Background
Methods
Study selection
Study eligibility
Data extraction
Quality assessment
Terminology
Synthesis
Results
Study characteristics
Study | Location | Study method (source, if not self-administered) | Sample size (response rate) | Participants (average age and/or age range) |
---|---|---|---|---|
Anderson [37] | United States | Survey (administered by the American Medical Colleges and the American College of Obstetricians and Gynecologists) | < Age 50, 2000 (40.3%) > Age 50, 2100 (57.3%) | Obstetrician-gynecologists (average age <50 was 44 years, average age >50 was 65 years) |
Austrom [58] | United States | Survey (modified version of American Association of Orthopaedic Surgeons survey) | 1834 (43%) | Multidisciplinary physicians and spouses (average age 75 years) |
Baker [56] | United States | Survey | 500 (46%) | Psychiatric physicians (age 50 to 69 years) |
Baker [59] | United States | Survey | 125 (53%) | Black psychiatrists (age 31 to 74 years) |
Baker and Hishinuma [74] | United States | Survey | AMA: 187 (58%); NMA: 85 (65%) | Multidisciplinary physicians. AMA members (age 50 years or older), NMA members (age 30 years or older) |
Batchelor [22] | United States | Survey/interviews | 20 (80%) | Senior women physicians (age 59 to 95 years) |
Bieliauskas [75] | United States | Computerized cognitive test/survey | 359 (82%) | Surgeons (age 45 or older, average age 61.4 years) |
Brett [51] | Australia | Survey | 281 (59%) | Multidisciplinary physicians (age 45 to 65, average age 52.4 years) |
Burke [76] | United Kingdom | Administrative data, Department of Health and f Insurance industry (the Dentists’ Provident Society) | 393(N/A) | Retired dentists (N/A) |
Chambers [69] | United Kingdom | Survey | 348 (72%) | Multidisciplinary physicians (average age 55 years) |
Crowson [6] | United States | Retrospective study (Duke University Hospital Department of Human Resources) | 208 | Multidisciplinary physicians (average age between 45 and 48.1) |
Davidson [77] | United Kingdom | Survey | 2398 (78%) | Multidisciplinary physicians (average age mid-40s) |
Davidson [52] | United Kingdom | Survey | 1460 (85%) | Multidisciplinary physicians (average age 48 years) |
Deitch [48] | United States | Survey (ACR Committee on Manpower) | 2804 (69%) | Radiologists, radio-oncologists, and nuclear medicine specialists (average age in years <35 (11%), 35 and 44 (37%), 45 and 54 (32%) and 55 or older (20%). |
De Santo [78] | Algeria, Australia, Brazil, Egypt, France, Germany, Greece, Italy, Malta, Libya, Poland, Romania, Slovak Republic, Slovenia, Switzerland, The Netherlands, Tunisia, Turkey, UK and USA | Survey | 113 (89.1%) | Active professors and emeritus/retired professors from 99 departments of medicine/universities worldwide (NA) |
Dodds [46] | United States | Survey | 96 (82%) | Academic chairs of ophthalmology departments (age range <50 to >70, average age 58 years) |
Donner [79] | United States | Review of data based on survey (ACR Commission on Human Resources, 2012 and 2013) | N/A | Radiologists |
Draper [40] | Australia and New Zealand | Survey | 281 (60%) | Psychiatrists (ages 55–87 and average age 65.5 years) |
Draper [80] | Australia and New Zealand | Survey (respondents were fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand) | 529 (57.9%) | Psychiatrists (age 40 years and older) |
Eagles [30] | United Kingdom | Survey | 180 (50%) | Consultant psychologists (N/A) |
Evans and Ghosh [43] | United States | Survey | 749 (17%) | Headache medicine specialists |
