Opening a dialogue on physician retirement is key
By AdvocateDaily.com Staff
Physician retirement is an ongoing issue for hospitals these days and it’s important for health organizations to adopt policies that will help them plan as best as possible for doctors who are leaving the workforce in their golden years, says Toronto health lawyer Kate Dewhirst.
“This is a pervasive and stressful issue facing all hospitals and it’s not going away in the context of our aging population,” she tells AdvocateDaily.com.
Dewhirst, principal at Kate Dewhirst Health Law, advises hospitals to establish structures to deal with retirement, including a policy that requires physicians to provide a certain amount of notice about their retirement.
“We can’t always plan all retirements because some people have unexpected illnesses,” she says. “However it’s important to have policies for notice in place and also to have conversations with physicians of all ages that will enable the hospital to do physician resource planning.”
Dewhirst says there generally isn’t a lot of proactive planning for physician retirement and many hospitals simply don’t talk about it.
“It’s often left to individual physicians as opposed to having an open, transparent conversation about how a program, a department, a hospital plans for the eventual retirement of all of its physicians,” she says.
Dewhirst says part of the reason for a lack of dialogue on the issue is doctors leave the workforce at different ages – some working until their 50s or 60s, while others continue to practise later in life.
“There isn’t a mass exodus at age 65. Lots of physicians can practise into their late 60s, 70s and 80s,” she says. “And so, there isn’t a magic trigger point on which hospitals can base their planning for physician recruitment. There’s no natural moment in time when a hospital administrator can initiate a conversation with a physician about retirement to encourage people to come forward about their plans.
The reality, Dewhirst says, is that many physicians don’t know themselves when they will retire until one or two years prior to their leaving the workforce.
“It will depend on their own financial circumstances, their physical abilities and the type of medicine they practise,” she says. “Some physicians can continue working well into their older years. And people are living longer and more healthy lives, so this is more possible.”
The unpredictability of the age at which physicians retire makes it challenging for hospitals to plan ahead for it, says Dewhirst.
She explains that the majority of physicians who work in a hospital aren’t employees, but are independent contractors who have a relationship with hospitals through privileges, which are regulated under the Public Hospitals Act.
“So it’s not as structured as an employment arrangement – it is more complex because physicians annually have to apply for reappointment to hospitals,” she says. “And once a physician has an appointment to a hospital, they have rights that attach to them. This means that if a hospital was to revoke its relationship with a physician, there would be a formal legal process they would have to undertake.”
The issue of retirement often comes up in the hospital setting when a senior physician indicates he or she would like a reduction in certain kinds of activities, including on-call work, says Dewhirst.
“Medical work can be onerous and when doctors are in their senior years they may not want to perform those late night and long day on-call duties,” she says. “And the problem for hospitals is that if the senior people aren’t doing the on-call work, for example, then someone has to pick those duties up.”
This negatively impacts the ability for hospitals to recruit new physicians to the team when they are told they have to do a larger share of those less-desirable duties such as on-call work, says Dewhirst.
“It makes it difficult for recruitment if all of the senior people cherry-pick the more desirable tasks,” she says.
Dewhirst says beginning a dialogue on the issue of physician retirement is an important first step for hospitals so that the process is “principled and objective” for all physicians who are entering their golden years. It will allow for fairness across the board when dealing with retirement issues and in instances where physicians are “stepping down” their practices, she says.
“This allows for some consistency that physicians can expect from the hospital and allows the hospitals to properly plan for patient care coverage,” she says.