On March 3, 2015, the Association of American Medical Colleges released new physician workforce projections. To me, one of the most striking findings was the potential impact of changes in retirement on the projections. Of the 767,200 physicians under the age of 75 currently in active practice who completed graduate medical education, 10% were between 65 and 75 and 26% were between 55 and 64. Physicians in these age groups have a high likelihood of retirement within the next ten years. In the projections, a delay in the average age of retirement by two years would result in an additional 27,900 physicians in the overall supply. However, should physicians retire two years earlier, the number of physicians would decrease by 33,000. Considering that the projections are for a workforce deficit of 46,100 to 90,400 physicians, the impact of changes in retirement could be extremely important.
When I recently discussed retirement decisions with some senior colleagues, I heard a mix of arguments–some pushing toward retirement and others pulling back toward continued practice. The arguments for retiring included anxiety and unhappiness with the current health care delivery system, frustrations with the electronic medical record, reductions in income, and the physical and mental problems that affect the ability to practice. I also heard many positive reasons for retirement, such as the desire to explore other interests, investigate new work opportunities, and the chance to slow down, enjoy family, and participate in community activities. Those who wanted to continue in practice feared what might happen to their various projects, patient panels, or students when they retired; some also had financial concerns. Some of these colleagues had never developed outside interests and did not know what they would do with their time. In their recently published research report, which will appear in the June issue, Onyura et al present findings from focus group interviews with late-career academic physicians who were contemplating retirement. Their study helps to move discussions about retirement from the realm of anecdote to a more scholarly level. They note that, for late-career physicians, their occupational identity as physicians was central to their overall personal identity, and that retirement represented a threat to that identity. In addition, these physicians experienced an institutional attitude of indifference to aging within their work environment with a lack of institutional structures to support aging physicians, leaving them to cope with the transitions to a different set of activities on their own.
With the clear need to address a future physician workforce deficit, we have an opportunity to enlist our late-career physicians to be part of the workforce solution through the creation of incentives that could keep them practicing two years beyond the traditional retirement age. The work of Onyura et al demonstrates that physicians are deeply dedicated to their occupational identity and would probably be responsive to opportunities to maintain it. We should consider developing options for part-time practice, research mentorship, and teaching that would be attractive to our senior academic physicians if some of the current impediments to clinical practice could be addressed. As we continue to study workforce needs, we should not ignore the attrition side of the workforce equation. Academic medical centers could provide leadership by developing work models for aging physicians, and in the process they might improve flexibility and the work environment for all our faculty.