Farley [39] | United States | Survey (American Academy of Orthopaedic Surgeons in cooperation with the Association of American Medical Colleges Center for Workforce Studies) | 3001 (33.5%) | Orthopedic surgeons (age 50 years and older) |
Fletcher and Schofield [38] | Australia | Data from the Australian Institute of Health and Welfare (AIHW) Medical Labour Force Survey from 1995 to 2003 | N/A | Psychiatrists (age 50 years and over) |
Florence [81] | United States | Survey | 785(22%) | Transplant surgeons (average age 48.7 years) |
French [36] | United Kingdom | Survey | 2923(61%) | Consultants and specialists (average age 47 years) |
French [23] | United Kingdom | Survey/interviews/focus groups | 924 (50%) | Multidisciplinary physicians (average age 43 years) |
Gee [82] | United States | Telephone interview (Gallup Poll) | 451 (89%) | Urologists (age in years <36 (9%), 37 to 45 (29%), 46 to 54 (30%), 55 to 64 (25%), <65 (7%)) |
Goldberg [57] | United States | Survey of American College of Emergency Physicians members (two separate mailings in the fall of 2006 and winter of 2007) | 1000 (80%) | American College of Emergency Physicians members over the age of 55 years (average age 57 years) |
Grauer and Campbell [50] | Canada | Survey | 58 (53.7%) | Multidisciplinary physicians (average age 71.2 years) |
Greenfield and Proctor [83] | United States | Survey | 659 (75%) | Surgeons (age in years <50 (7%), 50–60 (29%), 60–70 (35%), >70 (28%) |
Gregory and Menser, [63] | United States | Longitudinal (three wave) online survey | 97, 91, 56 (65.5%, 54.9%, 58.4%), respectively | Primary/ambulatory care physicians (N/A) |
Grondin [61] | Canada | Survey | 97 (71%) | Thoracic surgeons (average age 47.7 years) |
Hall [5] | United States and Canada | Survey | 1444 APS members (35%); 148 pediatric department chairs (40%) | Senior pediatricians and pediatric department chairs (ages 39 to 94, average age 65 years) |
Heponiemi [44] | Finland | Survey (Finnish Health Care Professional Study) | 1393 (27.9%) | Multidisciplinary physicians (ages 45 to 65 years) |
Hill [24] | United Kingdom | Semi-structured interviews/survey | 23 (N/A) | Dentists (NA) |
Jacobson and Eran [25] | Israel | Interview | 317 (89.5%) | Multidisciplinary physicians (age 50 years or older) |
Jonasson and Kwakwa [84] | United States | Survey | 373 (84%) | General surgeons (NA) |
Joyce [42] | Australia | Longitudinal survey (Medicine in Australia: Balancing Employment and Life, Cycles 2009 to 2012) | 1073 (2009, 82.64%, 2010, 82.24%, 2011, 75.51% and 2012, 75.32%) | Physicians and specialists aged ≥65 years |
Kendell and Pearce [85] | United Kingdom | Survey | 173(82%) | Consultant psychiatrists (NA) |
Landon [49] | United States | Data for this study are from the first 2 rounds of the Community Tracking Study (CTS) Physician Survey | 16,681 (63%) | Primary care and specialist physicians initially spending at least 20 h/week in direct patient care activities were studied (average age 47.5 years for practicing and 63.0 years for retired physicians) |
Lee [86] | United States | Telephone interview/survey | 33 (75%) | Multidisciplinary rural physicians (age 60 years or older) |
Lee [87] | United States | Survey | 995 (N/A) | Surgeons (age in years <35 (13.37%), 35–44 (12.96%), 45–54 (18.69%), 55–65 (31.06%), >65 (23.92%)) |
Luce [7] | United Kingdom | Survey | 518 (72.5%) | Multidisciplinary physicians (age 45 years or older) |
