I recognize many of them at the gym, older men and women pedaling and sweating on the machines. Their sweats and athletic gear create a different image from the green scrubs and white coats I associate with them. They are a competitive group even in the gym peering at each other’s machines to see how many miles have been in run and in what amount of minutes. Sometimes they engage in conversations a between gasping breaths. The sentences are short, to allow for the needed oxygen requirements of our exercise regimens. I relate one such conversation.
“How’s work?” I ask one of my surgical colleagues.
“Don’t ask,” he says.
“Why?” I say, between breaths.
“It’s the OR. Never on time.”
“Oh,” I say.
“I was there till 8PM last night.”
“The case was supposed to start at 2.”
“ Kept getting bumped.”
“Didn’t start until 5.”
“Missed dinner with my wife.”
“Yeah, I’ve had it. Time to retire.”
We return to our own thoughts for a while, pedaling on our machines. This is someone I have known for twenty five years, and I have great respect for his surgical skills and judgment. His retirement would be a terrible loss for our medical community. But I have been having more and more conversations like this lately, either at the gym or in the hallways of my medical center. Sometimes the conversation starts with frustration with the electronic medical record; sometimes it is frustration with the clinic or operating room schedule; sometimes it is the increasing amount of overnight and weekend call. But eventually we come to the same place. The frustrations with the practice environment are driving older doctors to consider retirement.
An article in Academic Medicine‘s February issue investigates policies about aging physicians in academic emergency medicine. Kevin M. Takakuwa, MD and colleagues conducted a survey of academic emergency medicine leaders that inquires about policies associated with aging physicians and work schedules. More than half of the responding programs had policies to accommodate aging faculty. In emergency medicine it has long been recognized that older physicians do not tolerate overnight work as well as their younger colleagues, and many groups have exempted their older members from overnight shifts, just as many hospitals have exempted older specialists from overnight call duties. Such policies place a burden on younger physicians, who are typically balancing family-raising responsibilities. Depending on the incentives for night work and the proportion of older and younger physicians, the policies can be divisive. As more specialties, such as hospitalists, provide routine overnight services, I suspect the issues in the survey will become more broadly applicable to specialties beyond emergency medicine.
Recently Academic Medicine put out a call for proposals for articles to address the issues of health care workforce, which we will publish in an upcoming issue. We received over a hundred and fifty submissions, and though they covered a range of topics, there were very few that looked at retention of our older practicing physicians. I wonder if that may be because no one entity is responsible for keeping practicing physicians in practice. In academic medicine we focus on pipeline, premedical, medical, and residency education. We have some offerings in the continuing medical education area for practicing physicians, but the connection between our academic medical centers and the practicing physician community is variable and inconsistent. As we approach an impending physician shortage, perhaps now is the time to strengthen our ties between academic medical centers and community physicians and work together with state licensing boards to develop plans that will help in retaining our older practicing physicians, as well as help them master new skills needed for our evolving health system.
Do you have ideas about how academic medicine can address retention of our outstanding older physicians? I’d love to hear about your ideas in the comments. Unlike the conversation above, that occurred between breaths on an exercise machine, I would be happy to entertain longer sentences that can more fully develop ideas and solutions than my surgeon friend and I could manage between our breaths and gasps.