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.

Factors Influencing Retirement Decisions of Senior Faculty at U.S. Medical Schools: Are There Gender-Based Differences?

Purpose: Women comprise almost one-third of academic medicine faculty 60 years of age and older. Gender disparities have been documented across many measures in medicine, including salary, promotion rates, and leadership positions and may impact long-term career and retirement decisions. The authors sought to describe gender differences in retirement decisions among late-career, full-time medical school faculty. Materials and Methods: The authors conducted a secondary analysis of cross-sectional survey data from a 2017 survey of faculty 55 years of age and older at 14 U.S. Medical Schools. Responses were compared for differences by gender using bivariate and multivariable analyses. Results: Among the 2,126 respondents (41% response rate), the majority were male (67%) and the average age was 62. Less than half (45%) had current plans to retire and 50% reported that they would consider working part time. Women faculty were less likely to be professors or on a tenure track and more likely to be single and report past and current caregiving responsibilities. Women differed from men in the personal and professional factors influencing retirement decisions with women more likely to identify health insurance, sense of burnout, lack of access to career advancing resources and opportunities, feeling devalued at work, and caregiving responsibilities as important issues. Conclusions: Women late-career faculty report unique and salient factors influencing retirement plans that may reflect cumulative gender-based career differences and disparities. Institutions should be aware of these differences and work to support women during late career and retirement transitions, including creating opportunities for faculty to remain engaged in meaningful work during retirement transitions if they desire to do so.

Practise till you drop: Trialing an online intervention for late-career medical practitioners to promote planning for retirement

Many medical practitioners in Australia work beyond the traditional retirement age. Transitioning to retirement is important, however, because the likelihood of poorer clinical outcomes increases with practitioner age. The objective of the present study was to develop and trial an online educational intervention to promote planning for a smoother transition to retirement using a non-randomized control group pre- and post-test design. Medical practitioners aged 55 or over (N = 262, Mage = 61.9) and working 30 or more hours per week were recruited to complete four online modules that addressed a range of topics (physical, health, financial, social, cognitive, and emotional well-being) and encouraged planning for retirement resources. Outcome measures included work centrality, mastery, and goal perceptions across the aforementioned resource domains. Eighty-one doctors completed post-training measures; a control group who completed only the measures (n = 23) and a training group (n = 58). Pre-post comparisons showed no significant changes for the control group. However, the training group at Time 2 showed lower work centrality t(57) = 2.12, (p = .036), and changes to social t(57) = 2.35, (p = .022), emotional t(57) = 3.18, (p = .002) and health goal perceptions t(57) = -2.02, (p = .049). Controlling for baseline scores and self-selection bias determinants, Generalized Linear Model (GLM) analyses indicated a training group increase in mastery scores (β = 0.87, p = .045) and decrease in negative perception of the consequence of not meeting emotional goals (β = -0.37, p = .043). Although not significant, GLM results also showed an increase in resources, three of four health goal domains and financial goals, indicating the potential for positive training effects in future applications of the program. The online retirement planning resource showed promise in promoting a sense of mastery and a reassessment of retirement plans, taking into consideration resource accumulation and goal setting across five specific goal domains. We discuss the theoretical and practical implications of our findings.

'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.

'Should I stay or should I go now?': A qualitative study of why UK doctors retire

OBJECTIVES

Health care delivery and education face critical potential shortages in the foreseeable future in terms of retaining doctors nearing the time of retirement - doctors who have experience-based knowledge to pass onto the next generation. Retirement decisions are driven by a combination of macro-related, job and individual factors. This is a constantly shifting space; findings from earlier studies do not always help us understand the retirement decisions of contemporary cohorts of doctors. To address these issues, and identify new knowledge to inform approaches to retaining expertise, we aimed to identify and explore what may keep an older doctor in the workforce ('stay') factors and ('go') factors that might prompt retirement.

METHODS

We invited doctors aged 50 years or over from diverse areas of Scotland to participate in qualitative, semi-structured interviews. Initial analysis of interview transcripts was inductive. The embeddedness theory of Mitchell et al encompassing the dimensions of 'link,' 'fit' and 'sacrifice,' was used for subsequent theory-driven analysis.

RESULTS

A total of 40 respondents participated. In terms of 'link,' retiring could feel like a loss when work links were positive, whereas the opposite was true when relationships were poor, or peers were retiring. Considering 'fit,' intrinsic job satisfaction was high but respondents had less confidence in their own abilities as they grew older. However, the data foregrounded the inverse of the notion of Mitchell et al's 'sacrifice'; for UK doctors, staying in work can involve sacrifice because of tax penalties, work intensity and arduous demands.