Moriarty [88] | United States | Survey sent to all members of the American College of Radiology (ACR), the Association of University Radiologists (AUR), and the Society of Chairs of Academic Radiology Departments (SCARD) | ~37900 (11%) | Practicing radiologists (NA) |
McGuirt and McGuirt [89] | United States | Survey | 438 (31.5%) | Otolaryngologists (ages 40 to 80, average age 63.2 years) |
Mears [41] | United Kingdom | Survey | 835 (59%) | Consultant psychologists (age 50 years or older) |
Meghea and Sunshine [54] | United States | Survey (American College of Radiology’s 2003 Survey of Radiologists) | 1676 (63%) | Radiologists (ages 35 to 75 years) |
Newton [26] | United Kingdom | Semi-structured interviews | 21 (N/A) | Multidisciplinary physicians (age 44 years or older) |
Onyura [19] | Canada | Secondary analysis of data from a larger study on issues of late-career planning among academic physicians; semi-structured interviews | 21 | Academic physicians at a Canadian medical school (n = 21, average age = 63 years, age range = 46–72 years) |
Orkin [34] | United States | Survey | 8670 (37.2%) | Anaesthesiologists (age 50–79 years, average age 60.1 years) |
Peisah [45] | Australia, Canada, United States | Semi-structured interviews | 25 (N/A) | Multidisciplinary physicians (aged 60 or older, average age 67.5 years, age range = 60–88 years) |
Pit and Hansen [16] | Australia | Survey | 92(56%) | Multidisciplinary physicians (average age 51 years) |
Quandango [27] | United States | Semi-structured interviews | 40 (N/A) | Multidisciplinary physicians (ages 55 to 72) |
Rayburn [31] | United States | American Medical Association Master file | N/A | Obstetrician-gynecologists |
Reuben and Silliman [47] | United States | Survey | 282 (70%) | Multidisciplinary physicians (age 65 or older, average age 71 years) |
Rittenhouse [33] | United States | Survey | 967 (N/A) | Multidisciplinary physicians (<55 years, 62.8%, 55–64 years, 27.3%, >65 years, 9.9%) |
Rowe [90] | United States | Survey | 169 (84%) | Physicians (52–96 years) |
Sansom [28] | England | Semi-structured interviews | 23 | General practitioners (50–60 years) |
Shanafelt [53] | United States | Survey, American Society of Clinical Oncology | 2998 (49.7%) | US oncologists |
Sibbald [32] | United Kingdom | Survey | 1949 (N/A) | Multidisciplinary physicians (average age 55 years) |
Silver [29] | Canada | Focus groups | 16 | Academic physicians over 50 years old within the Department of Medicine at the University of Toronto |
Smith [91] | Canada | National survey was administered to all Canadian otolaryngologists | 65 (65%) | Otolaryngologists who were identified to have a clinical practice composed of >50% rhinology (average age: 46 years) |
Sutinen [35] | Finland | Survey | 819 (55%) | Multidisciplinary physicians (ages 26 to 63 years) |
Van Greuningen [17] | Netherlands | Retrospective survey (2 waves) | 520 (60%); 405 (54%) | Self-employed general practitioners retired before age 65 |
Wakeford et al. [18] | United Kingdom | Interview | 250 (79%) | Multidisciplinary physicians (average age: 61.4 years) |
Selection a | Comparability b | Outcome c | Quality score | |||||
---|---|---|---|---|---|---|---|---|
37 | Representativeness of sample | Sample size | Non-respondents | Ascertainment of exposure | Assessment of outcome | Statistical test | ||
Anderson [47] | A | A | B | C | A | C | A | 6 |
Austrom [58] | B | A | A | B | – | C | A | 6 |
Baker [56] | A | A | A | C | – | C | B | 4 |
Baker [59] | A | A | A | B | – | C | B | 5 |
Baker and Hishinuma [74] | B | A | B | B | A/B | C | A | 7 |
