Michelle Pannor Silver1*, Angela D Hamilton2, Aviroop Biswas3 and Sarah A Williams4
1University of Toronto Institute of Health Policy, Management and Evaluation, and the University of Toronto Scarborough Campus, Canada
2University of Toronto Scarborough Campus, Canada
3University of Toronto Institute of Health Policy, Management and Evaluation, Canada
4University of Toronto Department of Anthropology, Canada
Received: 23 November, 2015; Accepted: 22 December, 2015; Published: 02 January, 2016
Michelle Pannor Silver, 1265 Military Trail Toronto, Ontario Canada, M1C1A4, Tel: 416-287-5642; Fax: 416-287-7283; E-mail:
Silver MP, Hamilton AD, Biswas A, Williams SA (2016) Life after Medicine: A Systematic Review of Studies of Physicians’ Adjustment to Retirement. Arch Community Med Public Health 2(1): 001-007. DOI: 10.17352/2455-5479.000006
© 2016 Silver MP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: A physician’s decision to retire has personal and social consequences. While there has been growing interest in how individuals adjust to retirement, less is known about physicians’ adjustment to retirement.
Objectives: To identify and examine: 1) factors that influence how well physicians adjust to retirement; 2) reasons physicians give for retiring; and 3) advice physicians give for a successful adjustment to retirement.
Methods: A systematic review of the literature was performed by searching Medline, Web of Science, Scopus, CINAHL, Ageline, Embase, Health star, ASSA, and PsycINFO databases for peer-reviewed studies published with quantitative and/or qualitative analyses of physicians’ adjustment to, satisfaction with, and/or quality of life in retirement. Two independent reviewers performed data abstraction, a quality assessment and an additional reviewer resolved inconsistencies. Content analysis was used to identify and stratify information from selected studies into themes and subthemes.
Results: Based on analyses of 12 articles that met the eligibility criteria, it is evident that retirement from medicine was seen as a generally favorable phenomenon. Financial security, favorable health, engagement in activities, and psychosocial well-being were identified as key factors relevant to physician retirement adjustment. Findings suggest that physicians’ retirement transitions could be eased by a greater focus on financial planning, implementation of strategies to encourage the development of outside interests, and institutional retirement planning that honors the physician and takes place mid-career or well in advance of retirement.
Conclusions: Advance planning to ensure that physicians have a strong financial situation, good health, engagement in activities outside of medicine, and positive psychosocial dynamics are likely to enhance adjustment to retirement for physicians. Future studies should account for multiple interrelating factors such as gender, changes over time, and spousal retirement to further enhance our understanding of physicians’ adjustment to retirement.
Interest in the factors that promote adjustment to life after work has become an increasingly relevant and critical topic of study [1,2], particularly because transitioning to retirement can be associated with depression and other challenges [3-5]. An increase in the number of physicians facing critical retirement decisions has been projected as North American physicians enter traditional retirement age [6,7]. However, less is known about what constitutes successful adjustment to retirement for physicians and how a positive transition might be facilitated.
Health care has undergone rapid changes in the last several decades while models of training and practice have not kept up, resulting in great stressors for practicing physicians [8,9]. Concerns about the aging physician population have largely centered on early attrition , burnout , the high costs associated with replacing retired physicians , and fears about shortages in the supply of physicians relative to the demands of a growing aging population [11,12]. Other evidence suggests that physicians may be reluctant to retire due to fears of losing their personal identity and life purpose [13-16]. Understanding the needs of physicians and factors that support their successful adjustment to late career transitions is a critical area for study.
For many older workers, retirement comes as a welcome respite at the end of a lifetime of toil, while for others it is a fearful time of unknowns where one’s identity and standing in the world are called into question and eventually re-made into something new and not necessarily welcomed. As increasing life expectancies extend the amount of time people spend in retirement to as many as three or four decades, retirement itself becomes a life stage with considerable importance and opportunity for growth and personal development. Medicine is an all-consuming and demanding profession. Physicians enter into medicine after lengthy training and are required to treat individuals at their most vulnerable state. After decades of practice and dedication to patients, physicians may have spent little time thinking about or planning for retirement. Toward the later part of their life-course, physicians may also become vulnerable and knowledge about how to enhance their adjustment to retirement can be helpful for both encouraging the hesitant physician to retire and for ensuring that the transition to retirement is made in a way that maximizes the chances of a smoother transition.
This systemic review examined the current state of what is known about physicians’ adjustment to retirement and identifies potential gaps in this literature by addressing three research questions: 1) what factors influence how well physicians adjust to retirement?; 2) what reasons do physicians give for retiring?; and 3) what advice do physicians give for a successful adjustment to retirement?
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the reporting and production of this systematic review . The PRISMA checklist is included as Additional File 1. Published articles were searched using Medline, Web of Science, Scopus, CINAHL, Ageline, Embase, Healthstar, ASSIA, and PsychINFO databases. Each author participated in the identification and final selection of studies.
