Physician assistants and retirement

People who refuse to rest honorably on their laurels when they reach "retirement" age seem very admirable to me. 


—Helen Hayes (1900-1993), US actor


For many working persons, retirement represents a milestone; after years of labor, the reward is a new stage of life free from the responsibilities of their occupation. As society has changed, the concept of retirement has evolved to mean more than freedom from paid work. The elements of retirement that have been important—financial security and leisure—retain their significance but are now accompanied by issues that reflect societal shifts, such as self-fulfillment, a sense of self-worth, social interactions, and intellectual stimulation. As life expectancies have increased and the period of retirement lengthens, many retirees find themselves unexpectedly having to fund, and fill, a longer requirement. For some, concerns about retirement income delay their exit from the labor force.¹ For others, retirement may occur at a time of dwindling energy and loss of interest in work; thus "leaving it behind" is longed for. Such variables make up the many factors that influence retirement decisions. These factors are important because the oldest of the baby boomers are entering retirement age, and their patterns of departure are not the same as those of their parents.² A growing generation of older PAs brings this topic to the fore and with it a lack of reliable information about it. 


The first large cohort of PAs trained during the 1970s and is now making retirement choices. Instead of dropping out of the medical workforce at the traditional age of 65, some are choosing to remain in practice (to some extent), though not necessarily maintaining the same activity level or doing the same kind of work.³ Prior to full retirement, many changes may occur, such as reduction in workload and narrowed scope of practice. These changes present significant implications for medical care provision and PA workforce planning, but the levels of activity and capacities are unknown. 


The 2010 AAPA Census indicates that 2,340 PA respondents were age 60 to 74 years and were clinically active; two-thirds were female. Are they active for economic, social, intellectual, or other reasons? A large research void looms in this area. Retirement research on physicians and NPs is limited as well. 


A survey of physicians in California was undertaken to test their intention to leave clinical practice, and those who said they were retiring within 2 years did so only one-third of the time.⁴ Job dissatisfaction had a strong association with expressed intention to leave clinical practice (odds ratio, 5.6) but was not highly predictive of actual departure from practice. The strongest predictor of intent to leave clinical practice and actual departure from practice was age: the older the subject, the more likely retirement would occur as planned. Although this seems intuitive, many physicians were still working in their eighth decade.⁴


The duration of a PAcareer is important to know as workforce models of supply and demand are constructed. Some PAs report they will retire on track, and others admit they cannot retire as planned.⁵ The time span from entering to departing the clinical workforce will determine staffing models and influence educational pipelines.⁶ A trend toward early (or delayed) retirement has important implications for the individual as well as for society. However, most models offer little in terms of predicting or understanding the timing of quitting. When it comes to exiting the workforce, it is not known whether PAs are prudent long-term planners or still working because economic signals in middle age were ignored. For others, a balance is sought to be old enough to retire and young enough to enjoy it. Another wrinkle is that life expectancy is changing, with the United States leading the world in number of centenarians (more than 70,000 as of 2010).⁷ 


PAs may be around longer than expected and perhaps need to bridge their retirement in unprecedented ways. Who, what, and why remain challenging questions. JAAPA

1. Cronan JJ. Retirement: it's not about the finances! J Am Coll Radiol. 2009;6(4):242-245.


2. Cahill KE, Giandrea MD, Quinn JF. Are traditional retirements a thing of the past? New evidence on retirement patterns and bridge jobs. US Department of Labor, Bureau of Labor Statistics, Office of Productivity and Technology. September 29, 2005. http://agingandwork.bc.edu/
documents/bridge_jobs_post_000.pdf. Accessed October 6, 2011.


3. Hooker RS, Ramos C, Daly RP, Fang R. Older physician assistants and their practices. JAAPA. 2012;25(1). In press. 


4. Rittenhouse DR, Mertz E, Keane D, Grumbach K. No exit: an evaluation of measures of physician attrition. Health Serv Res. 2004;39(5):1571-1588.


5. Jones E, Repka M, Draper D, Orcutt V. Physician assistant faculty retirement intentions. J 
Physician Assist Edu. 2006;17(4):17-21. 


6. Hooker RS, Cawley JF, Everett CE. Predictive modeling physician assistant supply: 2010-2025. Public Health Rep. 2011;126(5):700-706.


7. Centenarian. Wikipedia Web site. http://en.wikipedia.org/wiki/Centenarian. Accessed October 6, 2011.