Pediatricians Aged
ⱖ
50 Years
WHAT’S KNOWN ON THIS SUBJECT: Little is known regarding the retirement patterns of pediatricians. Previous research showed increasing interest in part-time work among pediatricians, but it is unclear how many older pediatricians work part-time and whether this is associated with delayed retirement.
WHAT THIS STUDY ADDS: This study shows that part-time work is common among older pediatricians and that pediatricians commonly work past age 65. The extended retirement patterns and the popularity of part-time work among pediatricians have implications for the pediatric workforce.
abstract
OBJECTIVE:This study examined patterns of work and retirement among older pediatricians, including the determinants of part-time work and retirement, as well as extended participation in the pediatri-cian workforce.
METHODS:A mail survey regarding recent and expected workforce participation was distributed to American Academy of Pediatrics mem-bers who were agedⱖ50 years. A total of 1158 (72%) responded, 1114 (70%) of whom were included in these analyses. Analyses examined levels of engagement in medicine, retirement plans, and differences between men and women and primary care pediatricians and pediat-ric subspecialists.
RESULTS:Providing or planning to provide patient care past age 65 was reported by 45% of the respondents. Engaging in part-time work was increasingly more common with age and may represent a step toward retirement for many. In this sample, women were more likely to work part-time (32% vs 18% of men) and less likely to work past age 65 (26% vs 57% of men). When compared with primary care pediatricians, pediatric subspecialists worked more hours per week (59 vs 53) but spent a smaller percentage of their time on patient care (63% vs 82%).
CONCLUSIONS:Part-time work and reduced work hours in anticipa-tion of retirement are opanticipa-tions that are used and desired by older pediatricians. Results of this study suggest that making provisions for gradual reduction in work hours or other forms of phasing out of the workforce could benefit the practice of pediatrics by extending the career length of the most experienced pediatricians.Pediatrics2010; 125:158–164
AUTHORS:Alicia C. Merline, PhD,aWilliam L. Cull, PhD,a
Holly J. Mulvey, MA,band Avrum L. Katcher, MDc
aDivision of Health Services Research,bDivision of Workforce
and Medical Education Policy, andcSection for Senior Members,
American Academy of Pediatrics, Elk Grove Village, Illinois
KEY WORDS
pediatric workforce, physician practice patterns, physician satisfaction
ABBREVIATIONS
AAP—American Academy of Pediatrics OR— odds ratio
www.pediatrics.org/cgi/doi/10.1542/peds.2008-3090 doi:10.1542/peds.2008-3090
Accepted for publication Jul 30, 2009
Address correspondence to Alicia C. Merline, PhD, American Academy of Pediatrics, Division of Health Services Research, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: [email protected]
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2009 by the American Academy of Pediatrics
Although 65 is generally regarded as “normal” retirement age in the United States, many professionals choose to work beyond this age.1Rather than exit
abruptly from the workforce, many older adults are choosing to reduce their working hours in anticipation of retirement. Reducing work hours in lieu of retirement may be a way to ac-commodate simultaneously the need for work reduction because of per-sonal health issues, family caregiving demands, or relief from work stress while addressing the desire to main-tain employment for financial reasons or intellectual stimulation. Phased re-tirement is becoming a more common way to exit the workforce,2and many
current full-time workers express a desire to retire gradually.3
Previous research has noted substan-tial growth in part-time work among both established practicing pediatri-cians and recently graduated pediatric residents, particularly women.4,5Little
is known regarding whether this pat-tern is reflected in work participation among pediatricians who are aged ⱖ50 years. Understanding patterns of work and retirement among older pe-diatricians has the potential to aid in anticipating and preparing for future shifts in the pediatric workforce. In this article, we examine (1) the ages at which pediatricians retire, (2) whether characteristics such as gender and be-ing in primary care pediatrics versus a pediatric medical or surgical subspe-cialty matter, (3) the factors that influ-ence retirement decisions, and 4) the degree to which older workers work part-time.