Our inclusion criteria were published peer-reviewed studies with quantitative and/or qualitative analyses of physicians’ adjustment to, satisfaction with, quality of life in, and/or opinions about retirement. Keywords in our search strategy included, ‘physician’ and ‘retire’ with appropriate synonyms. The full search strategy appears as Additional File 2. After discussion, the search strategy was narrowed to English-language articles up to November 2015 with no limit set for the earliest possible date of publication. We also conducted hand searching of citation lists for eligible studies and relevant review articles. We excluded a substantial portion of articles that appeared in our initial search on the basis of their being duplicate records, editorials, commentaries, articles that were not based on original data collection, articles grouping physicians with other healthcare professionals, or studies that focused on retirement planning among non-retired physicians (Figure 1).
- Yang Y (2012) Is adjustment to retirement an individual responsibility? Socio-contextual conditions and options available to retired persons: The Korean perspective. Ageing Soc 32: 177-195.
- Reitzes DC, Mutran EJ (2004) The transition to retirement: Stages and factors that influence retirement adjustment. Int J Aging Hum Dev 59: 63-84.
- Quick HE, Moen P (1998) Gender, employment and retirement quality: A life course approach to the differential experiences of men and women. J Occup Health Psychol 3: 44-64.
- Wang M (2007) Profiling retirees in the retirement transition and adjustment process: Examining the longitudinal change patterns of retirees' psychological well-being. J Appl Psychol 92: 455-474.
- Kirch DG, Henderson MK, Dill MJ (2012) Physician workforce projections in an era of health care reform. Annu Rev Med 63: 435-445.
- Association of American Medical Colleges. 2013 State Physician Workforce Data Book Center for Workforce Studies. Washington, DC: Association of American Medical College: 2014.
- Salsberg E, Grover A (2006) Physician workforce shortages: Implications and issues for academic health centers and policymakers. Acad Med 81: 782-787.
- Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D (2013) Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: A pilot study. Ann Fam Med 11: 412-420.
- Kjeldmand D, Holmstrom I (2008) Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med 6: 138-145.
- Schloss EP, Flanagan DM, Culler CL, Wright AL (2009) Some hidden costs of faculty turnover in clinical departments in one academic medical center. Acad Med 84: 32-36.
- Petterson SM, Liaw WR, Tran C, Bazemore AW (2015) Estimating the residency expansion required to avoid projected primary care physician shortages by 2035. Ann Fam Med 13: 107-114.
- Pong RW, Lemire F, Tepper J (2007) Physician retirement in Canada: what is known and what needs to be done. Proceedings of the 10th International Medical Workforce Conference, Vancouver, British Columbia.
- Silver MP, Pang NC, Williams SA (2015) "Why give up something that works so well?": Retirement expectations among academic physicians. Educ Gerontol 41: 333-347.
- Collier R (2008) Diagnosing the aging physician. CMAJ 178: 1121-1123.
- Reuben DB, Silliman RG (1988) Lessons from elderly physicians: Reflections on practice, changes in medicine, and retirement. J Appl Gerontol 7: 49-59.
- Cronan JJ (2009) Retirement: It's not about the finances! J Am Coll Radiol 6: 242-245.
- Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 151: 264-269.
- http://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Survey.pdf http://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Survey.pdf
- CASP (2015) The Critical Appraisal Skills Programme Systematic Review Checklist. Accessed 03/23. 2013.
- Bunn F, Goodman C, Pinkney E, Drennan VM (2015) Specialist nursing and community support for the carers of people with dementia living at home: An evidence synthesis. Health Soc Care Community Epub ahead of print.
- Schadewaldt V, McInnes E, Hiller JE, Gardner A (2013) Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review. BMC Fam Pract 14: 132.
- Reed MC, Wood V, Harrington R, Paterson J (2012) Developing stroke rehabilitation and community services: A meta-synthesis of qualitative literature. Disabil Rehabil 34: 553-563.
- Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 15: 398-405.
- Elo S, Kyngäs H (2008) The qualitative content analysis process. J Adv Nurs 62: 107-115.
- Austrom MG, Perkins AJ, Damush TM, Hendrie HC (2003) Predictors of life satisfaction in retired physicians and spouses. Soc Psychiatry Psychiatr Epidemiol 38: 134-41.
- Jackson JB, Kart CS, Wagner KS, Rowe AR (1985) A survey of retired dentists in the United States. Council on Dental Practice. J Am Dent Assoc 110:386-389.
- Draper B, Winfield S, Luscombe G (1997) The older psychiatrist and retirement. International Journal of Geriatric Psychiatry 12: 233-239.
- Lees E, Liss SE, Cohen IM, Kvale JN, Ostwald SK (2001) Emotional impact of retirement on physicians. Tex Med 97: 66-71.
- McGuirt WF, McGuirt WF (2002) Otolaryngology retirement profile in the Southeastern United States. Laryngoscope 112: 213-215.
