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CONTROLLING the exit from work and accumulating multiple resources early predict adjustment to retirement for doctors.
According to the authors of a Perspective published by the MJA, the final transition in a medical career is one that the profession has largely ignored.
This risks “unplanned departures that affect succession planning for practices, continuity of care for patients, and the wellbeing of the practitioner”, wrote the authors, Adjunct Associate Professor Chanaka Wijeratne, a Senior Staff Specialist at Royal North Shore Hospital and the University of Notre Dame Australia, and Associate Professor Joanne Earl from the Department of Psychology at Macquarie University.
“The eventual introduction of proposed mandatory health checks for practitioners aged 70 years and over in Australia may hasten the retirement of some, which only increases the urgency of retirement planning becoming a routine task for all practitioners.”
Retirement, rather than being a “lone event” comprised three phases, the authors wrote:
- the “pre-retirement” phase, during which the practitioner continues to work but may anticipate and prepare for retirement;
- the “transition” phase, during which decisions are made about how and when the practitioner should approach stopping work; and
- the “adaptation” phase which may involve some paid work but the practitioner is principally retired.
“Each phase is considered a critical turning point, in which action or neglect can influence the outcome of subsequent phases. Some practitioners may chart a non-linear transition, moving in and out of work,” Wijeratne and Earl wrote.
More than one-third of older practitioners failed to even reach the pre-retirement phase, as they reported no intention of retiring or were unsure about doing so, according to research cited by the authors. Retirement planning may be difficult for doctors for several reasons:
- even considering leaving work may be viewed as a sign of personal weakness;
- financial factors related to inadequate superannuation funds, continuing debt, or other commitments;
- a feeling of responsibility for patients;
- a lack of interests outside of medicine; and
- a fear of potential changes in their relationship with a spouse.
The authors recommended a series of considerations for a smooth transition to retirement:
- a structured transition to retirement plan – all practitioners formally write an initial transition to retirement plan by the age of 55 at the latest, review it regularly, and the intervals between reviews should become more frequent with time;
- resource accumulation – financial, physical health, social engagement and emotional resources; incorporating a professional advance care plan that outlines a set of premorbid views about ongoing practice in the event that capacity to practise is impaired;
- developing an encore career – allows the use of skills and experience developed over a career and helps maintain meaning and engagement; examples include governance roles with accrediting bodies, sitting on guardianship or mental health review tribunals, taking up committee membership, providing leadership through directorships or management roles in hospitals or medical services, and teaching or research pursuits, such as teaching medical students, mentoring trainees, or writing research grants and articles.
“Given medicine’s long-standing neglect of retirement planning, there is also a need for professional bodies to provide education about the transition process and for practitioners themselves to share stories of encore careers and inspire peers to explore avenues for transition,” the authors concluded.
Also online at the MJA
Perspective: Changes in medical scientific publication associated with the COVID-19 pandemic
Reade et al; doi: 10.5694/mja2.50855 … OPEN ACCESS permanently
Research: Suicide by young Australians, 2006–2015: a cross-sectional analysis of national coronial data
Hill et al; doi: 10.5694/mja2.50876 … OPEN ACCESS permanently
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Ah! the modern practise of Medicine – driven by people with “agendas”, less so scientific evidence and ‘acuity’ of thought!
AHPRA has never provided any service for doctors. Why expect guidance or compassion when considering retiring? Noel Whittaker’s latest book “Retirement made Simple” has it covered from $s to estate planning to lifestyle and is well worth the read.
I have been retired for over two years due mainly to burn out and I have found it refreshing and invigorating. Unfortunately I made no real plans to retire but I was able to cobble together enough income to keep out of a debt trap thus far. COVID could not have hit at a better time as it forced me and my wife to look at what we wanted to do with the rest of our lives. I would have considered part time even but AHPRA’s attitude as already discussed and insurance costs make this less attractive and I would rather have gone into a small business unrelated to medicine (you can imagine the prospects of success!). I think between the legal profession and bureaucracy general practice has been greatly diminished all for the sake of the mighty dollar. Medicare must feel proud that they have limited GP incomes as savagely as they have whilst the lawyers have done us all like a dinner. My advice is to ensure that you run your superannuation fund very efficiently and get as many solar panels as you can afford on your house before you retire. You will need the free power for home air-conditioning and to power your next car or the one after that.