METHODS
A cross-sectional survey was con-ducted by the American Academy of Pe-diatrics (AAP) in conjunction with the Association of American Medical Col-leges and 7 other medical
associa-tions.* Questionnaires were mailed to 1600 AAP pediatricians agedⱖ50 be-tween February and May 2006. For maximization of the number of older pediatricians who participated in this study, surveys were sent to members of the AAP Senior Section, which is open to AAP members who are aged ⱖ55 years (n ⫽ 730) and 870 ran-domly selected US members of the AAP who wereⱖ50 and not in the senior section. Repeat questionnaires were mailed up to 3 times to those who did not respond initially. Responses were collected from 72% (n⫽1158) of the AAP members, a response rate that compares favorably with other recent surveys of pediatricians.6
Respon-dents were asked to report their work status by choosing from among 5 op-tions: full-time, part-time, retired, tem-porarily not active in medicine, or never active in medicine. After exclu-sion of 20 respondents who were ei-ther temporarily inactive in medicine or had never been active in medicine and 24 who did not report their work status, the sample size for this study was 1114 (70%). Tests that compared sample respondents with all AAP mem-bers who were agedⱖ50 revealed that the respondent population was older (mean age: 68) than the target popula-tion of all AAP members who were agedⱖ50 (mean age: 60;P⬍.001). A larger proportion of the respondent population was male (73%) compared with the target population (66%;P⬍ .001). Sampling weights that adjusted for age and gender were calculated to compensate for the oversampling of Senior Section members and for dif-ferential nonresponse. These weights, used for all analyses reported here, al-low the data to reflect the appropriate
proportional representation of AAP members who were agedⱖ50.
Respondents were asked to report the number of hours that they worked dur-ing their most recent complete week of work. Furthermore, respondents were asked what percentage of their work-week was spent performing patient care, including clinical practice, re-lated office work, communications with hospitals/physicians regarding patients, and other related activities. Respondents rated both the viability of their practice and their satisfaction with medicine as a career on 5-point scales. Given the subjective nature of these 2 items, responses to each item were dichotomized. In the case of via-bility, scores were dichotomized to re-flect the extent to which pediatricians considered their practices to be via-ble (1 ⫽ extremely viable/very via-ble, and 0 ⫽ somewhat viable/mar-ginally viable/not at all viable). For the satisfaction variable, responses were dichotomized to distinguish between indications of satisfaction (very satisfied/somewhat satisfied) and lack of satisfaction (neither satis-fied nor dissatissatis-fied/somewhat dissat-isfied/very dissatisfied).
Additional questions asked about re-tirement plans (age when they plan to retire), age at retirement, and work history (having ever taken a sabbatical or worked part-time). Demographic in-formation about the respondents’ edu-cation, finances, health, marital status, and number of dependents was also collected. Respondents who reported their current work status as “retired” were also asked whether they had ta-pered their work hours in anticipation of retirement.
Several statistical techniques were used to analyze the data. Logistic re-gressions were used to predict both retirement and part-time status. Di-chotomous predictor variables that have been previously related to work
*The other medical associations were the Ameri-can Medical Association, the AmeriAmeri-can Academy of Family Physicians, American College of Cardiology, American College of Physicians, American College of Obstetricians and Gynecologists, American Soci-ety of Clinical Pathology, and the American SociSoci-ety of Plastic Surgeons.
choices and practice characteristics were included in the models4,5,7: age
⬎65, female gender, married, poor health (defined as reporting health as “fair” or “poor” rather than “excel-lent,” “very good,” or “good’), interna-tional medical school graduate, having dependents, and practicing a pediatric subspecialty. For examination of the associations between these predic-tors and part-time work, a multivariate logistic model was estimated in which all predictors were entered simulta-neously. The process was repeated to examine the associations between re-tirement and the dichotomous predic-tors. Some of the analyses reported in this article examined only the re-sponses of practicing pediatricians (n ⫽ 779) or retired pediatricians (n⫽335). The number of cases varied slightly across analyses as a result of differential item response.P⬍.05 was considered statistically significant for all analyses. This project was
ap-proved by the AAP’s institutional re-view board.