CONCLUSIONS

Retirement stay and go factors seem enmeshed in the cultural, social and economic structures of health care organisations and countries. Systems-level interventions that address ultimate causes, such as sufficient staffing, supportive systems, non-punitive taxation regimes and good working conditions are likely to be most effective in encouraging doctors to continue to contribute their knowledge and skills to the benefit of patients and learners.

Australia-wide cross-sectional survey of general practitioners' knowledge and practice of lung cancer screening

BACKGROUND

Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia.

AIM

To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme.

METHODS

A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months.

RESULTS

A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001).

CONCLUSION

In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

BACKGROUND

Lung cancer is the leading cause of cancer mortality in Australia. Guidelines suggest that patients with suspected lung cancer on thoracic imaging be referred for urgent specialist review. However, the term "suspected" is broad and includes the common finding of lung nodules, which often require periodic surveillance rather than urgent invasive investigation. The British Thoracic Society recommends that a lung nodule with a PanCan risk > 10% be considered for invasive investigation. This study aimed to assess which factors influence general practitioners (GPs) to request urgent review for a lung nodule and if these factors concur with PanCan risk prediction model variables.

METHODS

A discrete choice experiment was developed that produced 32 individual case vignettes. Each vignette contained eight variables, four of which form the parsimonious PanCan risk prediction model. Two additional vignettes were created that addressed haemoptysis with a normal chest computed tomography (CT) scan and isolated mediastinal lymphadenopathy. The survey was distributed to 4160 randomly selected Australian GPs and they were asked if the patients in the vignettes required urgent (less than two weeks) specialist review. Multivariate logistic regression identified factors associated with request for urgent review.

RESULTS

Completed surveys were received from 3.7% of participants, providing 152 surveys (1216 case vignettes) for analysis. The factors associated with request for urgent review were nodule spiculation (adj-OR 5.57, 95% CI 3.88-7.99, p < 0.0001), larger nodule size, presentation with haemoptysis (adj-OR 4.79, 95% CI 3.05-7.52, p < 0.0001) or weight loss (adj-OR 4.87, 95% CI 3.13-7.59, p < 0.0001), recommendation for urgent review by the reporting radiologist (adj-OR 4.68, 95% CI 2.86-7.65, p < 0.0001) and female GP gender (adj-OR 1.87, 95% CI 1.36-2.56, p 0.0001). In low risk lung nodules (PanCan risk < 10%), there was significant variability in perceived sense of urgency. Most GPs (83%) felt that a patient with haemoptysis and a normal chest CT scan did not require urgent specialist review but that a patient with isolated mediastinal lymphadenopathy did (75%).

CONCLUSION

Future lung cancer investigation pathways may benefit from the addition of a risk prediction model to reduce variations in referral behavior for low risk lung nodules.

Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977

OBJECTIVE

To report on retirement ages of two cohorts of senior doctors in the latter stages of their careers.

DESIGN

Questionnaires sent in 2014 to all medical graduates of 1974 and 1977.

SETTING

UK.

PARTICIPANTS

3695 UK medical graduates.

MAIN OUTCOME MEASURES

Retirement status by age at the time of the survey and age at retirement if retired. Planned retirement ages and retirement plans if not retired.

RESULTS

Of contactable doctors, 85% responded. 43.7% of all responding doctors had fully retired, 25.9% had 'retired and returned' for some medical work, 18.3% had not retired and were working full-time in medicine, 10.7% had not retired and were working part-time in medicine and 1.4% were either doing non-medical work or did not give details of their employment status. The average actual retirement age (including those who had retired but subsequently returned) was 59.6 years (men 59.9, women 58.9). Psychiatrists (58.3) and general practitioners (GPs) (59.5) retired at a slightly younger age than radiologists (60.4), surgeons (60.1) and hospital specialists (60.0). More GPs (54%) than surgeons (26%) or hospital medical specialists (34%) were fully retired, and there were substantial variations in retirement rates in other specialties. Sixty-three per cent of women GPs were fully retired.

CONCLUSIONS

Gender and specialty differences in retirement ages were apparent and are worthy of qualitative study to establish underlying reasons in those specialties where earlier retirement is more common. There is a general societal expectation that people will retire at increasingly elderly ages; but the doctors in this national study retired relatively young.

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.