The older psychiatrist and retirement

The Aging Surgeon: Evidence and Experience

BACKGROUND

With doctors in short supply and a strong demand for surgeon services in all areas of the United States, urban and rural, there are pressures to remain in active practice for longer. Even with an older workforce, there are currently no requirements for when a surgeon must retire in the United States.

OBJECTIVES

The aim of this article was to highlight the importance of the aging surgeon to the medical community and to provide an evidence-based overview of age-related cognitive and physical issues that develop during the later stages of a surgeon's career.

METHODS

A search of the PubMed/MEDLINE database was performed for the phrase "aging surgeon." Inclusion criteria were applied to include only those articles related to surgeon age or retirement. Additional reports were handpicked from citations to substantiate claims with statistical evidence.

RESULTS

The aging surgeon contributes extensive experience to patient care, but is also prone to age-related changes in cognition, vision, movement, and stress as it relates to new techniques, surgical performance, and safety measures. Studies show that although surgeons are capable of operating well into their senior years, there is the potential of decline. Nevertheless, there are proven recommendations on how to prepare an older surgeon for retirement.

CONCLUSIONS

Age-related trends in cognitive and physical decline must be counterbalanced with wisdom gained through decades of surgical experience.

The Aging Physician and Surgeon

BACKGROUND

As the population of aging physicians increases, methods of assessing physicians' cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely.

STUDY DESIGN

Literature was reviewed using Medline, PubMed and other sources. Articles discussing the problems of geriatric physicians were summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation were proposed. Neuropsychological cognitive test protocols were reviewed, and a reduced evaluation protocol was proposed for interdisciplinary longitudinal research.

RESULTS

Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time, and correlating them with performance.

CONCLUSION

Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or longstanding. A multi-institutional study over many years is proposed. Additional assessments of other factors, such as manual dexterity (perhaps using simulators) and physician frailty are recommended, but detailed discussion of these issues is beyond the scope of this article.

Retirement intentions of consultant psychiatrists

Aims and Method

Through a postal survey we sought to determine the current retirement intentions of consultant psychiatrists working in Scotland. Consultants were asked their likely date of retirement, whether they might return as a locum and what might induce them to retire later.

Results

Full data were returned by 180 consultants. The mean planned age at retirement was 58.0 years. Women intended to retire significantly earlier than men. Most respondents could be persuaded to retire later through changes in services, conditions or job content; only 7% regarded their proposed retirement date as immutable.

Clinical Implications

Early retirement among consultants is likely to contribute to an even more seriously understaffed service. It is necessary to seek national and individual changes to the factors that give rise to early retirement in psychiatry.

Aging women and men in the medical profession: The effect of gender and marital status on successful aging and retirement intent in Australian doctors

Despite increasing interest from the medical profession in aging and retirement, we know little about effects of gender, marital status, and cohort on aging within the profession. We surveyed 1,048 Australian doctors from "younger" (55-64) and "older" (65-89) cohorts, investigating gender and marital effects on perceptions of successful aging, career, and retirement intent. Women intend to retire earlier. Younger cohort and married women more frequently viewed their career as a calling, while women in general, and single women more frequently, endorsed personal successful aging more than men. Broader understanding of the different experiences of aging for men and women doctors is needed.

A systematic review of physician retirement planning

BACKGROUND

Physician retirement planning and timing have important implications for patients, hospitals, and healthcare systems. Unplanned early or late physician retirement can have dire consequences in terms of both patient safety and human resource allocations. This systematic review examined existing evidence on the timing and process of retirement of physicians. 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 strategies facilitate physician retention and/or retirement planning?

METHODS

English-language studies were searched in electronic databases MEDLINE, Web of Science, Scopus, CINAHL, AgeLine, Embase, HealthSTAR, ASSA, and PsycINFO, from inception up to and including March 2016. Included studies were peer-reviewed primary journal articles with quantitative and/or qualitative analyses of physicians' plans for, and opinions about, retirement. Three reviewers independently assessed each study for methodological quality using the Newcastle-Ottawa Scale for quantitative studies and Critical Appraisal Tool for qualitative studies, and a fourth reviewer resolved inconsistencies.

RESULTS

In all, 65 studies were included and analyzed, of which the majority were cross-sectional in design. Qualitative studies were found to be methodologically strong, with credible results deemed relevant to practice. The majority of quantitative studies had adequate sample representativeness, had justified and satisfactory sample size, used appropriate statistical tests, and collected primary data by self-reported survey methods. Physicians commonly reported retiring between 60 and 69 years of age. Excessive workload and burnout were frequently cited reasons for early retirement. Ongoing financial obligations delayed retirement, while strategies to mitigate career dissatisfaction, workplace frustration, and workload pressure supported continuing practice.

CONCLUSIONS

Knowledge of when physicians plan to retire and how they can transition out of practice has been shown to aid succession planning. Healthcare organizations might consider promoting retirement mentorship programs, resource toolkits, education sessions, and guidance around financial planning for physicians throughout their careers, as well as creating post-retirement opportunities that maintain institutional ties through teaching, mentoring, and peer support.

A personal perspective from the UK: ageing and psychiatrists

OBJECTIVE

Psychiatrists appointed to National Health Service (NHS) consultant posts in the United Kingdom before a specific date in 1995 qualified for early retirement and this has implications for workforce planning.