RESULTS
All Respondents
As shown in Fig 1, 88% of pediatricians between ages 50 and 54 were working full-time. Approximately 11% of pedia-tricians aged 50 to 54 were working part-time. The number of pediatricians who were either working part-time or retired was higher among those aged 55 to 64, but the majority in this age range remained employed full-time. Part-time work became more common than full-time work with age. For exam-ple, Fig 1 shows that among pediatri-cians aged 65 to 69, 27% were working part-time and 47% were working full-time. Among those aged 75 to 79, the proportion who were working full-time dropped to only 15%. Part-time work was most common among pediatri-cians between the ages of 70 and 74;
35% of respondents in this group re-ported a current work status of part-time. Fewer than half of participants in each age groupⱖ65 reported working full-time; the number who were work-ing full-time dropped to 25% by age 70. Among respondents agedⱖ75, more than half reported that they had fully retired from medicine.
As shown in Table 1, retirement was more common among those who were older than 65 (43% vs 3%; odds ratio
88% 89%
78%
47%
25%
15%
7% 14%
27%
35%
27%
22% 27%
41%
58%
70%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
50-54
n = 142
55-59
n = 146
60-64
n = 152
65-69
n = 188
70-74
n = 144
75-79
n = 158
>79
n = 171
Full Time Part Time Retired
FIGURE 1
Employment status by age.
TABLE 1 Characteristics of Pediatricians Associated with Retirement (N⫽1106)
Predictor OR 95% CI Older than 65 21.85a 12.62–37.81 Female 1.49 0.85–2.60 Married 0.79 0.41–1.55 Poor health 2.08b 1.03–4.17 International medical
school graduate
0.94 0.45–1.81
Dependents 0.69b 0.49–0.96 Subspecialist 0.53b 0.30–0.95
[OR]: 21.85; P ⬍ .001), were in poor health (36% vs 12%; OR: 2.08;P⬍.05), had no dependents (22% vs 12%; OR: 0.69;P⬍.05), or were practicing pri-mary care pediatrics rather than a pe-diatric medical or surgical subspe-cialty (13% vs 7%; OR: 0.53;P⬍.05).
Currently Active Pediatricians Aged>50
Table 2 provides an overview of pedia-tricians in this sample who were cur-rently active in medicine. Those who were working full-time reported work-ing an average of 55 hours per week. There was no significant difference be-tween the number of hours worked by men and by women; however, pediatric medical and surgical subspecialists reported working more hours (59) than primary care pediatricians (53). As depicted in Table 2, 23% of the ac-tively practicing respondents reported that they were currently working part-time. Current part-time work was sig-nificantly more common among fe-male pediatricians (32%) than fe-male pediatricians (18%). On average, pedi-atricians who were working part-time reported working 29 hours per week. Female part-time pediatricians re-ported working more hours (34) than male part-time pediatricians (26). An additional 24% of respondents who
were currently working full-time indi-cated that they were willing to work part-time in the future. More female than male full-time pediatricians were willing to work part-time. Further-more, many respondents (81%) indi-cated that the availability of part-time work would influence their willingness to work later into life.
On average, pediatricians in this sam-ple reported spending 76% of their time on patient care. Percentage of time spent on patient care was approx-imately equal for male and female pe-diatricians but significantly higher among those who were identified as being in pediatric primary care (82%) than among pediatric medical and sur-gical subspecialists (63%). Most pedi-atricians in this sample (60%) rated their practices as currently viable; women were less likely to report hav-ing a viable practice than men. Most (90%) respondents were satisfied with
medicine as a career. There were no significant differences in satisfaction between men and women or pediatric subspecialists versus primary care pediatricians.
