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.