Toward late career transitioning: a proposal for academic surgeons

The Aging Surgeon Cohort: Their Impact on the Future of the Specialty

Achieving technical excellence in surgery can happen at any point of a surgical career. The accumulation of wisdom brought by the aging surgeon's decades of experience, however, can only come with time and practice. With the accumulated life and professional experience obtained, aging surgeons can still contribute a valuable perspective/point of view to young trainees and colleagues. This article reviews the current literature of the aging surgeon and suggests strategies for how aging surgeons can use their expertise in an innovative fashion to train and develop the future legacy of the specialty.

The Aging Surgeon: Evidence and Experience

BACKGROUND

With doctors in short supply and a strong demand for surgeon services in all areas of the United States, urban and rural, there are pressures to remain in active practice for longer. Even with an older workforce, there are currently no requirements for when a surgeon must retire in the United States.

OBJECTIVES

The aim of this article was to highlight the importance of the aging surgeon to the medical community and to provide an evidence-based overview of age-related cognitive and physical issues that develop during the later stages of a surgeon's career.

METHODS

A search of the PubMed/MEDLINE database was performed for the phrase "aging surgeon." Inclusion criteria were applied to include only those articles related to surgeon age or retirement. Additional reports were handpicked from citations to substantiate claims with statistical evidence.

RESULTS

The aging surgeon contributes extensive experience to patient care, but is also prone to age-related changes in cognition, vision, movement, and stress as it relates to new techniques, surgical performance, and safety measures. Studies show that although surgeons are capable of operating well into their senior years, there is the potential of decline. Nevertheless, there are proven recommendations on how to prepare an older surgeon for retirement.

CONCLUSIONS

Age-related trends in cognitive and physical decline must be counterbalanced with wisdom gained through decades of surgical experience.

Passing the Scalpel: Lessons on retirement planning from retired academic surgeons

BACKGROUND

Almost half of practicing surgeons in the United States are currently older than 55, but guidelines on how to prepare for retirement are limited. We sought to identify possible facilitators for, and obstacles to, surgeons' preparations for retirement.

METHODS

A qualitative study was conducted using semi-structured interviews with clinically inactive academic surgeons. Emergent themes were identified via a grounded theory approach.

RESULTS

We interviewed 12 surgeons (83% male; median age 75 years). Major barriers to retirement from surgery included uncertainty about when to retire, limited identity outside of surgery, and perception of retirement as strictly individual/private. Facilitators of a successful retirement identified by the participants included early career financial planning, awareness of career trajectory, development of post-surgery goals, and utilization of collective knowledge.

CONCLUSION

There are numerous barriers encountered by surgeons seeking to transition from clinical practice to retirement that could be overcome by dedicated departmental and institutional efforts.

Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools

PURPOSE

The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work-life expectations.

METHOD

The authors conducted a survey (May-September 2017) of faculty 55+ at 14 U.S. medical schools.

RESULTS

Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse's/partner's plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities.

CONCLUSIONS

U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.

Retirement plans and perspectives among general surgeons: a qualitative assessment

Background

General surgeons’ retirement plans have wide-ranging personal, professional and system-level effects. We explored the drivers of and barriers to surgeon retirement to identify opportunities to support career-long retirement planning.

Methods

We conducted a qualitative study from May to October 2016 using semi-structured telephone interviews (mean duration 29 min) with general surgeons in Ontario. We used a purposive sampling strategy to recruit surgeons at 3 career stages (no plans to retire within next 5 yr, had slowed down practice or planned to slowdown within 5 yr, and no longer operating as primary surgeon). We analyzed the data using established techniques of thematic analysis.

Results

We interviewed 22 general surgeons. Their retirement status ranged from fully retired to no plans to retire. Preservation of reputation and quality care, commitment and succession planning, and retirement planning were dominant themes. Mid-career and senior surgeons’ plans were made later in their careers and were driven by desires to preserve reputations and surgical identity. Younger surgeons’ (≤ 50 yr) early retirement was driven by lifestyle choices and work environment. Logistical barriers and financial insecurity led to retirement delay.

Conclusion

Surgeons begin to plan for retirement both early and late in their careers. Most surgeons wish to establish retirement plans that allow for the gradual reduction of surgical patient care and the creation of job opportunities for younger colleagues balanced by a continued contribution to the profession. Opportunities to support surgeons at all career stages in their retirement planning require further exploration.