TMC PULSE

T M C » P U L S E | S E P T E M B E R 2 0 1 8 36 T he exodus of baby boomers from the workforce has begun and, with it, the retirement of tens of thousands of physicians. The United States could see a shortage of as many as 120,000 physicians by 2030, according to a recent report published by the Association of American Medical Colleges (AAMC). Fueling the shortfall is population growth, an increase in the number of aging Americans and the retirement of doctors. Should doctors work longer? Should they retire at 65? And what does the exodus mean for other physicians and patients? "We actually need physicians to stick around longer," said Barbara Bass, M.D., executive director of the Houston Methodist Institute for Technology, Innovation and Education (MITIE) and president of the American College of Surgeons. "We are anticipating major short- ages in general surgery, orthopedics and urology in the next decade or two as the current crop of physi- cians retire." A 2016 study published in the Annals of Family Medicine found that primary care physicians who retired from clinical practice between 2010 and 2014 were 65 years old on average. Bass recommends finding ways to keep retirement-age surgeons in good practice for a longer period of time. One suggestion: fewer hours. "We come to work at seven, go home at seven, and you couple that with a few nights of being on call and being up all night, it really takes its toll," she said. "It's one thing to stay up all night when you are 22, but when you are 62, it's really hard. Our work does demand a certain degree of physical performance and fitness—whether that is just stand- ing for a long time, visual acuity or manual dexterity." In a study released by American Medical Association Insurance— "The 2014 Work/Life Profiles of Today's U.S. Physician"—researchers found that 21 percent of responding physicians aged 60 to 69 worked fewer than 40 hours per week, but another 20 percent of the same age group worked more than 60 hours per week. Across all ages, nearly half the physicians surveyed said they would prefer to work fewer hours. Still, a national movement that supports older doctors working fewer hours has yet to take root. Tests and teaching Some have suggested that physi- cians who hope to work past age 65 might benefit from regular testing to gauge their mental and physical acuity. Others counter that, although no mandatory evaluation process for aging physicians exists in the U.S., board certification and hospital regulations help ensure that patients receive the best quality of care. "The closest thing really has to do with re-credentialing—that has to happen at all hospitals on a two- or three-year basis," said Savitri Fedson, M.D., associate professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. "To maintain hospital privileges to do a certain procedure, you have to have demonstrated that you have done a certain number of procedures in the last two years with an acceptable complication rate." In addition, she said, physicians Bracing for a Deficit of Doctors As baby boomers retire, health care is poised for a change B y B r i t n i R . M c A s h a n The U.S. could see an overall shortage of as many as 120,000 physicians by 2030. One-third of all currently active doctors will be 65 or older in the next decade. The U.S. population is estimated to grow 11 percent by 2030, with those over age 65 increasing by 50 percent. Source: Association of American Medical Colleges with board certification receive continuing education in their specialty and keep up with advances in technology, patient safety and more. A "board-certified" physician is dedicated to providing top- notch patient care via a rigorous, voluntary commitment to lifelong learning. Some physicians are able to shift into academic roles in their later years, but that's not a viable option for the majority. "One of the things that hap- pens in academic centers is that as people get older and you try and get them out of clinical responsibilities, they certainly have a huge wealth of knowledge and would be some of the best teachers for medical stu- dents," Fedson said. "But that is not a financially feasible model the way our health care is set up, because the reimbursement for teaching is not done to the same extent that reimbursement is done for proce- dures and, therefore, it is hard to justify salaries." Brain drain Experts anticipate a massive brain drain in health care as baby boom- ers leave medicine. "The concern for me is the loss of wisdom that comes from people who are still practicing at a good level," said Joseph Kass, M.D., Baylor professor in the depart- ments of Neurology, Psychiatry and Behavioral Sciences and in Medical Ethics and Health Policy. "Maybe their hand skills aren't as amazing as they used to be, but they still have a wisdom and a knowledge—not just because they have been doing this for 40 years, but because they have kept up with developments, they UNITED STATES PHYSICIAN SHORTAGE

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