METHODS

The author reflects on the implications this has for ageing psychiatrists and for relationships between psychiatrists and patients and families using mental health services, from the perspective of a psychiatrist who took advantage of the opportunity to retire early from a consultant post in the NHS and to develop a new career.

RESULTS

Older psychiatrists continuing to practise after retirement from consultant roles may bring disadvantages and advantages.

CONCLUSIONS

Older psychiatrists may be a valuable resource for future mental health services, and they may be in a position to try out new ways of working which might be relevant to their younger colleagues in the uncertain future faced by mental health services at a time of austerity.

A psychiatrist retires: an oxymoron?

The author examines the various factors that a psychiatrist may consider in making the decision whether or when to retire. These include one's professional persona, the prevailing professional culture, attachment to patients, practice situation, age, health, family situation, finances, other interests, other professional commitments, adaptability, and more. Personal experience and the limited literature indicate that the prevailing psychiatric professional culture is averse to retirement, but this may vary with changing practice patterns. The decision is a highly individual one that calls for much thought and preparation. This is the first of two articles dealing with retirement.

Medical masters: A pilot study of adaptive ageing in physicians

AIM

To describe models of career and lifestyle options for ageing doctors that suggest adaptability to ageing and retirement.

METHOD

Doctors aged 60 or older from Australia, Canada and the United States (n= 25) deemed to be ageing well by peers were administered a semistructured interview to obtain demographic and qualitative data regarding lifestyle, attitudes to ageing and retirement.

RESULTS

Emergent themes included: (i) insights into the physical and psychological vicissitudes of ageing and the effects of such on practice; (ii) the need for adaptations in working hours and choice of work; (iii) the importance of long-term retirement planning; (iv) the usefulness of a transitional phase to ease into retirement; and (v) the need to cultivate a variety of medical and non-medical pursuits and relationships early in one's career.

CONCLUSION

These insights might encourage doctors to engage in long-term occupational, familial, social and financial planning and provide potential models of adaptive ageing in doctors for further study.

The problem of the aging surgeon: when surgeon age becomes a surgical risk factor

The question of when a surgeon should retire has been the subject of debate for decades. Both anecdotal evidence and objective testing of surgeons suggest age causes deterioration in physical and cognitive performance. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more likely it is he or she is remote from his or her initial education in his or her specialty. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize their skills will decline, a properly planned retirement can be satisfying, and the retired surgeon has much to offer the medical and teaching community.

The impact of generational change and retirement on psychiatry to 2025

BACKGROUND

Australia is currently experiencing widespread shortages of psychiatrists. The changing nature of the workforce and increasing demand mean that these shortages are unlikely to ease. This study aims to identify demographic change and retirement patterns of the Australian psychiatry workforce from 1995 to 2003, and the implications of those changes for future workforce planning.

METHODS

Data from the Australian Institute of Health and Welfare (AIHW) Medical Labour Force Survey from 1995 to 2003 is used to examine ageing of the psychiatry workforce and attrition of psychiatrists aged 50 years and over. Future attrition from the workforce is projected to 2025.

RESULTS

Sixty two percent of psychiatrists practicing in the year 2000 are predicted to have retired by 2025. Most psychiatrists continue to work until late in life, with only 18 per cent retiring before age 65. The psychiatry workforce aged significantly between 1995 and 2003 (p < 0.001), with men older than women in both years. A reduction in hours worked by psychiatrists reflects both the increasing proportion of females and the older members of the profession reducing their hours in preparation for retirement.

CONCLUSION

The impact of ageing of the workforce may be more immediate for psychiatry than for some other health professions. With the growing proportion of females and their typically lower workforce participation, more than one younger psychiatrist will be required to replace each of the mostly male retirees.

The challenge of developing career pathways for senior academic pediatricians

Physicians are living longer and are healthier than in previous times. The opportunity to use their experience, expertise, and wisdom after what would be "normal" retirement age needs to be explored. The object of this study was to survey senior academic pediatricians and pediatric department chairs to define the present status of pediatricians who are in academic settings and are older than 65 y, to explore the options that are open to pediatricians who are older than 65 y for continuing to use their skills, and to increase the awareness of the unused potential that exists among senior pediatricians. Structured questionnaires were sent to the 1444 members of the American Pediatric Society (APS) and to the 148 pediatric department chairs of the medical schools in the United States and Canada to identify current practices concerning retirement and utilization of senior pediatricians. Thirty-five percent of APS members and 40% of chairs of pediatrics responded. The responding APS members were interested in exploring avenues to continue to use the skills that they had developed. The responding pediatric chairs reported that they were constrained from supporting their senior faculty members by institutional pressures for space, salary monies, and the need to recruit new faculty members. However, they recognized the value of senior pediatricians. The skills and expertise of senior pediatricians (and probably other physicians) are often not used after the usual age of "retirement." New programs and pathways need to be developed not only to use the resource of these skills but also to enhance the health and sense of satisfaction of senior pediatricians.

The Senior Psychiatrist Survey I: age and psychiatric practice

OBJECTIVE

The aim of this study is to determine the effects of age on the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

METHOD

A postal survey of Fellows of the RANZCP resident in Australia or New Zealand was conducted. The main outcome measures were: age; location and type of psychiatric practice; hours of work; attitudes towards re-accreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age to psychiatric practice and case selection.

RESULTS

Of 1086 eligible subjects, 629 participated. The mean age of the sample was 52.7 years (SD = 13.5). Those psychiatrists favouring re-accreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up to date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism.

CONCLUSIONS

Age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists.