to design the interview guide and inform the thematic analysis. Iterative analysis of the interview transcripts was deductive and inductive. Of the 8 retired physicians who participated in the program's first cohort, 7 participated in this study. Analysis of the data yielded 4 main themes: a challenging shift to retirement, a desire for reengagement after retirement, role dissonance, and gaining by giving. The retired physicians were motivated to engage as educators. Although they experienced some discomfort in their new nonclinical roles, they described their experiences as fulfilling, with benefits such as intellectual stimulation, social connectedness, and a sense of purpose. Retired physicians' motivations to reengage academically and their experiences contributing to educational activities in this program highlight the importance of supporting physicians during the transition to retirement and establishing formal programs to engage retired physicians as educators.

The effects of physician retirement on patient outcomes: Anticipation and disruption

The physician retirement rate in the United States is increasing as the population ages. I use an event study model allowing for anticipation to evaluate the effects of primary care physician (PCP) retirement on elderly adults’ health care utilization and quality of care. I find that, despite moderate anticipatory effects, PCP retirement results in an approximately $572 increase in total Medicare costs per beneficiary in the first 1.5 years post-retirement and an over 10% increase in detection of new chronic conditions. Heterogeneity analyses show that the increase in costs is disproportionately driven by the retirement of solo practitioners; Medicare beneficiaries with a retired PCP practicing in states with mandatory physician departure notice experience less disruption in care; and beneficiaries living in primary care health professional shortage areas experience greater disruption in care.

Cognitive Screening for Senior Physicians: Are We Minding the Gap?

ABSTRACTSenior physicians are an invaluable community asset that comprise an increasing proportion of the physician workforce. An increase in demand for health care services, with demand exceeding the supply of physicians, has contributed to discussions of the potential benefit of delaying physician retirement to help preserve physician supply. The probable increase in the number of senior physicians has been associated with concerns about their competent practice. Central to this issue are the changes that occur as part of normal aging, how such changes might impact medical practice and what steps need to be taken to ensure the competency of senior physicians. We propose that while age may be an important risk factor for performance issues, it is not the only factor and may not even be the most important. Data on cognitive performance among physicians referred for behavioral and performance concerns reveal that cognitive impairment afflicts physicians across the career span. If the overarching goal is to prevent patient harm through early detection, older physicians may be too narrow a target. Approaches focusing on health screening and promotion across the career span will ultimately be more effective in promoting workforce sustainability and patient safety than age-based solutions.

Strengthening the public health workforce in Slovakia through professionalization

Abstract Issue The Coalition of Partners (CoP) takes collective action to strengthen public health (PH) services and capacities across the WHO European Region. A review of the implementation of the European Action Plan for Strengthening PH Capacities and Services showed that, despite robust action, its potential remained largely unrealized. In 2017-2018 Slovakia has joined the WHO activities aimed to accelerate a progress in Europe and in individual Member States. One of the main problem of the Slovak PH system is a lack of experts and unbalanced infrastructure. Description of the problem The critical shortage of PH workforce in Slovakia is a result of increasing retirement of physicians, decreasing interest of young physicians and PH professionals to enter to PH practice, and limited opportunities for other professionals in the current PH system. Therefore, the Ministry of Health (MOH) and the Public Health Authority of the SR, the relevant academic institutions and non-governmental organisations agreed to deal with strengthening the PH workforce and took the responsibility for mobilizing the resources needed to implement the Agenda for Action. Results In September 2019, regional PH institutes, universities, professional associations, and other experts were invited to evaluate the PH workforce professionalization using a rapid assessment tool (Czabanowska, Slock, 2019). In October-December 2019, three national round tables were held with aim to formulate the areas for cooperation. In February 2020, the core team and three expertś teams were nominated by the State secretary of the MOH to continue on prioritising the future recommendations in the fields of: education and training, research and development, system and financing. Lessons The initiative supporting PH professionalization has a potential to form a national CoP on strengthening PH capacities and services. Its long-term vision is focused on effectively and efficiently governed PH system in Slovakia. Key messages In Slovakia, strengthening the public health workforce is essential. Started cooperation on supporting public health professionalization is an important step for future actions at national level.

MINdI: Mindfulness Instruction for New Interns.

IntroductionTrainee burnout has reached epidemic proportions and is increasing among physicians compared to non-health care professionals. Burnout is associated with depression and lower empathy, poor patient adherence to medical plans, and early physician retirement. Mindfulness is the quality of being nonjudgmental and present and has been shown to decrease physician burnout. Implementation of mindfulness curricula may decrease trainee burnout.MethodsUsing Kern's six-step approach, we developed an easy-to-implement, facilitator-friendly mindfulness curriculum for pediatric interns. Curricular sessions were held monthly during preexisting 1-hour didactics over 6 months, facilitated by individuals without mindfulness experience. Learners were assessed on knowledge, attitudes, and behavior with postintervention surveys during a pilot in 2016. Qualitative data were used for curricular improvement resulting in the published curriculum.ResultsPostcurriculum surveys from our pilot revealed that 69% of interns reported a more positive attitude toward mindfulness, while 62% reported having (1) greater knowledge about evidence supporting mindfulness, (2) improved knowledge on how to apply mindfulness techniques, and (3) the belief that techniques they had learned positively impacted their lives. Thirty-three percent endorsed using mindfulness techniques more frequently than they had prior to the start of the mindfulness curriculum.DiscussionOur novel curriculum provided longitudinal mindfulness training that meaningfully impacted trainee knowledge, behaviors, and attitudes. The curricular structure overcame the need for local topic experts and was feasible to implement within the confines of our complex program structure. Ongoing work will determine the impact of our curriculum on objective measures of burnout, empathy, and mindfulness.

Life Beyond Medicine: The Joys and Challenges of Physician Retirement

Life Beyond Medicine: The Joys and Challenges of Physician Retirement

El retiro digno del médico.

Retirement of physicians from their professional activity is a subject of global interest. In Mexico, there is no official regulation that determines the age at which physicians should retire from their profession as in other countries. This symposium presents the measures implemented at the ABC Medical Center in recent years about physicians' retirement, with the establishment of a committee. This has been achieved in part also with the creation of group medical practices that integrate doctors in their different specialties, whose interest among other aspects of individual and collective interest, is the establishment of a retirement fund.

Does Physician Retirement Affect Patients? A Systematic Review.

Older patients that have aged with their doctors will likely experience their physician retiring. It is unclear if this interruption in continuity of care leaves patients at risk for adverse events or whether a new physician improves care. We sought to identify and synthesize findings from all articles examining the association between physician retirement and patient outcomes. Systematic review. We searched English-language articles cataloged in Medline, Embase, Cochrane, and PsycINFO, from database inception to May 4, 2018. Any patient whose physician (generalist or specialist) retired. Physician retirement, defined as voluntary practice closure, death, or departure. Articles were categorized as anecdotes, qualitative studies, or quantitative studies. Each patient outcome was indexed under one of 11 themes (eg, adverse event, difficulty accessing care) and classified as favorable, neutral, or unfavorable. Patient outcomes included but were not limited to clinical (eg, death), resource utilization (eg, hospitalization), treatment plan adherence (eg, access to medications), and patient satisfaction (eg, expressed frustration). Two reviewers independently assessed study quality. Of 2099 articles screened, 17 met inclusion criteria: 12 anecdotes, 2 qualitative studies, and 3 quantitative studies. Most patient outcomes described were unfavorable. These included feelings of loss, difficulties with transition to a new provider, adverse clinical outcomes, and increased use of high-cost services. The quality of qualitative studies was high, but that of quantitative studies was poor or moderate. Current evidence from qualitative studies suggests physician retirement affects patients unfavorably and that patients are vulnerable during this transition of care. High-quality quantitative research is lacking to identify whether this disproportionately affects older adults and whether physician retirement has significant consequences for the broader healthcare system. J Am Geriatr Soc 68:641-649, 2020.

End-of-career practice patterns of primary care physicians in Ontario.

