opinion

Senior physicians keep working, putting off the R-word

A message to all physicians from AMA President Peter W. Carmel, MD.

By Peter W. Carmel, MD is a pediatric neurosurgeon in Newark, N.J., and is immediate past president of the AMA. Posted April 30, 2012.

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Physicians have never been the kind of people who take early retirement. So many of us find our work emotionally stimulating and satisfying that we keep on working as long as we can.

Traditionally for a physician, retirement meant cutting back office hours or limiting surgeries, or perhaps volunteering our skills a few days a week or month. Today, however, slowing down in a practice, especially a surgical practice like mine, is quite difficult. The cost of licensing and medical liability premiums means that if we want to continue working professionally we must keep going full tilt.

Others, particularly general practitioners and internists in solo or small practices, keep working full time because there simply is no one to take over their patient load.

Then there are those physicians who did have plans for a postretirement life on a golf course, a sailboat — or as a volunteer. A great many of these doctors are finding themselves working through customary retirement age because, thanks to our rocky economy, their personal financial situations are such that they simply cannot afford to stop working.

A final and fast-growing group of postretirement age physicians are those who can and do choose to work part time, either on their own or in an employee position. A survey taken by the Virginia Healthcare Workforce Data Center of physicians in that state reported that by age 65, more than a third of survey responders still in practice were working part time, and by age 70 more than half were practicing part time (link).

Like most other Americans, physicians can expect to live longer than our parents. Men have a 49% chance of living to age 86 and a 26% chance of living to 92; women live even longer.

Already, about 20% of U.S. physicians are older than 65. Many of us stay sharp; our work keeps us engaged emotionally, physically and intellectually.

And America’s patient population needs us. This country is facing a shortage of doctors to meet the needs of our growing and aging population, one that will only grow worse as more people enter Medicare and coverage is expanded to those currently uninsured.

It seems obvious that senior physicians will play a crucial role in filling this gap. The governing council of the AMA’s 55,000-member Senior Physicians Group has pointed out that senior physicians will be invaluable in dealing with the critical physician shortages projected for American medicine, both by extending their careers in clinical medicine and, in many cases, by re-entry into medical practice. And that a number of entities, including the AMA, will be active in assessing, relicensing and credentialing senior physicians in the future.

My father, who was an internist, retired at 65 and moved to Florida. He was one of those senior physicians who returned to medical practice part time.

After only a few months, he began attending rounds at a local hospital. A few months later, he was lured into part-time work by a group of young general practitioners who had heard him speak at grand rounds. Because he was “a real New York doctor,” they asked him to come in a few afternoons a week to see cases that they couldn’t figure out. He loved it. It was challenging, and he didn’t have to talk to his patients about money, something he had always hated.

About a year later, his new colleagues asked if they doubled his salary, would he see hospital patients in the mornings? Many of those patients were people he had already seen. He was in seventh heaven. He had all the best cases. He was never on call at night. And he did not have to talk with patients about money.

When he was 74, my father was operated on for colon cancer. He went back to work almost immediately. He continued at his same pace for four years more, and then dropped his hospital patients. When he was 80 years old, he stopped seeing office patients. And he died at 83.

Should someone have told him to stop?

Me, I am 75 and still operating. Should I stop?

These are difficult questions — economic, emotional and societal.

Yet they are extremely important questions. Better that we, as physicians, have the conversation first among ourselves and determine viable next steps.

When physician retirement is discussed, it is often in conjunction with the retirement requirements for airline pilots, who must take annual hands-on flight competency tests and annual physical examinations and who must, by law, retire at age 65. Congress, incidentally, recognized the serious need for pilots that exists today and raised the pilot retirement age from age 60 just five years ago.

The AMA Senior Physicians Group is one place where the above questions have come up. If you are a senior physician, I would encourage you to investigate the SPG as a source of information and a way to address issues affecting growing segment of our profession (link).

Because the facts are that like the rest of the Americans, the physician population is rapidly tilting toward the higher ages. And because so many of us are going to keep working as long as we are able, either from choice, necessity or because our patients need us.

Peter W. Carmel, MD is a pediatric neurosurgeon in Newark, N.J., and is immediate past president of the AMA.

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