As shown in Table 2, 45% of currently active pediatricians in this sample vided patient care or expected to pro-vide patient care past age 65. Although, as described already, men and women spent an equal percentage of their work time providing patient care, men and women varied in the average age at which they stopped providing pa-tient care. There is a significant gender difference in that female pediatricians were less likely to provide or expect to provide patient care past age 65 than male pediatricians. Similarly, although 15% of practicing pediatricians pro-vided or expected to provide patient care past age 70, this number was higher among male pediatricians (19%) than among female pediatri-cians (6%). Table 3 shows the percent-age of active pediatricians who indicated that various factors were very important in influencing their decisions to continue practicing. For both men and women, the most commonly selected reason was ca-reer satisfaction.
As shown in Table 4, part-time work was more common among practicing pediatricians who were older than 65 (54% vs 17%; OR: 7.17; P ⬍ .001), women (33% vs 18%; OR: 3.57; P ⬍ .001), in poor health (49% vs 22%; OR: 3.11;P⬍0. 01) graduates of US or Ca-nadian medical schools (24% vs 16% among international medical school TABLE 2 Experiences of Currently Active Pediatricians (N⫽774)
Parameter Total Gender Specialty Men Women Subspecialist Primary
Care Current work experiences
Hours for full-time pediatricians, mean 55 55 56 59 53a Currently part-time, % 23 18 32a 19 24 Hours for part-time pediatricians, mean 29 26 34b 31 29 Full-time pediatricians willing to work part-time, % 24 21 30b 23 25 Time spent on patient care, % 76 76 77 63 82a
Viable practice, % 60 63 55c 62 60
Satisfied with medicine as career, % 90 90 90 90 91 Expectations for future work, %
Provided or will provide patient care past age 65 45 54 28c 45 45 Provided or will provide patient care past age 70 15 19 6c 12 16 Willing to work longer if part-time is available 81 81 82 82 78
aP⬍.001. bP⬍.01. cP⬍.05.
TABLE 3 Factors Influencing Nonretired Pediatricians to Remain Active in Medicine (N⫽774)
Reason Total, % Men
(n⫽556), %
Women (n⫽218), %
Career satisfaction 77 77 78
Financial needs or obligations 62 62 62
Good income 52 53 50
Needs of my patients 44 44 45
Need for health insurance 32 32 33
Difficultly recruiting a replacement 9 8 11
graduates; OR: 0.48;P⬍.01), and had no dependents (38% vs 20%; OR: 0.74; P⬍.05).
Experiences of Retired Pediatricians
In this study, retired female pediatri-cians reported a mean retirement age of 62 and retired male pediatricians reported a mean retirement age of 68. As shown in Table 5, many pediatri-cians were working past the expected retirement age: 49% of respondents reported working, either full-time or part-time, past age 65; 24% of respon-dents reported working past age 70. Working past age 65 was more com-mon acom-mong men (57%) than acom-mong women (26%). More men than women also worked past 70, but the difference did not reach significance. Retiring from pediatrics does not always mean leaving the workforce entirely. Among retired pediatricians, 12% reported that they were currently working for pay in a nonmedical field.
As depicted in Fig 2, of the retired pe-diatricians in this study, 59% of the men and 76% of the women reported having phased into retirement through
some combination of working part-time or tapering their hours. Having worked part-time or having both worked part-time and tapered work hours was reported by 64% of female and 42% of male retired pediatricians. An additional 17% of retired male pedi-atricians and 12% of retired female pe-diatricians reported having tapered their work hours but not having worked part-time. Among the retired pediatricians who did not taper their hours before retirement, 35% re-ported that they would have delayed retirement had flexible hours or part-time work been an option (result not listed in tables).
As shown in Table 6, increasing reg-ulations, decreased autonomy, and on-call responsibilities are the most frequently reported factors influenc-ing pediatricians’ decisions to retire.