Batchelor [22] | C | B | B | B | – | C | B | 2 |
Biellauskas [75] | B | B | C | A | A/B | C | A | 6 |
Brett [51] | B | B | B | B | – | A | A | 5 |
Burke [76] | C | A | C | B | – | C | B | 3 |
Chambers [69] | A | A | A | A | – | C | A | 6 |
Crowson, [6] | A | A | A | A | A | B | – | 7 |
Davidson [77] | A | A | A | C | – | C | A | 5 |
Davidson [52] | A | A | C | B | A | C | A | 6 |
Deitch [48] | A | A | A | B | A/B | C | A | 8 |
De Santo [78] | A | A | B | B | – | C | B | 4 |
Dodds [46] | A | A | A | A | A/B | C | A | 9 |
Donner [79] | D | C | C | C | – | D | B | 0 |
Draper [40] | A | A | A | B | A | C | A | 7 |
Draper [80] | A | A | B | A | A/B | C | A | 8 |
Eagles [30] | A | A | B | B | A | C | B | 5 |
Evans and Ghosh [43] | A | B | B | A | – | C | A | 5 |
Farley [39] | A | A | B | A | – | C | B | 4 |
Fletcher and Schofield [38] | A | A | C | A | A/B | C | A | 8 |
Florence [81] | A | A | B | B | – | C | B | 4 |
French [36] | A | A | A | A | A | C | A | 8 |
French [23] | A | A | A | A | A | C | A | 8 |
Gee [82] | A | A | B | B | – | C | A | 5 |
Goldberg [57] | A | A | B | A | – | C | A | 6 |
Grauer and Campbell [50] | D | B | C | B | – | C | B | 2 |
Greenfield and Proctor [83] | A | A | B | B | A | C | B | 5 |
Gregory and Menser [63] | B | A | B | A | A | C | A | 7 |
Grondin [61] | A | A | B | A | – | C | A | 6 |
Hall [5] | A | A | B | B | – | C | B | 4 |
Heponiemi [44] | A | A | B | A | A/B | C | A | 8 |
Hill [24] | C | A | C | B | – | C | B | 3 |
Jacobson and Eran [25] | A | A | B | A | A/B | C | A | 8 |
Jonasson and Kwakwa [84] | A | A | B | B | A | C | B | 5 |
Joyce [42] | A | A | A | C | A | C | B | 8 |
Kendell and Pearce [85] | A | A | B | C | – | C | B | 3 |
Landon [49] | B | A | A | B | A/B | C | A | 8 |
Lee [77] | A | A | A | B | – | C | B | 5 |
Lee [87] | B | A | B | B | – | C | A | 5 |
Luce [7] | A | A | B | A | – | C | A | 6 |
Moriarty [88] | A | B | B | B | A/B | C | B | 5 |
McGuirt and McGuirt [89] | B | A | B | B | – | C | B | 4 |
Mears [41] | A | A | B | B | A | C | A | 6 |
Meghea and Sunshine [54] | A | A | A | B | A/B | C | A | 8 |
Newton [26] | C | A | B | A | – | C | B | 4 |
Onyura [19] | B | A | C | B | – | C | B | 4 |
Orkin [34] | A | A | B | B | A/B | C | A | 7 |
Peisah [45] | C | A | C | A | – | C | B | 4 |
Pit and Hansen [16] | B | A | B | A | A/B | C | A | 8 |
Quandango [27] | C | A | B | B | – | C | B | 3 |
Rayburn [31] | A | A | B | B | – | B | B | 5 |
Reuben and Silliman [47] | A | A | A | B | A/B | C | A | 8 |
Ritternhouse [33] | A | A | A | B | A/B | B | A | 9 |
Rowe [90] | A | A | B | C | – | C | B | 3 |
Shanafelt [53] | A | A | A | A | A/B | C | A | 9 |
Sibbald [32] | A | A | A | A | A/B | A | A | 9 |
Silver [29] | B | A | B | B | – | C | B | 4 |
Smith [91] | A | A | C | A | – | C | B | 5 |
Sutinen [35] | A | A | A | A | A/B | C | A | 8 |
Van Greuningen [17] | A | A | B | A | – | C | A | 7 |
Wakeford [18] | A | A | C | B | – | C | B | 4 |
Batchelor, 1990 [22] | French et al., 2006 [23] | Hill et al., 2010 | Jacobson and Eran, 1980 [24] | Newton et al., 2004 [26] | Peisah, Gautam, and Goldstein, 2009 [9] | Quandango, 1978 [27] | Sansom, 2016 [28] | Silver, Pang, and Williams, 2015 [29] | Wakeford, Roden, and Rothman, 1986 [18] | |
---|---|---|---|---|---|---|---|---|---|---|
1. Does the study address a clearly focused question/issue? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
2. Is the research method (study design) appropriate for answering the research question? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
