Physician retirement wave: Can innovative policy stem the tumble?

Bold new proposals are percolating across the country out of rising concerns in policymaking circles about the effect on quality and extent of patient care from a rapidly-evolving physician workforce.Policies to stabilize the job prospects of specialists, expanding efforts to make drastic cuts to red tape and a retirement outlook for Canadian physicians that looks increasingly volatile are among new environmental factors for the medical profession now giving rise to changes in direction and extent of new and innovative proposals.British Columbia’s three-year-old longitudinal family physician (LFP) payment model was on the cutting edge of the new wave, for example.It was developed by the provincial ministry of health, Doctors of BC and B.C. Family Doctors as a response to “an urgent need to retain and attract family physicians by making longitudinal family practice sustainable and rewarding,” the news release said. “To reflect the comprehensive and continuous nature of family medicine, it is a blended payment model that compensates physicians for time, interactions and their overall patient panel,” the release also said. Doctors have historically had a higher traditional retirement age than the public. But now its downward trend suggests an important shift due to administrative burnout and post-pandemic exhaustion, according to documents, surveys and reports by various sources.Doctors who have worked, on average, until their 70s and beyond are now said to be more likely to call it quits while they're in their mid-60s.A recent survey by the Ontario Medical Association found 52% of family doctors are considering retirement or plan to retire over the next five years, up from just 39% just one year ago.In Ontario, where the retirement risk level has been described as “critical” by the Canadian Institute for Health Information, about 2.5 million people now don’t have a family doctor. Because of the relatively advanced age of the workforce and difficulty in “rural succession,” the risk is deemed “high” in Atlantic Canada. And in Quebec, it’s considered “moderate-to-high” because of “high administrative scrutiny” resulting from surveys of doctors over 60 administered by Quebec’s medical practice regulator.The ‘retirement wave’ Crushing administrative loads and the burden of running what are essentially small businesses on their own are commonly thought to be triggering what’s been branded in some circles as a “retirement wave.”“The OMA is committed to working with government to address (its) shortage, and our recommendation is clear: build patient core teams around family doctors by pairing them with registered nurses, physician assistants and support staff to provide comprehensive care and keep patients out of emergency departments,” stated an OMA email.Nova ScotiaSignificantly, Nova Scotia, a national leader at implementing precedent-setting initiatives to cut red tape, has already shown that multiple components of government can collaborate successfully on such efforts.“We were very much tied to old ideas,” said Dr. Ajantha Jayabarathan, director of the Coral Shared-Care Health Centre in Halifax.There were “short sighted missteps” at the worst of times in relations between the profession and government, she added. “They were taking a wrecking ball to health care, going forward with the government plan, and there was no way to let the public know what was going on.”So a public awareness campaign was launched and public debates held. “We made sure we stayed in the public eye. Our story was told by the media in real-time,” she added.Things began to get a lot better when physicians were allowed to sit on various committees and help design programs that, up to then, had been unavailable to them.Nova Scotia was one of the first province to focus on reducing red tape for physicians. And since 2022, several provinces have approached its planners before launching their own projects, she added.Based on projections made this year, more than a quarter of Canada's physicians are now members of the so-called over 60 cohort.“This represents a critical mass of the workforce that has reached or surpassed the typical age of retirement readiness,” warned the OMA and CIHI.“The OMA has continuously been advocating for government policy changes to retain late-career physicians in family medicine,” stated a group email prepared for the Medical Post.“Specific efforts include landing a physician services agreement that saw the largest compensation increase for members in over 40 years, which also introduced time-based billing under the modernized FHO+ agreement, advising the government on the rollout of physician-led, team-based care and expanding HOOPP (Healthcare of Ontario Pension Plan) pension eligibility to doctors,” the email added. “These policies all help to ease administrative burden for doctors as well as entice them to continue practicing family medicine.”Canadian medical schools: Key statisticsSchoolEstablishedFirst-year intakeDeanMcGill1829249Leslie FellowsMontreal1843300Patrick CossetteToronto1843289Lisa RobinsonLaval1852227Marie ArsenaultQueen's1854140Lisa TannockDalhousie1868150David Anderson (Saleem Razack eff. Sept. 1)Western1881190John YooManitoba1883140Peter NickersonAlberta1913182Brenda HemmelgarnSaskatchewan1926100Sarah FogieOttawa1945170Melissa FogieUBC1950328Sharmila AnandasabapathyMcMaster1965225Nancy Baxter Sherbrooke1966275Louis ValiquetteCalgary1967180Todd AndersonMemorial196785Margaret SteeleNOSM200278Sarita VermaMetro Toronto202594Teresa ChanPEI202520Preston SmithSimon Fraser202548David J. PriceYork202880David PetersTOTAL—3,550—Nearly 48,000 openings are expected to open up for FPs between now and 2033. About 75% of them will be driven specifically by retirements, putting pressure on Canadian medical schools to replenish the stock.OMA stats show a significant percentage of physicians aged 55–64 is exploring “early” retirement or shifting to part-time/consultative work, citing the 10-plus hours of weekly administrative burden for the “burnout pull-back.”Not only does no one seem sure of what kind of response there will be to these shifting professional environmental factors, they’re naturally also unsure how to anticipate the impact on patient care.One 74-year-old Ontario psychiatrist says she feels she’s been allowed to practise a bit longer in the wake of the COVID shift to telemedicine telepsychiatry. She was able to close her practice and not have to pay for rent or a secretary. Now, she does telepsychiatry from home and “doesn’t have to get dressed up and drive an hour in Toronto traffic.”It’s certainly extended her career. Telepsychiatry gave her a way to keep working beyond when she would normally retire.When a doctor who’s been in practice for 40 years decides to retire, they don’t just leave a job. They’re leaving a business and a patient population that Canadian medical schools and their new team-focused graduates aren’t quite designed to absorb.Retirement of a single senior physician today will have a “multiplier effect” on shortages. It lies in the “volume gap” produced by retiring doctors now carrying patient loads of more than 2,000 by physicians entering the field likely to more often opt for team-based models or specialized roles with smaller rosters averaging 1,200 patients, perhaps as few as 1,000.Not only this, but team-based care is relatively new. Is there enough data to mold it into a medical school curriculum that can reflect what family practice will look like in the future? Over 1.7 million Canadians are currently estimated to be attached to a family physician who is aged 65 or older and likely to retire by 2030.What will happen to them? Who will inherit 2,000-patient rosters?All good questions.Matt Borsellino was national editor of the Medical Post for many years.

Physician retirement wave: Can innovative policy stem the tumble?

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