When should Doctors Retire ?

“The trouble with retirement is that you never get a day off”

                                                                                                          – Abe Lemons

How many of us doctors wake up on Monday morning and immediately start grumbling that our Sunday interlude is over and yet another busy week has begun? I think for most of us having Monday blues is a norm. We long for a time when we can spend weekdays too at our leisure, reading the newspaper, visiting the latest art fair in town, going to a music concert; small pleasures most doctors can’t afford in the midst of our hectic schedules. In this context, the decision to retire should be easy for doctors, shouldn’t it? After all, it would afford them a more relaxed lifestyle centred around themselves and their family rather than on their
patients.

But surprisingly, it isn’t so! Research shows that the international trend over the last 40 years is that a disproportionate number of physicians continue to practice beyond the traditional retirement age of approximately 65 years. In India too in 2017, the retirement age of doctors attached to the Central Government was increased to 65 to cope with the shortage of doctors and improve the patient-doctor ratio to meet WHO standards. Let us learn more about the retirement age of doctors.

What is the Retirement Age for Doctors?

Doctors may be broadly classified into two categories– physicians and surgeons. So the question to consider is there and furthermore should there be a difference in the retirement ages of these groups considering the difference in the nature of their work in healthcare with the physician’s role being limited to diagnostic and therapeutic modalities with little or no surgical procedure performance?

A systematic review published in 2016 shows that most physicians retire between the age of 60 and 69. Why are physicians reluctant to retire early? Most doctors have a deep sense for value attached to their work, it is this unique quality perhaps which separates how a doctor functions from that of other professionals. Consequently, this may make it difficult for them to step away from their profession, as for them their profession is linked to their basic sense of identity which they are afraid of losing.

Other reasons for delayed retirement include flexible hours being offered to doctors by institutions or by virtue of running their own practices, a desire to keep active and inadequate financial planning for retired life. Also, as mentioned earlier most doctors, while they are working, find it difficult to make time to
cultivate external hobbies or interests due to which they fear how they will spend their time post-retirement.

What about surgeons? Is there an age beyond which the surgeon’s age becomes an unacceptable part of the risk of surgery? Evidence suggests that age causes deterioration in physical and cognitive performance of surgeons. Also, with medical education and technology evolving at a rapid pace, 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 speciality. Research also shows surgeons like physicians are reluctant to plan for retirement.

While so far there is limited literature specifically studying the retirement age of surgeons alone, it is believed to be in the same age range as physicians between 60 to 70. Their reasons for delayed retirement are also linked to their sense of identity similar to physicians. Yet qualitative studies have shown surgeons aged 50 years and above consider preservation of reputation and ability to deliver quality care as dominant factors in slowing down and retirement planning due to the critical and time-bound nature of their work.

When Do Doctors Decide to Retire?

Many plan to stop working as the primary surgeon before any noticeable deterioration of surgical or cognitive skill occurs. However, at the same time, they are aware of the tricky nature of self-assessment
in healthcare and hope their colleagues and juniors will point out to them the warning signs. The other barrier to retirement for surgeons is the all or none phenomenon. Unlike physicians, they require hospital facilities such as an OT, anaesthetist etc. to operate.

Most hospitals are willing to provide these facilities only if the surgeons are available on-call day and night which may be taxing for surgeons as their age progresses. Doctors serve society throughout their life and often at a great personal cost. What could be some of the measures we can undertake to make retirement enjoyable to them and also simplify the way they make this decision? Since self-assessment becomes difficult for a doctor to perform, perhaps standardised objective testing can be done post 50 to enable both physicians and surgeons to judge deterioration in their clinical/ surgical skills or an increasing gap between the care they provide and newer knowledge and guidelines which have come in.

Flexible hours can be offered by institutions so that doctors can gradually reduce their working hours rather
than having to suffer through a drastic change they are unprepared for. Financial advisors attached to medical institutions should be roped in to help doctors formulate a retirement plan right from the time they first start working so they are equipped to deal with their post-retirement expenses.

More importantly, doctors can always be of service to healthcare by using their knowledge and experience to teach medical students and fresh graduates. They can extend their career by making adjustments in their role. For example, a senior anaesthetist I deeply admire has switched to opening a charitable general medicine practice for needy patients. It is his way of giving back to the profession to which he owes his life. What could be more admirable in that?

A senior dentist now heads the ethics committee of a dental college and supervises the research studied being conducted in the college. Thus, even post-retirement there are myriad ways that doctors can contribute to healthcare and the time has come to explore some of these.

As doctors the motto we need to adopt is, retirement may be an ending or closing, but let us not forget its also a new beginning…..

References:

Silver MP, Hamilton AD, Biswas A, Warrick NI. A systematic review of physician
retirement planning. Hum Resour Health. 2016;14(1):67. Published 2016 Nov 15.
doi:10.1186/s12960-016-0166-z
Blasier RB. The problem of the aging surgeon: when surgeon age becomes a surgical risk
factor. Clin Orthop Relat Res. 2009;467(2):402–411. doi:10.1007/s11999-008-0587-7