3. Was the context clearly described? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
4. How was the fieldwork undertaken? Was it described in detail? Are the methods for collecting data clearly described? | Y | Y | Y | Y | Y | N | Y | Y | Y | N |
5. Could the evidence (fieldwork notes, interview transcripts, recordings, documentary analysis, etc.) be inspected independently by others? | N | Y | Y | N | Y | Y | Y | Y | Y | N |
6. Are the procedures for data analysis reliable and theoretically justified? Are quality control measures used? | N | Y | Y | N | Y | N | Y | Y | Y | N |
7. Was the analysis repeated by more than one researcher to ensure reliability? | N | Y | Y | Y | Y | N | N | Y | Y | N |
8. Are the results credible, and if so, are they relevant for practice? | Y | Y | Y | Y | Y | N | Y | Y | Y | Y |
9. Are the conclusions drawn justified by the results? | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y |
10. Are the findings of the study transferable to other settings? | Y | N | Y | Y | Y | N | Y | Y | N | N |
Physician retirement age
50–59 years | 60–69 years | >70 years | “Never” | |
---|---|---|---|---|
Expected retirement age | Burke [76] Eagles [30] Luce [7] Fletcher [38] Mears [41] Goldberg [57] Sansom [28] | Anderson [37] Dietch [48] Dodds [46] Farley [39] Florence [81] Grondin [61] Mears [41] French [36] French [23] Gee [82] Pit [45] Rayburn [31] Shanafelt [53] Smith [91] Wakeford [18] | Batchelor [22] | Draper [40] |
Actual retirement age | Baker [52] Eagles [30] Sansom [28] | Anderson [37] Austrom [58] Batchelor [22] Farley [39] Fletcher [38] French [36] Jonasson [84] Meghea [54] Luce [7] Orkin [34] Rayburn [31] Rowe [90] Van Greuningen [17] Wakeford [18] | Joyce [42] Rayburn [31] | – |
Reasons for retiring early and obstacles to practice
Subtheme | Study |
---|---|
Workplace frustration: bureaucracy, accreditation, healthcare reform, demands from government, alienation by changes to working life, low job control, low organizational justice, poor teamwork and workforce shortages | |
Workload pressures: patient demands, long hours, demanding on-call schedules and sacrifice of family/free time, work-life balance | |
Career dissatisfaction: lost interest in work | |
Health: excessive stress, health and mental health concerns (thoughts of suicide, emotional exhaustion), and spousal health | |
Finances: pension, economic concerns, costs of continuing to practice, retirement not being written into partner agreements, general guidance, insurer policies affecting payment | |
Skills and competencies: worry over competencies amidst technological advancements and new modalities of diagnosis or treatment |
Reasons for delaying retirement
Strategies to facilitate physician retention and retirement planning
Subtheme | Study |
---|---|
Flexible work hours: part-time employment options, gradual reduction, flexible hours or sabbatical, decreased on-call, relief of workload pressure | |
Minimal work barriers: less bureaucracy, increased staff, improved working conditions, support to maintain/update competencies, more time with patients | |
Work satisfaction: professional/clinical freedom, attend conferences and rounds, office space, chances to develop or change content of their work (i.e., teaching opportunities) | |
Health: continuing good or better than expected health at expected retirement age, strategies to reduce work-related stress, support prioritizing health | |
Finances: protected pensions, being highly paid, financial necessity |