Medical masters: A pilot study of adaptive ageing in physicians

Retired Orthopedic Surgeons' Reflections on Their Lives and Careers: A Cross-Sectional Study

Background: Retired surgeons often have limited opportunities to disseminate their wisdom and expertise in a structured manner to their younger colleagues. In addition, when asked to reflect on their personal and professional lives, many physicians say they wish they had done something differently. The extent to which this is true of retired orthopedic surgeons is not known. Purpose: We sought to determine the percentage of retired orthopedic surgeons who say that they would like to have changed something in their life/career and delineate the most commonly desired changes. Methods: We conducted a cross-sectional study of retired orthopedic surgeons, by emailing a Qualtrics survey to 5864 emeritus members of the American Academy of Orthopaedic Surgeons (AAOS), with 1 initial email invitation in April 2021 followed by 2 reminders in May 2021. The survey employed a branching logic, with up to 16 questions designed to determine whether they would have done anything differently in their life/career. Results: The survey was completed by 1165 of 5864 emeritus AAOS members, for a response rate of nearly 20%. The 3 most represented surgical subspecialties were general orthopedics, adult reconstruction, and hand and upper extremity surgery. Respondents' average age was 74.9 years and age at retirement was 67.8 years; nearly half worked part-time before retiring. More than 80% of the participants said that they had retired at the appropriate time, and 28.5% said they wished they had done something differently. The wished-for changes most often noted were spending more time with family, spending more time on personal wellness, and selecting better practice partners. Conclusion: The results of our survey of retired orthopedic surgeons show that while most were satisfied with their lives and careers, some had regrets. These findings suggest that there may be factors in the work lives of current surgeons that could be altered to reduce regret. Further study is warranted.

Beyond burnout II: A case series of doctors seen in a new publicly funded doctors' mental health service

OBJECTIVE

Doctors' mental health has received increased focus recently and has been met with a variety of systemic responses. A Professional Support Unit (PSU) in a public hospital was established to address service gaps. This paper aims to describe the care of doctors referred to this service.

METHODS

Participants in the first four cases were referred to the PSU and assessed by the first author.

RESULTS

The cases revealed: (i) variety of referral sources, symptom presentations and backgrounds of doctors referred to a dedicated doctors' health service; and (ii) the person-centred, multi-modal treatments and adjunctive services required.

CONCLUSION

Doctors' mental health is an urgent priority, with direct impacts on patient safety and care. The mix of patients presented here suggest difficulties beyond burnout and highlight the workings of a new service model designed to complement existing services in the Australian context.

'Quit while you are ahead - and smell the roses!' A survey of retired Fellows of the Australian and New Zealand College of Anaesthetists

There are no published data on the age of retirement of anaesthetists in Australia and New Zealand. We surveyed 622 retired Fellows of the Australian and New Zealand College of Anaesthetists to determine their ages of complete retirement from clinical practice, demographics, and whether they had retired at the age they had intended to retire. We also aimed to explore factors affecting the decision to retire, the practice of 'winding down', common post-retirement activities, and the arrangement of personal and professional affairs. Responses were received from 371 specialists (response rate 60%). The mean (standard deviation) age of retirement was 65.2 (6.9) years. The mean (standard deviation) retirement ages ranged from 62.0 (7.1) years (those who retired earlier than planned) to 68.0 (4.3) years (those who retired later than they had intended). The mean (standard deviation) age of retirement of the male respondents was 66.0 (6.5) years, and for female respondents was 62.7 (7.7) years. Two hundred and thirty-three respondents (63%) reported winding down their practice prior to retirement, and 360 (97%) had made a will. Poor health and loss of confidence were the two most common factors in the retirement decisions of those who retired earlier than they had planned. Our results may assist current practitioners plan for retirement, and suggest strategies to help health services, departments and private groups accommodate individuals in winding down their practice.

Physician Age and Performance on the American Board of Emergency Medicine ConCert Examination

OBJECTIVE

This study was undertaken to expand on results from a 2014 study on the association between physician age and performance on the American Board of Emergency Medicine (ABEM) ConCert examination.

METHODS

This was a retrospective, longitudinal growth study comparing performance on the ConCert examination and physicians' ages at the time of examination. All examination attempts from 1990 to 2016 made by residency-trained physicians were eligible for inclusion. Multilevel growth models were constructed to examine the relationship between age at time of examination and performance, controlling for physician characteristics.

RESULTS

The study group included 15,533 examination attempts by 12,786 physicians. The mean (±SD) age of the physicians across all examination administrations was 45.02 (±5.18) years (range = 35 to 72 years). The mean (±SD) ConCert examination score across all administrations was 85.39 (±5.71; range = 51 to 100). Among first-time ConCert examination takers, older age was associated with lower examination scores (r = -0.25, p < 0.0001). Across all examination attempts, age was negatively correlated to examination scores (r = -0.24; p < 0.0001).

CONCLUSIONS

After physician characteristics were controlled for, there was an association between advancing age and declining performance on the ABEM ConCert examination. This information may be important to the individual physician to develop targeted competency assessment and professional development.