To characterize the process of end-of-career attrition among primary care physicians. Longitudinal, open cohort, population-based study of primary care physicians using health administrative data from ICES.Setting Ontario. All family physicians providing comprehensive care between 1992 and 2013. Changes in workload and scopes of practice over time. The cohort included 15 552 family physicians who provided comprehensive care at some point during the study period. Physicians reduced workloads and narrowed scopes of practice in advance of full retirement at an average age of 70.5 (95% CI 70.1 to 70.8) years. Female physicians provided fewer clinical services than male physicians did and retired 5 years earlier. Canadian medical graduates provided fewer clinical services and retired 2 years earlier than international medical graduates did. Up to 60% of physicians stopped providing comprehensive primary care before retirement, continuing with other clinical activities, at reduced workloads, for an average of 3 years before retiring fully. End-of-career practice patterns are characterized by gradual, modest changes in the provision of services rather than abrupt declines, and the retirement process unfolds differently for different physicians. This study highlights the importance of considering physician workload, scope of practice, and demographic factors for more accurate prediction of physician retirement trends and effective work force planning.

Will the Real Physician Retirees Please Stand Up?

Policy makers and health workforce planners rely on counts of practice licences as a measure of the size of the active physician workforce. We use a population-based approach to correlate estimates of retirement from clinical care based on these data with those produced using physician payment data. We find that licensure data generates per-capita estimates of physician supply in British Columbia that are substantially higher than activity-based estimates. Licensure data are unlikely to produce reliable estimates of the timing and extent of physician retirement and therefore should not be used as the primary basis for estimating current or future physician supply.

Effect of Surgeon Age on Bariatric Surgery Outcomes.

This study sought to explore the relationship of bariatric surgeon age and patient outcomes. Regulators, policy makers, and patient advocacy groups have recently been pushing to establish clear guidelines for physician retirement in the United States. Although it is often assumed that increasing physician age leads to worse patient outcomes, the relationship is lacking robust evidence, and is still unclear. We conducted a study analyzing all bariatric surgeons in Michigan who participated in a statewide collaborative quality improvement program (n = 71) who performed primary laparoscopic Roux-en-Y Gastric Bypass, or sleeve gastrectomy operations, and data on their patients (n = 60430) over the past 10 years. Our primary outcomes were 30-day postoperative complications. Odds ratios for overall complications and serious complications were calculated for each age group, and surgery type. Late career surgeons had more bariatric surgery experience and had a higher average annual case volume than early career surgeons. Considering all cases in the past 10 years, older surgeons performed more Roux-en-Y Gastric Bypass (40%) and less sleeve gastrectomy (38.8%) than younger surgeons (34.7% and 51.5%). When adjusting for patient and surgeon characteristics, there were no statistically significant differences in overall or serious complication rates for either procedure among surgeon age groups. When evaluating bariatric surgeons in the State of Michigan, we found no statistically significant association between surgeon age and patient outcomes. Our findings do not provide evidence for age-specific retirement cut-offs, but support the development of guidelines which are holistic, and focus on evaluating and improving physician outcomes at all career levels.

Patterns of physician retirement and pre-retirement activity: a population-based cohort study.

Knowing when physicians retire and how they practise in the pre-retirement years is important information for health human resource planning. We identified patterns of retirement for physicians in British Columbia and the determinants of when and how physicians retire. For this population-based retrospective cohort study, we used administrative data to examine activity levels and to identify retirements among BC's practising physicians. We included all physicians who were at least 50 years of age as of March 2006 and who had received payments for clinical services in at least 1 year between 2005/06 and 2011/12. We defined retirement as a permanent drop in monthly payments to less than $1667/month ($20 000/yr). We examined the patterns and timing of retirement by age, sex, specialty and location using linear and logistic regression models. Of the 4572 physicians who met the inclusion criteria, 1717 (37.6%) retired during the study period. The average age at retirement was 65.1 (standard deviation 7.8) years. Controlling for other demographic and practice characteristics, we found that women and physicians working in rural areas retired earlier, by 4.1 (95% confidence interval [CI] -4.9 to -3.2) years and 2.3 (95% CI -3.4 to -1.1) years, respectively. We found no difference in retirement age by specialty. We identified 4 patterns of pre-retirement activity: slow decline, rapid decline, maintenance and increasing activity. About 40% of physicians (440/1107) reduced their activity levels by at least 10% in the 3 years preceding retirement. During the study period, physicians in BC - particularly women and those in rural areas - retired earlier than indicated by licensure and survey data. Many physicians reduced their practice activity in the pre-retirement years. These trends indicate that forecasts relying on licensure "head counts" are likely overestimating current and future physician supply.

