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Older doctors and retirement

Brian M Draper
Med J Aust 2017; 206 (5): 202-203. || doi: 10.5694/mja16.01424

Planning for life after work should commence as early as possible

Many older doctors work beyond the traditional retirement age of 65 and have no clear retirement plans, as discussed by Wijeratne and colleagues in this issue of the MJA.1 Yet it is also known that older doctors are at higher risk of poor performance.2 The move towards revalidation, as being considered by the Medical Board of Australia (MBA), should be regarded as complementary to retirement planning, in that both involve components that need to start early in the doctor’s career. Successful retirement usually requires the doctor to have interests outside medicine, financial security, and good health, each of which should be developed during a long career. The trend to later retirement was noted 15 years ago.3 Since then, there has been a further ageing of the medical workforce, and around 1700 employed doctors in Australia are 75 or older, particularly in general practice, psychiatry, ophthalmology and general medicine.4 This delay in retirement is consistent with baby boomer trends in the general population.5

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  • Brian M Draper

  • Euroa Centre, University of New South Wales, Sydney, NSW

Correspondence: b.draper@unsw.edu.au

Competing interests:

No relevant disclosures.

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access_time 08:01, 24 March 2017
alex thomson

Dear Sir

Brian Draper's comments are to be welcomed as they attempt to deal with an issue of perhaps increasing relevance - “what is the impact on quality of care as doctors age”. The author's conclusion is that older doctors provide worse health care, but the presented evidence is not strong. The wider literature on the impact of experience on all aspects of clinical practice has been neglected. While admitting to a conflict of interest (I am over 67), in most cases, the author argues that process measures of quality favour younger doctors. However, being "behind the eight ball” may reflect the conservatism of experience rather than clinical failure. Those of a similar age to me can recall failure to prescribe HRT to every menopausal woman, not aggressively using NSAIDs to prevent joint damage in OA, not prescribing the latest therapeutic agents (think mianserin, practolol), and many other examples as being considered by the so-called medical experts of the time as a failure to embrace best practice. Evidence-based medicine, and best-practice protocols, are another recent tool by which we are all judged on a daily basis. The reality is that older doctors may be more conservative, arguably appropriately or inappropriately, by virtue of their experience. They may be less likely to inflict new harms on patients but more likely not to inflict "new benefits" on patients. If we comprehensively assess the outcomes of medical intervention in terms of death, disease, disability, discomfort, dissatisfaction, cost (dollars) and disruption to patients and their families, rather than just with simplistic measures, we may see an altogether different pattern of the impacts of physician age emerging. More robust research and debate is required before labelling increased doctor age as a patient risk factor.

Competing Interests: No relevant disclosures

Dr alex thomson
General Practitioner, Tasmania

access_time 11:10, 29 March 2017
Diane Campbell

Thank you for this thoughtful and practical article.

A time-honoured way for older doctors to step down from full time work is locum or contract work. Locums fill an important need supporting rural practitioners who need recreational and study leave.

Unfortunately, recent changes in the industry are making this difficult. Hospitals increasingly use agencies, direct enquiries to agencies, and almost invariably refuse to employ locums under the relevant award, preferring a flat rate.

As a result much of the work offered is well outside safe working hours guidelines. When I started working as a locum, usually a bona fide locum tenens, I simply stepped into the roster of the doctor on leave and was employed under the award. It is now common for employers to demand 7, 8, 10 or occasionally more 10-hour shifts in succession. One such offer this week included six consecutive nights on-call. The flat rate means no remuneration for on-call or even call-ins, so of course the employers will list the locum for as many on-calls as possible. Many employers insist on anticlockwise shift progression (against advice, see https://ama.com.au/system/tdf/documents/FINAL_NCP_%20Hours_of_work_2016.pdf.) This is worsened when doctors are expected to travel on the first day - I recall a locum resident arriving for a 1300 shift who had left Christchurch at 0200. I occasionally see advertisements for GP locums where ED cover is requested and there, too, the locum may expect to accept unreasonable hours.

The Locum Issues Working Group convened in 2004 (Skinner et al 2004) was concerned largely with the control of junior doctors and to some extent with safety. It was recognised then that there was no monitoring of the working hours of locums, although my recollection was the concern was over locums not taking adequate rest between assignments rather than employers insisting on unsafe working hours. That is, locums rather than employers were seen as a threat to patient safety. The reverse is now true.

Locum work can be interesting and rewarding and could be an ideal way of stepping down from fulltime practice. But it is time, and past, that locum and casual staff are given the protection of award conditions.

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1. Clare A Skinner, Rebecca L Riordan, Kylie L Fraser, John D Buchanan and Kerry J Goulston "The challenge of locum working arrangements in New South Wales public hospitals" Med J Aust 2006; 185 (5): 276-278

Competing Interests: No relevant disclosures

Dr Diane Campbell
Itinerant emergency physician

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