Occupational Determinants of Successful Aging in Older Physicians

OBJECTIVES

Demographic, physical and psychological associations of successful aging (SA) have been evaluated, but occupational factors have not. Nor has SA been evaluated in a specific occupational group. The aims of this study were to examine the occupational associations of SA in older physicians, and to explore the concept of occupational SA.

METHODS

Physicians aged 55+ years completed self-ratings of occupational and personal SA on a 10-point visual analogue scale (VAS; 1 being "least successful" and 10 "most successful"). Associations between occupational and personal SA (defined as 8-10 on the VAS), respectively, and demographic and practice characteristics; health; social and financial resources; cognitive, emotional and motivational resources; work centrality; and anxiety about aging were examined.

RESULTS

Rates of occupational SA (69.2%; 95% CI: 66.3-72.0) were significantly higher than personal SA (63.1%; 95% CI: 60.1-66.0) in the sample of 1,048 physicians. Occupational and personal SA were strongly positively correlated (r = 0.73, N = 1,041, p < 0.001). Personal SA was predicted by demographic (older age, female, international medical graduate, urban practice), physical (better self-rated health), psychological (less depression, better cognitive, emotional and motivational resources, and greater anxiety about aging), and occupational (higher work centrality, fewer practice adaptations and not intending to retire) factors.

CONCLUSIONS

Occupational factors are central to physicians' self-conceptualization of SA. That greater work centrality, fewer work adaptations and less retirement planning were associated with personal SA suggests older physicians' sense of "success" is intertwined with continuing practice. There is a need for educating physicians to adapt to aging and retirement.

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.

Successful ageing for psychiatrists

OBJECTIVE

This paper aims to explore the concept and determinants of successful ageing as they apply to psychiatrists as a group, and as they can be applied specifically to individuals.

CONCLUSIONS

Successful ageing is a heterogeneous, inclusive concept that is subjectively defined. No longer constrained by the notion of "super-ageing", successful ageing can still be achieved in the face of physical and/or mental illness. Accordingly, it remains within the reach of most of us. It can, and should be, person-specific and individually defined, specific to one's bio-psycho-social and occupational circumstances, and importantly, reserves. Successful professional ageing is predicated upon insight into signature strengths, with selection of realistic goal setting and substitution of new goals, given the dynamic nature of these constructs as we age. Other essential elements are generativity and self-care. Given that insight is key, taking a regular stock or inventory of our reserves across bio-psycho-social domains might be helpful. Importantly, for successful ageing, this needs to be suitably matched to the professional task and load. This lends itself to a renewable personal ageing plan, which should be systemically adopted with routine expectations of self-care and professional responsibility.

Attitudes toward retirement of ophthalmology department chairs

PURPOSE

To identify common perceptions and ideas about preparation and planning for retirement of chairs of academic departments of ophthalmology, determining areas of particular stress and proposing ways to better prepare for retirement.

DESIGN

Cross-sectional study.

PARTICIPANTS

One-hundred sixteen chairs of academic departments of ophthalmology in the United States.

METHODS

A confidential online survey emailed to ophthalmology chairs.

MAIN OUTCOME MEASURES

Surveys assessed demographics; current work schedule; perceptions, preparation, and planning for retirement; and retirement training for faculty and residents.

RESULTS

Ninety-six department chairs responded to the survey (82% response rate). Most chairs anticipate retiring around age 70. Significantly, only 9% are looking forward to retirement. Reasons for delaying retirement include keeping active (37%), income/insurance/benefits (20%), and maintaining lifestyle (17%). The most common concern is financing retirement (46%). Forty percent anticipate their reason for retirement will be because of age or health, whereas 20% anticipate fatigue or burnout. Nearly half of the respondents have no specific plan upon retirement. Most respondents anticipate pursuing other interests (43%); 32% intend to spend time with family, vacationing, and travelling. Younger respondents are more concerned with the financial aspects of retirement while more senior respondents appear to delay retirement to keep active or because they enjoy their work.

CONCLUSIONS

Retirement is a source of stress for many ophthalmology department chairs and many indicate financial preparation is their major concern. Despite this, the major reason for putting off retirement is a desire to keep active. Developing a retirement plan eases stress and engenders a feeling of confidence about the future.

The greying intensivist: ageing and medical practice - everyone's problem

The medical profession is ageing in parallel with the wider community, with more Australian doctors working into their 70s. This has implications for workforce planning and raises questions about competence. However, no Australian specialist college has policies relating to the special circumstances of ageing practitioners. Ageing practitioners are affected by a number of age-related sensory and neurocognitive changes, including a decline in processing speed, reduced problem-solving ability and fluid intelligence, impaired hearing and sight, and reduced manual dexterity. A policy of mandatory retirement is not consistent with the wide individual variations in cognitive ageing. However, there may be an age ceiling, which varies by medical specialty and individual. Studies show the older doctors in several specialties perform worse than their younger colleagues. Older doctors, many of whom are found to be cognitively impaired, are more likely to be reported to the authorities for poor performance. The wisdom and experience of older doctors is of great value. However, work adaptations may need to be considered. For intensivists, these could include part-time work towards retirement, reduced after-hours call and shift work, and reduced exposure to acute crisis intervention, with an increased focus on mentoring, teaching, administration and research.