Does Physician Retirement Affect Patients? A Systematic Review

Abstract

OBJECTIVES Older patients that have aged with their doctors will likely experience their physician retiring. It is unclear if this interruption in continuity of care leaves patients at risk for adverse events or whether a new physician improves care. We sought to identify and synthesize findings from all articles examining the association between physician retirement and patient outcomes. DESIGN Systematic review. We searched English‐language articles cataloged in Medline, Embase, Cochrane, and PsycINFO, from database inception to May 4, 2018. PARTICIPANTS Any patient whose physician (generalist or specialist) retired. INTERVENTION Physician retirement, defined as voluntary practice closure, death, or departure. MEASUREMENTS Articles were categorized as anecdotes, qualitative studies, or quantitative studies. Each patient outcome was indexed under one of 11 themes (eg, adverse event, difficulty accessing care) and classified as favorable, neutral, or unfavorable. Patient outcomes included but were not limited to clinical (eg, death), resource utilization (eg, hospitalization), treatment plan adherence (eg, access to medications), and patient satisfaction (eg, expressed frustration). Two reviewers independently assessed study quality. RESULTS Of 2099 articles screened, 17 met inclusion criteria: 12 anecdotes, 2 qualitative studies, and 3 quantitative studies. Most patient outcomes described were unfavorable. These included feelings of loss, difficulties with transition to a new provider, adverse clinical outcomes, and increased use of high‐cost services. The quality of qualitative studies was high, but that of quantitative studies was poor or moderate. CONCLUSION Current evidence from qualitative studies suggests physician retirement affects patients unfavorably and that patients are vulnerable during this transition of care. High‐quality quantitative research is lacking to identify whether this disproportionately affects older adults and whether physician retirement has significant consequences for the broader healthcare system. J Am Geriatr Soc 68:641–649, 2020

Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure

“…More time might be needed to establish a trusting relationship enabling patients to feel comfortable and disclose more information. Indeed, despite replacement, physician retirement was found to be associated with unfavourable outcomes such as with the loss of a trusted advisor, with difficulty with transition or with emotional distress (Lam et al., 2020). Further research is needed to clarify the existence of these three empathic processes.…”

How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017

“…A recent systematic review assessed how physician Open access retirement impacted patients and found mainly unfavourable outcomes, mainly published as anecdotes and qualitative studies. 2 The authors point to some possible mechanisms related to difficulty accessing care, difficulty with transition and poor handover of information. Our results indicate that special attention should be given to elderly and frail patient groups as early as possible when the discontinuity is known to happen.…”

“…Loosing access to your general practitioner (GP) can be emotionally stressful, 1 and patients can be vulnerable during the transition of care from one GP to another. 2 Some discontinuities of GP practice are inevitable, as GPs retire, get sick and take parental leave. A study on American patients forced to change their physician due to healthcare insurance changes, indicated this disruption to be damaging to the patient receipt of quality GP care.…”

“…Loosing access to your general practitioner (GP) can be emotionally stressful,1 and patients can be vulnerable during the transition of care from one GP to another 2. Some discontinuities of GP practice are inevitable, as GPs retire, get sick and take parental leave.…”

How long does it take patients to find a new primary care physician when theirs retires: a population-based, longitudinal study

“…There are longstanding concerns about the potential impact of primary care physician retirements on patient access to and continuity of care, and on service supply more broadly [ 1 – 8 ]. While considerable research has been done on the services that older physicians provide as they age and transition out of the workforce [ 1 , 2 , 9 – 13 ], very little attention has been given to how physician retirement affects patients [ 7 ]. Existing work suggests that disruption to longitudinal relationships between patients and physicians has been associated with difficulty accessing care [ 14 ], emotional distress [ 14 , 15 ], poorer health outcomes [ 8 ], and decreased use of downstream primary care services [ 7 , 8 ].…”