Physician retirement: gender, geography, flexibility and pensions.

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.170231][2]][2] KEY POINTS Although much attention is given to how to meet the increasing demands placed on Canada’s health care system as its population ages, there has been little consideration of the needs of aging physicians. In

Commentaries on health services research

Commentaries on health services research

Planning for retirement from medicine: a mixed-methods study.

Evidence suggests there are important personal and social consequences associated with inadequate retirement planning for physicians. We evaluated whether academic physicians felt satisfied with their retirement planning, and identified obstacles to retirement planning and a set of factors to facilitate retirement planning. We applied a sequential mixed-methods research design to explore and examine factors that facilitate academic physician retirement planning using data collected from multiple sources (including 7 focus groups, an internet-based survey and 23 in-depth interviews). We examined survey results regarding retirement planning satisfaction and preferences for complete versus gradual retirement. We used thematic analysis to examine verbatim transcripts and notes from the focus groups and interviews. Survey data (response rate 51%) indicated that 10% of respondents were very satisfied with their retirement planning and 89.5% would prefer to retire gradually rather than stop work completely. Key barriers to retirement planning that emerged included poor personal financial management, rigid institutional structures and professional norms. Facilitators included financial planning resources for physicians at multiple career stages, opportunities and resources for later-career transitions and later-career mentorship support for intergenerational collaboration, and recognition of retirees. Key findings highlight perceived barriers to retirement planning at various career stages in addition to factors that can enhance physicians' retirement planning, including creating gradual and flexible retirement options, supporting ongoing discussions about financial planning and later career transitions, and fostering a culture that continues to honour and involve retirees. Medical institutions could foster innovative models for later-career transitions from medicine in ways that address physicians' needs at various career stages, support gradual transitions from practice and recognize the value of experienced, capable later-career physicians and retirees.

A Systematic Review of Physician Retirement Planning

Background: This systematic review identified empirical studies to elaborate on the understudied aspect of retirement timing related to physician’s preparation and engagement with the retirement planning process. Four questions were addressed: 1) When do physicians retire? 2) Why do some physicians retire early? 3) Why do some physicians delay their retirement? 4) What are some strategies that facilitate physician retention and/or retirement planning? Methods and Findings: English-language studies were searched in electronic databases through June 2015 to meet the following inclusion criteria: peerreviewed primary journal articles, published with quantitative or qualitative analyses of planning and opinions about physician retirement. Three independent reviewers assessed each study for methodological quality and a third reviewer resolved inconsistencies. In total, 60 studies meet the inclusion criteria and were analyzed. Representative sampling was used in 75% of studies, however most did not control for confounding variables. The majority were methodologically strong. Physicians commonly reported retiring between 60 and 69 years. Excessive workload and burnout were frequently cited reasons for early retirement. Obstacles to continuing practice included: career dissatisfaction, workplace frustration, and workload pressure; whereas, ongoing financial obligations delayed retirement. Conclusions: This is the first review of literature related to early, late, and on-time retirement of physicians. Health organizations aiming to either delay or encourage retirement should accommodate flexible working hours, provide resources and information about financial planning, and consider stipulations in practice plans that clarify timing and transitions from medicine.

Future growth of physicians and non-physician providers within the U.S. Dermatology workforce

Trends in the training, supply, availability, career decisions, and retirement of US dermatology physicians are not well delineated. The current study evaluates whether growth in the dermatology workforce will keep pace with population expansion in the United States. A dermatologist supply model was projected to 2030 drawing on data from the American Academy of Dermatology, American Medical Association, Bureau of Labor Statistics, American Association of Medical Colleges, and other associations. The clinically active dermatologist workforce in 2015 was 36 per capita (1,000,000); entry following postgraduate training was age 30 with career separation at age 65 on average. Added to the provider model are physician assistants and nurse practitioners in dermatology practices. A linear regression micro simulation model based on age cohorts produced a per capita supply of dermatology providers of 61 (±3) per 1,000,000 by 2030, up from 47 in 2016. The dermatology workforce is growing faster than population expansion. Workforce estimates could be affected by changing trends in retirement and training of dermatology providers. Investments in training of nurse practitioners and physician assistants, in addition to training more doctors, may be an effective strategy for increasing access to care in populations with low dermatologist density.