- Seim HC, Mitchell JE (1995) Life after medical practice. A retirement profile of Minnesota physicians. Minn Med 78: 27-30.
- Rowe ML (1989) Health, income, and activities of retired physicians. New York State Journal of Medicine 89: 450-453.
- Batchelor AJ (1990) Senior women physicians: The question of retirement. N Y State J Med 90: 292-294.
- Virshup B, Coombs RH (1993) Physicians' adjustment to retirement. West J Med 158: 142-144.
- Peisah C, Gautam M, Goldstein MZ (2009) Medical masters: A pilot study of adaptive ageing in physicians. Australas J Ageing 28: 134-138.
- Ritter MA, Austrom MG, Zhou H, Hendrie HC (1999) Current concepts review-retirement from orthopaedic surgery. J Bone Joint Surg Am 81: 414-418.
- Adams KB, Leibbrandt S, Moon H (2011) A critical review of the literature on social and leisure activity and wellbeing in later life. Ageing Soc 31: 683-712.
- Stearns J, Everard KM, Gjerde CL, Stearns M, Shore W (2013) Understanding the needs and concerns of senior faculty in academic medicine: Building strategies to maintain this critical resource. Acad Med 88: 1927-1933.
- Sklar DP (2015) How do I figure out what I want to do if I don't know who I am supposed to be? Acad Med 90:695-696.
- Schofield D, Fletcher S, Page S, Callander E (2010) Retirement intentions of dentists in New South Wales, Australia. Hum Resour Health 8: 9.
- Schofield DJ, Fletcher SL, Callander EJ (2009) Ageing medical workforce in Australia - where will the medical educators come from? Hum Resour Health 7.
- Jewett EA, Brotherton SE, Ruch-Ross H (2011) A national survey of 'inactive' physicians in the United States of America: Enticements to reentry. Hum Resour Health 9.
- McGuire LK, Bergen MR, Polan ML (2004) Career advancement for women faculty in a US school of medicine: Perceived needs. Acad Med 79: 319-325.
- Meerten M, Rost F, Bland J, Garelick AI (2014) Self-referrals to a doctors' mental health service over 10 years. Occup Med (Lond) 64: 172-176.
- Szinovacz ME, Davey A (2004) Honeymoons and joint lunches: Effects of retirement and spouse's employment on depressive symptoms. J Gerontol B Psychol Sci Soc Sci 59: P233-245.
- van Solinge H, Henkens K (2005) Couples' adjustment to retirement: A multi-actor panel study. J Gerontol B Psychol Sci Soc Sci 60: S11-20.
- Moen P, Kim JE, Hofmeister H (2001) Couples' work/retirement transitions, gender, and marital quality. Soc Psychol Q 64: 55-71.
- Burton KR, Wong IK (2004) A force to contend with: the gender gap closes in Canadian medical schools. Canadian Medical Association Journal 170: 1385-1386.
- McKinstry B (2008) Are there too many female medical graduates? Yes. BMJ 336: 748.
- Nivet MA (2011) Commentary: Diversity 3.0: A necessary systems upgrade. Academic Medicine 86: 1487-1489.
- Frank E, McMurray JE, Linzer M, Elon L (1999) Career satisfaction of US women physicians: results from the Women Physicians' Health Study.Archives of Internal Medicine 159: 1417-1426.
- Gjerberg E (2002) Gender similarities in doctors’ preferences—and gender differences in final specialisation. Social science & medicine 54: 591-605.
- Riska E (2001) Towards gender balance: but will women physicians have an impact on medicine? Social science & medicine 52: 179-187.
- Wallace JE (2014) Gender and Supportive Co-Worker Relations in the Medical Profession. Gender, Work & Organization 21: 1-17.
- Bianchi SM, Milkie MA (2010) Work and family research in the first decade of the 21st century. Journal of Marriage and Family 72: 705-725.
- Nunez-Smith M, Curry LA, Bigby J, Berg D, Krumholz HM, et al. (2007) Impact of race on the professional lives of physicians of African descent. Annals of internal medicine 146: 45-51.
- Rosenblatt RA, Andrilla CHA (2005) The impact of US medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Academic Medicine 80: 815-819.
- Heiligers PJ, Hingstman L (2000) Career preferences and the work–family balance in medicine: gender differences among medical specialists. Social Science & Medicine 50: 1235-1246.
- White RT, Arzi HJ (2005) Longitudinal studies: Designs, validity, practicality, and value. Res Sci Educ 35: 137-149.
- Farnell B, Graham LR (2014) Discourse-centered methods. In: Bernard HR, Gravlee CC (eds). Handbook of Methods in Cultural Anthropology. ed. Rowman & Littlefield.
- Webster F, Rice K, Dainty KN, Zwarenstein M, Durant S, et al. (2015) Failure to cope: The hidden curriculum of emergency department wait times and the implications for clinical training. Acad Med 1: 56-62.
Follow us on Academia.edu
Access denied for user 'root'@'localhost' (using password: YES)