On-call responsibilities was the most frequently reported factor influencing retirement decisions among men, whereas it was only the ninth most fre-quently reported factor among women. Personal health and family responsibility were factors influencing retirement de-cisions reported more frequently by women. Factors such as occupational safety issues and increased competition within specialty were rarely reported by either men or women as influencing re-tirement decisions.
DISCUSSION
Extending Careers Beyond 65
Of the pediatricians in this sample, nearly half worked full-time past age 65 and one quarter worked full-time past 70, indicating that it is common for pediatricians to work through their 60s and beyond. This demonstrates that they continue to practice medi-cine well after what is considered “normal” retirement age and beyond the mean retirement age for the United States.8
Among pediatricians who are now aged ⱖ50, men remain active in the
7.4
33.8 34.4
30.1 17.1
12.2
0 10 20 30 40 50 60 70
) 0 7 = n ( n e m o W )
2 6 2 = n ( n e M
Pe
rc
en
t Tapered hours but not part-time
Tapered and part-time Part-time only
FIGURE 2
Preretirement work experiences of retired pediatricians.
TABLE 5 Experiences of Retired Physicians (N⫽332)
Experience Total, % Gender, % Specialty, % Men Women Subspecialist Primary Care
Worked past 65 49 57 26a 54 48
Worked past 70 24 28 13 19 26
Currently in nonmedical field 12 12 12 18 10
aP⬍.01.
Predictor OR 95% CI Older than 65 7.17a 4.64–11.09 Female 3.57a 2.43–5.25 Married 1.07 0.63–1.83 Poor health 3.11b 1.51–6.43 International medical
school graduate
0.48b 0.28–0.81
Dependents 0.74c 0.59–0.94 Subspecialist 0.81 0.54–1.21
field of pediatrics until later in life than women. Women both retire earlier than men (mean age: 62 for women vs 68 for men) and stop providing or plan to stop providing patient care earlier than men (only 28% of women provide or plan to provide patient care past age 65, as opposed to 54% of men). Many pediatricians choose to work part-time as they age. Many more indi-cate that having part-time hours as an option would make them willing to postpone retirement. A willingness to postpone retirement when flexible work options are available has been noted in populations of older workers not limited to doctors; and older work-ers in highly skilled positions, who have a high income and who have a higher level of education, have been found to be more likely to use flexible work options in this way.2,3
Part-time Work as a Step Toward Retirement
The growth in part-time work among younger pediatricians has been dem-onstrated previously.4,5This study
ex-tends those findings to show that part-time work is also common among pediatricians aged ⱖ50, suggesting growing preferences for part-time work options across the age spectrum of pediatrics. Part-time work and reduced work hours in anticipation of retirement
are also options that are both used and desired by older pediatricians.
Other studies have reported that older workers in general would like alterna-tive work schedules as a step toward or in lieu of retirement.2For
individu-als who opt to reduce their hours be-fore leaving the workforce, retirement is more of a process than an abrupt transition. This study’s findings of part-time work among older pediatri-cians reflects a growing trend in which physicians and other older American workers choose, when possible, to phase out their jobs gradually rather than transition directly into retirement.2
Reasons for Retirement
Several factors were frequently re-ported as influencing retirement deci-sions. These included issues related to the practice of medicine, such as mal-practice insurance and reimburse-ment, and personal reasons, such as stress, health, and wanting to pursue other interests. Most reasons were re-ported by a similar proportion of men and women; however, on-call responsi-bilities appeared as a top reason for men but not for women. This suggests that, at least for men, obligatory on-call time is a deterrent to remaining employed later in life; it also confirms other research indicating that older
phy-sicians, particularly men, find being on-call particularly burdensome.9,10 Family
responsibility and poor health were more frequently endorsed as reasons for retirement by women than by men. Women pediatricians’ frequent en-dorsement of family responsibility as a factor in retirement decisions is con-sistent with evidence that during mid-dle age and late life, women (including women who practice medicine) often provide care for family members such as aging parents, an ill spouse, or young grandchildren.11,12
Limitations
The limitations of this study require cautious interpretation of the results. Questions regarding retirement plans and retirement ages were self-reported and, in many cases, retro-spective. It is possible that some indi-viduals may inaccurately remember or misreport their retirement age. The item regarding practice viability pro-vided no guidelines to assist respon-dents in rating their practice and is therefore highly subjective; however, collapsing viability into a dichotomous variable may help to compensate for its subjective nature. Similarly, re-spondents could self-define as part-time or full-part-time regardless of the number of hours they worked. Results regarding on-call duties also call for cautious interpretation, because retir-ees’ on-call responsibilities before re-tirement are unknown. Furthermore, this information was gathered in early 2006, before a nationwide recession that may lead some doctors to remain in practice longer as the value of their assets and retirement savings change.