Query re developing an encore career in the article
I retired this year after 41 years and AHPRA sent me a letter defining Practice which says ” it also includes working in a direct non -clinical relationship with clients, working in management , administration,education, research, advisory regulatory or policy development roles and any other roles that impact on safe , effective delivery of services in the profession and / or use your professional skills
So from what AHPRA has said I am unable to take on most of the roles suggested in the “encore career ” part of the article . This would apply to all retired practitioners I would think .
I am 55 and work as an Anaesthetist. I have cut down my hours to .5. I have replaced it with being engaged in activities I am passionate about. I have got involved in yoga and meditation that have increased my physical and mental fitness to a much greater level.
I seem to be working longer hours pleasurably.
One word of warning about “semi-retirement”. I closed my full time private Obstetric practice in June. Planning to postpone my reliance on my superannuation I am now doing some surgical assisting. However unless I completely retire (ie cease being registered) I am responsible for my own run-off cover. The defence fund I had been with for 27 years quoted $32810 for each of three years (reduced to $17800 p.a. with the premium support scheme). Having changed funds I am now paying a one off $28000. Gives new meaning to the phrase “saving for retirement”!
AMA Victoria Professional Development and Careers service recognise that this is such an important issue and that doctors often struggle to retire well. It is an aspect of a medical career that is not historically well supported and we were seeing many doctors who were finding the prospect of retirement daunting, often leading to postponing retirement from clinical work and not implementing alternate opportunities. Two years ago we developed several coaching and support offerings for doctors to help them better prepare. We continue to further develop the programs and work closely with doctors as they plan for retirement. We support both members and non-members. More information can be found on the AMA Victoria website. https://amavic.com.au/careers-advice/retirement-support
Regarding registration with AHPRA, I agree with the comments above. The Medical Board of SA, prior to the formation of the national body, permitted retired doctors to provide specialist referrals and repeat prescriptions . i submit that little or no harm can come from these privileges. The privileges were withdrawn because of concern about cognitive decline etc but I am sure some ivory-tower risk manager would have advised this without there being a single instance of any harm done. AHPRA registration is expensive and together with litigation insurance, not worthwhile for doctors wishing to maintain a limited practice. It is a shame that vast experience and expertise is lost to the community. Some kind of inexpensive transitional registration and insurance for these circumstances should be considered.
For surgeons, or doctors with theatre experience, surgical assisting is a good way to transition into retirement. As a semi retired general surgeon, It has allowed me to stay involved, keep up with developments and stay connected with colleagues. I have also had the chance to do some teaching of medical students seconded to private hospitals, to help and support junior scrub nurses, and on occasions to mentor and advise younger surgical colleagues. You can determine your own workload, and choose which lists you wish to assist at. Oh, and you can earn some money too ! All you need is a car and mobile phone, and AHPRA registration. Medical indemnity insurance is much cheaper if you are only assisting.
I would have continued part time, but the AHPRA all or nothing rule meant that I have fully retired from medical practice. Can’t ask for investigations, write scripts or do any medical stuff for community or family, certainly not worth paying for registration and insurance for 2 days a week monitoring old, long term patients/friends.
3 months to go to retirement; I have been thru all the stages mentioned and it is tough to let go, but now I’m ready.
I can’t imagine life as a retiree.
AHPRA’s extremely un-sophisticated “all or nothing” approach to medical registration again has avoided mention in this otherwise sound and helpful advice on retirement. Sadly, the unsatisfactory state of affairs of thee years ago (and indeed since the imposition of AHPRA, remains unchanged. A careful reading of the AHPRA “definition of practice” is recommended before planning an “encore career”.
https://insightplus.mja.com.au/2017/10
The authors and no doubt the bureaucracy are out of touch. I am still in practice at 78 as are some of my contemporaries. Only public servants need to and probably should retire at 55 – maybe for the good of the community before that.