April 7, 2011
Older family physicians more likely to narrow scope of practice than retire
More than 1 in 10 Canadian physicians is age 65 and older, but many doctors remain active in clinical practice after reaching the traditional retirement age, according to a study released today by the Canadian Institute for Health Information (CIHI). In 2009, 12% of the active physician population was at least 65, up from 9% five years earlier. However, one-third of doctors in their senior years were still working full time.
CIHI data also shows that older physicians no longer classified as full time still carried, on average, 40% of a full workload.
"One in five active physicians in Canada is over the age of 60. With so many doctors about to reach their so-called retirement years, some Canadians have expressed concern about whether they will continue to have access to the medical services they need in the coming years," says Michael Hunt, Director of Pharmaceuticals and Health Workforce Information Services at CIHI. "However, our study shows that physicians do not tend to retire, in the conventional sense, when they reach age 65. Instead, they slowly wind down their practice over the years. In addition, thanks to an influx of new medical school graduates, the number of active physicians working in Canada is on the rise, and the average age of physicians is stabilizing."
Older family physicians lessen workload, narrow practice
The report, Putting Away the Stethoscope for Good? Toward a New Perspective on Physician Retirement, found that rather than leave the workforce completely, many older physicians lessen the intensity of their clinical practice. In 2007, 7% of physicians age 55 and older, and close to 12% of physicians age 65 and older, became minimally active; that is, they worked 33% or less of their previous workload.
Although there were no major differences between family physicians in different age groups with respect to clinical activities, such as office assessment and mental health care, the older general practitioners became, the less likely they were to provide certain services. For example, fewer than 35% of female family physicians age 65 to 69 provided hospital inpatient care, compared with 59% of those younger than 40. Similarly, 56% of male family physicians age 65 to 69 provided services requiring advanced procedural skills, compared with 77% of those age 40 to 44. This shift in scope of practice was also evident in family physicians providing obstetrical and anesthetic services and happened faster among female physicians than among their male counterparts.
More physicians intend to retire than actually leave the workforce
According to the 2007 National Physician Survey, just more than 3% of all physicians reported that they planned to retire in each of the two years following the survey. However, CIHI's study found that estimates of actual retirement rates were significantly lower, with less than 1% of doctors (between 0.54% and 0.79%) retiring annually from the workforce in this period.
"In the physician workforce, retirement is not a sudden event," says Dr. Raymond Pong, a researcher at the Centre for Rural and Northern Health Research at Laurentian University and author of the study. "Instead, we see a transition to retirement, with doctors progressively taking on less work and carefully choosing the work that they do take on. It's a process that can extend over months and, in some cases, years. As the proportion of older physicians increases, understanding what they do, how much they do and how long they stay active is going to become very important for workforce planning."
Quick facts on physician retirement
- In 2009, one-third of physicians age 65 and older were still working full time.
- In 2009, there were approximately 68,100 active physicians working in Canada, one-tenth (12%) of whom were 65 and older, up from 9% in 2004.
- In 2007, more than 7% of physicians age 55 and older, and close to 12% of those age 65 and older, became minimally active; that is, they worked 33% or less of their previous workload.
- The older general practitioners became, the less likely they were to engage in such activities as hospital inpatient care, obstetrics, anesthesia and services requiring advanced procedural skills.
- In 2007, while just more than 3% of surveyed physicians reported that they planned to retire in each of the two years following the survey, the estimated average annual retirement rate was actually well under 1% annually.
Putting Away the Stethoscope for Good? Toward a New Perspective on Physician Retirement
This study is an attempt to understand how aging affects physicians' work, including staying in or leaving clinical practice. It also examines both retirement intentions and behaviours, without assuming that they are the same phenomenon.
Canadian physicians tend to quit work later than average workers. Instead of dropping out of the medical workforce abruptly and completely at age 65, many older physicians choose to remain in clinical practice, though they do not necessarily maintain the same activity level or do the same kind of work as when they were younger.
Depending on what "older physicians" refers to and where the full-time equivalent (FTE) threshold is set, different proportions of older physicians could be considered minimally active. For 2007, if the FTE threshold was set at 33% or less of previous workload, the proportion of physicians considered minimally active would range from 7.3% of physicians age 55 and older to 11.9% of physicians 65 and older. If the FTE threshold was set at 15% or less of previous workload, the range of those considered minimally active would be 3.3% to 4.9% for physicians age 55 and older and those age 65 and older, respectively.
The study includes
- A review of pertinent literature concerning physician retirement in general
- Three interrelated sets of empirical analysis: estimating the extent of physician retirement; estimating the number of older physicians who are minimally active and could, therefore, be considered retired from a health workforce planning perspective; and exploring an alternative approach to understanding how aging affects physicians' clinical practice.
- Table 1 Supply of Physicians, by Age Group, 2004 to 2009 (Scott's Medical Database, CIHI)
- Figure 1 Percentage of Family Physicians/General Practitioners and Specialists Planning to Retire From Clinical Practice in the Next Two Years, by Age Group, Canada, 2007 (Figure 4 in the report)
- Figure 2 Percentage of Physicians Retiring in 2005, 2006 and 2007, by Age Group and Sex, Canada (Figure 8 in the report)
- Table 2 Number of Older Physicians Who Were Minimally Active by Specialty and Full-Time Equivalent Threshold, Canada, 2007 (Table 1 in the report)
Source: Canadian Institute for Health Information