The sample was drawn from a list of AAP members. Although most pediatri-cians opt to become AAP members, not all board-certified pediatricians join the AAP or maintain their membership over time. Any systematic differences between pediatricians who join the TABLE 6 Factors Influencing Pediatricians to Retire (N⫽332)
Reason Total, % Men (n⫽262), % Women (n⫽70), % Increasing regulation of medicine 38 34 49 Decreasing clinical autonomy 35 35 35
On-call responsibilities 34 37 26
Rising malpractice costs 29 25 39
Stress of practice 25 23 31
Nonmedical interests 25 22 35
Insufficient reimbursement 21 18 28
Personal health issuesa 19 14 32
Lack of professional satisfaction 17 14 24 Effort needed to keep up with clinical changes 15 14 17 Increased family responsibilitiesa 13 8 29
Recertification requirement 10 10 9
Increased competition within specialty 5 5 5
Occupational safety issues 1 1 3
aP⬍.05.
in AAP after retirement and those who allow their membership to lapse after they retire could limit the applicability of this study’s results.
As with any study involving older adults, results may be biased because of differential selectivity as a result of incapacity or death; therefore, our group of responders is likely healthier than pediatricians who are agedⱖ50 overall. Longitudinal research would be necessary to show conclusively whether findings regarding age differ-ences reflect intra-individual change
also help in indicating whether those who work part-time after age 65 are also those who had a history of part-time work.
CONCLUSIONS
This study shows that working part-time and reducing work hours both are very common work patterns and work options desired by pediatricians who are agedⱖ50. Pediatricians who are agedⱖ50 are, on the whole, satis-fied with their work and describe their practices as viable. They are likely to continue working past age 65,
al-ment. The tendency for older pediatri-cians to begin part-time work, coupled with the trend for women to retire ear-lier than men, will likely have implica-tions for future workforce projecimplica-tions and needs. As the field becomes in-creasingly more dominated by women, a reduction in the average retirement age may occur. This study’s findings suggest that greater practice flexibil-ity, such as making part-time work and other phased retirement options more readily accessible, may be a useful strategy for retaining older pediatri-cians in the workforce.
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Multitaskers Not Always Worth Envying:According to an article inThe New York Times
(Pennebaker R,The New York Times, August 30, 2009) multitaskers may not be as high-performing as many have thought. Summarizing a recent study in theProceedings of the
National Academy of Sciencesby Ophir et al. (Proc Natl Acad Sci U S A, 2009; 106(37):15583-7.
Epub 2009 Aug 24), college students who viewed themselves as high-performing multitaskers when compared to low-performing one task at a time colleagues did worse in accomplishing tasks proficiently that required focus and memory. This surprised the investigators who stated that they expected to learn more of the unique strengths of the multitasker but got just the opposite result. Finally, unitaskers get a chance to celebrate their one-at-a-time ways.
DOI: 10.1542/peds.2008-3090 originally published online December 14, 2009;
2010;125;158
Pediatrics
Alicia C. Merline, William L. Cull, Holly J. Mulvey and Avrum L. Katcher
50 Years
≥
Patterns of Work and Retirement Among Pediatricians Aged
Services
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