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The Role of Veteran Physicians in the Staffing Continuum

March - April 2004

The natural tendency of many physician recruiters is to focus their attention on those doctors who are entering the field — the roughly 16,000 U.S. residents who complete their training each year. The obvious reason is that many of these physicians are actively seeking jobs and, therefore, are prime candidates for recruitment.

But what about those doctors at the other end of the spectrum — the “old pros” who may be close to leaving medicine? What role do they play in the staffing continuum? Why should recruiters ensure that they are included in any strategic staff plan?

A recent Merritt, Hawkins & Associates survey suggests some answers to these questions. Conducted late last year, the results of this survey of 436 physicians aged 50 to 65 were released in January 2004. Merritt, Hawkins & Associates conducts this survey periodically in order to monitor the career trends among what is statistically considered a very significant group of physicians. According to the American Medical Association, 38% of all physicians are 50 years old or older, while 30% are 55 years old or older. Should a significant number of these doctors decide to leave medicine, or cut back on the number of patients they see, overall physician availability would be considerably compromised.

A Physician Exodus

Unfortunately, the survey suggests that a defection of older physicians from medicine is to be expected. The survey shows that 51% of physicians aged 50 to 65 plan to make significant changes to their practice in the next one to three years, as follows:

When we last conducted this survey in 2000, 38% of physicians surveyed indicated that they planned to retire in the next one to three years, a much higher number than the 8% who indicated plans to retire in the 2004 survey. In fact, three to four years ago, we did observe an increasing number of older physicians retiring from medicine; however, the decline in the stock market slowed this trend. As a result, early physician retirement appears to have abated somewhat.

62.5 Million Patient Visits Lost

Nevertheless, the 2004 survey shows that while physicians today are not willing or able to retire in great numbers, they are still seeking ways to opt out of traditional patient care or significantly reduce the number of patients they see. There are some 250,000 physicians currently between the ages of 50 and 65. If only 10% of them retire or drop out of patient care in the next one to three years, that would be 25,000 doctors lost from the workforce. Assuming a modest per-physician annual outpatient visit rate of 2,500, the loss of these doctors would create 62.5 million outpatient visits that would have to be absorbed by the remaining physicians. Should only 5% to 6% of these physicians stop seeing new patients, or significantly reduce the number of patients they see, millions of patient visits would still need to be absorbed by an already strained physician workforce.

Keep in mind that 92% of the physicians we surveyed were between 50 and 60 years old, while 61% were between 50 and 55 years old. Typically, these are the “workhorse” physicians who carry heavy patient loads and make numerous hospital referrals. In the past, such doctors generally could be counted on to work through their 60s and often beyond. Should these physicians leave the practice of medicine prematurely, the result will be lost revenues for their affiliated hospitals or groups, longer appointment times, and decreased patient satisfaction.

Impulse Decisions

When physicians turn in their stethoscopes, they often do so on impulse. After a run-in with an insurance company, a bad patient, or a plaintiff’s lawyer, an older physician may simply call it quits. And usually, this physician has not made any plans to transfer his or her patients to another doctor or to participate in a formal transition process.

The survey bears this out. Though over half of physicians surveyed are planning to alter their practice patterns, only 9% indicated they are involved in a succession plan with their affiliated hospital or group. This raises the key issue of who will replace these physicians if they leave. The preferable scenario is for a younger physician to gradually replace an older one.

Even here, however, questions arise. Sixty-four percent of physicians surveyed said that doctors coming out of training today are less dedicated and hardworking than physicians who trained 20 to 30 years ago. Not a single older physician surveyed indicated that young doctors today are more dedicated or hardworking than doctors from the “old school.”

In our experience, younger doctors, while hardworking, are more interested in quality-of-life issues than older doctors, so they do require more vacation time, regular hours, and a more comfortable call schedule than the “old school.” This means that each younger physician entering the field is not necessarily a full replacement for each older physician leaving. Even an orderly practice transition may not fully address the strain that will be created when an older physicians departs.

Don’t Neglect Your Foundation

It will be critical in the next few years for physician recruiters to focus on retaining the foundation of most medical staffs — the “old pros.” Bringing in new doctors is a daily priority, but you are not even treading water if you are losing your veteran physicians at the same time.

The Merritt survey indicates that a “general dissatisfaction with today’s medical practice environment” is a significant reason why many doctors are looking to get out of patient care or out of medicine altogether. Recruiters should ensure that their employers conduct their own survey of existing medical staff to gauge their level of career satisfaction. In particular, the survey should focus on the retirement or future practice plans of older doctors.

Efforts must then be made to address those issues that are causing physicians to become disillusioned. Over half of physicians surveyed only did one to two hours of bureaucratic paperwork a week when they first started practicing medicine. Now, the majority of physicians do seven hours or more. Practice management to reduce paperwork may be one way to alleviate these burdens, as would any other activity that saves physicians time or reduces hassles. In general, this means an efficient workplace where tests come back quickly, where OR space is readily available, and where the nursing staff is competent. It won’t eliminate all of the frustrations doctors encounter, but it may eliminate enough of them to persuade some physicians to maintain full clinical practices for at least a few more years.

In addition, older doctors should be persuaded to participate in succession plans. Many may be willing to do so because they don’t want to leave their patients, or their communities, without appropriate medical services. In addition to establishing an orderly transition, a succession plan can help older physicians slow down and enjoy the quality-of-life benefits that many younger physicians aspire to. This, in turn, may prolong the careers of older doctors who have realized that practicing medicine 24/7 is not always healthy for them, their families, or their patients.

And while this article has focused on retention, it should be mentioned that many older physicians also make excellent recruitment candidates. Unfortuately, the employers seeking “poster boy” candidates who fit a specific demographic profile don’t always embrace these doctors. An opportunity is lost here because older doctors generally know how to set up and run a practice, yielding immediate dividends in terms of patient satisfaction, hospital referrals, and quality of care. True, some older physicians may not be long-term players, but the fact is that younger doctors often pull up stakes prematurely because they don’t know what to look for in a practice and choose practices that are not appropriate for them. More experienced physicians typically don’t make that mistake.

Older physicians have worked hard and made vital contributions to health care delivery. It would be unfortunate if they left the medical profession out of frustration when they still have much to offer. Recruiters should work closely with their leadership and strive to see that this doesn’t happen, while they work to bring new physicians into their communities.

Source: James Merritt is president of Merritt, Hawkins & Associates, a national physician search and consulting firm based in Irving, Texas. He can be reached at jmerritt@mhagroup.com. For a free copy of the survey, visit www.merritthawkins.com/ or call (800) 876-0500.

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