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Hospitals must do more to help late-career docs transition to retirement


Unemployed youth is a worldwide problem.  This problem is creeping into medicine and affecting our new doctors too.  In recent years, there have been discussions about the lack of physicians in Canada. Much of this has been based on anecdotal and reported evidence of unmet health care needs of Canadians including long waiting lists and difficulty in accessing medical care.  However, despite what we hear about the doctor shortage, there is an increasing trend of newly trained physicians who are either unemployed or underemployed. One in six new medical specialists is having trouble finding work in the field they trained for, according to a report from the Royal College of Physicians and Surgeons. They include some cancer specialists and orthopedic and cardiac surgeons. It is very likely that this new phenomena is only going to get worse.

An important factor (not the only one) adding to the lack of opportunities for young physicians is that older physicians are not retiring as early as they did in the past.   For several reasons, they are working into their late sixties or seventies. In 1987, 8% of physicians worked over the age of 65; today it is closer to 17 %.  Over 41 % of physicians are older than age 55, representing 31,000 of members of the Canadian Medical Association. This is the boomer generation. So there are more physicians as a percentage of the total work force working later in life and there are more in this age group as compared to the past. Had the percentage of physicians working over age 65 stayed at 8%, this would have freed up more opportunities for younger physicians.

Why are physicians practicing longer these days?  There are several good reasons for this.  First, there is the economic necessity, partly due to the financial crisis of 2008/2009.  They do not have enough retirement savings so they continue to work. As well, they are facing an increase in longevity, and realize that they will likely be living 10–15 years longer compared with life expectancy in the 1970s. They have to fund those extra years.

Many physicians identify their place in society as being a doctor. They enjoy their work and cannot identify any other activities that will provide the same personal satisfaction as medicine. Throughout their medical careers, some have failed to develop hobbies or other outside interests that could substitute for the satisfaction their practice provides. In some cases, their spouse is not anxious to have them at home all the time with no planned meaningful and purposeful alternative activities. The Retired Spouse Syndrome is a term coined to describe the stress syndrome experienced by nearly half of women with newly retired husbands, defined by increasing levels of stress, depression and sleeplessness.

There are also known health risks or outcomes for physicians who poorly plan this part of their life.  Retirement has been reported to increase the probability of suffering from clinical depression by up to 40 per cent and increases the probability of having at least one diagnosed physical condition by about 60 per cent.

Physicians who practice late in their careers do face some risks. Cognitive and technical skills can decrease with age. Older physicians may fail to remain current in their area of medicine, or may suffer from health problems that limit their ability to function optimally in their profession.  These changes can lead to poorer quality of patient care.

The College of Physicians and Surgeons of Ontario has an age-related assessment policy whereby once a physician turns age 70, s/he will be selected for peer assessment (if the physician has not been randomly selected in the previous five years). These physicians are then assessed at every five years thereafter. To the best of our knowledge, no other College in Canada has a similar explicit policy that mandates physician practice review at a certain age. The British Columbia College of Physician and Surgeons, after recent reviews, have encouraged physicians over 70 to retire before their cognitive or physical skills diminish and potentially put patients at risk.

Most hospitals lack any well-structured approach to adequately discuss with physicians both their needs and wants later in their careers, as well as the needs of the hospital.  For example, physicians may want to generate some income, do less strenuous work, and continue to enjoy the camaraderie of the hospital, while the hospital wants to recruit younger physicians with new skills. The best approach is for physicians to glide into retirement or an encore career. Hospitals or academic university departments often do not have the human resource skills to properly manage this phase of a physician’s career. These discussions or negotiations may need to be done with the guidance of an independent person with human resource skills, such as the hospital Vice President of Human Resources, who has a better understanding of the situation. The goal would be to achieve a ‘win–win’ outcome.  It is not acceptable for hospitals to merely inform physicians that they will no longer be needed after a certain date. After having worked for years to meet the hospital’s mission, physicians deserve a caring and dignified approach to this transition.

Hospital boards and administrations are just now understanding they have a responsibility to ensure this transition occurs for the benefit and health of their physicians and ensuring quality care to their patients. One excellent example of this is the Department of Orthopedic Surgery at Toronto’s Sunnybrook Hospital, which has developed a transition strategy by which, over a period of six years, senior surgeons’ OR time would transition to new surgeons, with a mentor-mentee relationship.

Hospitals will have to provide more resources to better manage their physicians’ human resource needs. Physician leaders, such as department heads and Chief of Staffs, will require education in this area, and should also have the ability to draw on outside expertise as they address their older physician’s transition. The hospital may need to try innovative initiatives, such as establishing a division of senior physicians, similar to the role of a professor emeritus at a university.  These senior physicians would have a defined position within the hospital, and could provide services such as assisting in the operating room, teaching health professionals, mentoring medical students or acting as ambassadors for the hospital or its foundation.

What is lacking today is the ownership of the challenge and resources to assist physicians in the planning and transition into retirement or an encore career.  Hospitals will need to develop a well-resourced program. As this phase of a physician’s career becomes better managed, we will have healthier and happier physicians, and the opportunity to free up resources to recruit newly trained physicians.

Chris Carruthers is a retired orthopedic surgeon, the former Chief of Staff of the Ottawa Hospital, and is enjoying an encore career as health care consultant. Mamta Gautam is a psychiatrist and the founder of the University of Ottawa’s Faculty of Medicine Wellness Program and the International Alliance on Physician Health. 

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5 comments

  1. John Van Aerde

    Thank you for this thoughtful paper. I would submit that our medical associations don’t have this issue on their radar either.

  2. Tom Faloon MD CCFP FCFP

    This is an excellent article. Today the issues facing many new physicians with their transition into practice (TIP), are profoundly impacted by the consequences of senior physicians delaying their transition out of practice (TOP). Doctors Carruthers and Gautam have summarised this extremely well and I agree 100%. I also agree that “ownership of the challenge and resources to assist physicians…” is lacking on many fronts. Hospitals, universities and institutions must take a greater role. Provincial Medical Associations need to bolster their efforts too. However, I truly believe that individual physicians must practice what they preach and take ultimate ownership of their own personal and professional wellness. We all need to proactively apply a primary (preventative) care approach to the planning, financing and management of our personal and professional affairs. This is where many physicians have failed terribly.
    For years I have facilitated numerous billing workshops for family physicians and continue to be shocked and saddened that the majority do not stay up to date with their fee schedule, fail to reconcile their monthly RAs and aged accounts receivables and do not appropriately bill for uninsured services. Lost income over a career of $750,000 to $1,000,000 is probably a conservative estimate. Imagine how one’s net worth and ability to ‘afford to retire’ is impacted by the failure to close the loop on getting paid for what one provides.
    Furthermore, polling the several hundreds of attendees at recent ‘Winding Down Your Practice” and retirement readiness seminars sponsored by the Ontario Medical Association and MD Financial Management indicated that the majority of physicians did not reconcile their monthly charge card or bank statements. The majority did not budget nor were they aware, within $5,000, what they spent after tax in the last year.

    2008/2009 was only a factor if the doctor did not have an excellent professional advisory team led by a comprehensive financial consultant. Having closed my practice in June 2008 to work part -time I can attest to the fact that we weathered the storm very well because of the excellent long term investment advice from our Financial Advisors and Personal Investment Counselors at MD Financial Management.

    Chris and Mamta are absolutely right. More advocacy and proactive involvement by hospitals, academic institutions and medical associations to assist older physicians with their TOP will be a win -win for all. However this must complement the efforts of individual physicians to take ownership of their personal and professional financial wellness. Seek and follow the advice of an excellent accountant and financial planner and get back to the basics of managing ones financial affairs like when we were residents.

    Tom Faloon MD Class of 77. Retirement date July 1, 2015

  3. Eduart K

    Maybe physicians should have a side pension from the hospitals they wiork too. That would make them feel not just self employed to make their money. BEfore they leave for retiring

  4. Margaret Abell

    Manitoba College of Physicians & Surgeons require a peer review every 5 years starting at age 75, and earlier if necessary.

    I’m sure these young specialists who are having difficulty finding work would be welcomed with open arms if they applied to many areas of Manitoba. Maybe it is just a little too cold here!!

  5. jjamieson

    Is this healthy debate ?Not from where I sit . This is pressure pure and simple by those who make decisions on training new doctors to force older ones out.To be clear 2007/2008 was not the only financial hit we had to endure so I will enlighten you 1987,2000/2002 and National and provincial medical fee increases that do nothing for me or my colleagues .So you need to remember who trained these new physicians and likely it was not you who spend all your time at the RCPS meetings figuring out how to screw us for the false promises you made to these students about where they will find work.

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