Public Release: 

Physicians, especially female and rural doctors, retiring earlier than expected

May mean number of active doctors is less than previous estimates

Canadian Medical Association Journal

Physicians in British Columbia are retiring earlier than previously thought and many are reducing their working hours in the years leading up to retirement, found new research published in CMAJ (Canadian Medical Association Journal). These findings indicate that estimates based on physician "head counts" from data on physician licences may be overestimating the number of active physicians.

"The finding that many physicians reduced their activity levels in the years before retirement is of particular importance because it implies that physician resource plans relying on 'head counts' of the physician population will overestimate 'effective' or active physician supply," says Dr. Lindsay Hedden, School of Population and Public Health, University of British Columbia and researcher at the Vancouver Coastal Health Research Institute.

Female physicians and those practising in rural areas retire earlier, with female physicians retiring 4.1 years earlier than male physicians and rural doctors retiring 2.3 years earlier than those in large metropolitan centres.

The authors hypothesize that burnout of rural physicians, or possibly lower cost of living, may be behind earlier retirement.

"Regardless of the reason, early retirement in these communities is of particular concern, given that many rural areas are known to have substantial difficulties recruiting and retaining physicians," write the authors.

The study included 4572 physicians aged 50 years or older in the province of British Columbia, with fee-for-service payment data from BC's Medical Services Plan (2005 to 2012) and the BC Ministry of Health's Alternative Payment Program, which tracks non-fee-for-service payments. Of the total number, 80% were male, 48% were aged 65 or over by the end of the study, and 11% were over age 75. About two-thirds (65%) practised in urban areas, and 64% had trained in Canada.

The findings are relevant to other provinces in Canada with similar physician payment systems.

"Retirement and pre-retirement activity represent complex decisions for physicians, and pose challenges for decision-makers charged with health human resources planning," write the authors.

About 40% of physicians reduced their practice activity by at least 10% leading up to retirement.

"Current planning efforts that rely on physician licensure data are vulnerable to overestimation of physician supply, because they do not account for physicians who are maintaining an active licence while no longer practising or the reduction in workload associated with the pre-retirement years," conclude the authors.

In a related commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.171302, Dr. Michelle Pannor Silver, University of Toronto Scarborough, Toronto, Ontario, writes, "this research highlights several vulnerabilities in the Canadian health care system that must be addressed through careful planning of the physician workforce that pays particular attention to the needs of female physicians and physicians in rural areas, considers mechanisms for creating scaled down or flexible work hours and examines the merits of access to a public pension plan for physicians."

As more than 40% of doctors in Canada are 55 years or older, she suggests policy-makers should focus on issues around physician retirement, such as flexible or reduced work hours, to ensure an adequate supply of physicians and reduce burnout.

The study was conducted by researchers from Vancouver Coastal Health Research Institute and the University of British Columbia, Vancouver, BC; Simon Fraser University, Burnaby, BC.

"Patterns of physician retirement and pre-retirement activity: a population-based cohort" is published December 11, 2017.

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Infographic post-embargo link: http://www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.170231/-/DC1

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