Motives for early retirement of self-employed GPs in the Netherlands: a comparison of two time periods

Abstract

BackgroundThe high cost of training and the relatively long period of training for physicians make it beneficial to stimulate physicians to retire later. Therefore, a better understanding of the link between the factors influencing the decision to retire and actual turnover would benefit policies designed to encourage later retirement. This study focuses on actual GP turnover and the determining factors for this in the Netherlands. The period 2003–2007 saw fewer GPs retiring from general practice than the period 1998–2002. In addition, GPs’ retirement age was higher in 2003–2007. For these two periods, we analysed work perception, objective workload and reasons for leaving, and related these with the probability that GPs would leave general practice at an early age.MethodsIn 2003, a first retrospective survey was sent to 520 self-employed GPs who had retired between 1998 and 2002. In 2008, the same survey was sent to 405 GPs who had retired between 2003 and 2007. The response rates were 60% and 54%, respectively. Analyses were done to compare work perception, objective workload, external factors and personal reasons for retiring.ResultsFor both male and female GPs, work perception was different in the periods under scrutiny: both groups reported greater job satisfaction and a lower degree of emotional exhaustion in the later period, although there was no notable difference in subjective workload. The objective workload was lower in the second period. Moreover, most external factors and personal reasons that may contribute to the decision to retire were reported as less important in the second period. There was a stronger decrease in the probability that female GPs leave general practice within one year than for male GPs. This underscores the gender differences and the need for disaggregated data collection.ConclusionsThe results of this study suggest that the decrease in the probability of GPs leaving general practice within one year and the increasing retirement age are caused by a decrease in the objective workload, a change in GPs’ work perception, external factors and personal reasons. Based on the results of this study, we consider workload reduction policies are the most useful instruments to control retention and retirement.

A systematic review of physician retirement planning

“…This disillusionment was expressed by a sense of frustration with colleagues [27, 35], feeling undervalued, lacking prestige [16, 41], and a loss of interest in their work [10]. Excessive workload [17, 42] and burnout were associated with intentions to retire [28, 43]. Medicolegal issues often arose from a lack of satisfaction with the regulation of medicine for reasons of unwelcome change, bureaucracy, oppressive management [26, 35, 44], and issues with physician partners [26, 45].…”

“…Findings based on these studies of physicians suggest that a reduction of working hours may present as one of the most successful instruments for staff retention [17]. A shift toward non-clinical duties such as teaching and mentorship may also help with retention [42] and also facilitate knowledge transfer to younger professionals.…”

“…While several attempts, including our own study, have aimed at improving understanding of health workforce issues and implications of aging and timing of physicians’ work, future policy research should continue forecasting physician retirement trajectories and human resource strategies in ways that can account for older physicians who want to remain in clinical practice beyond traditional retirement age [17, 72, 73]. Recommendations for next steps in policy reform at the organizational and health system level may come from within hospital and other related organizations which aim to address intentions to leave by improving psychosocial working conditions for the medical profession [64] and scaling back workloads to retain the best talent in experienced physicians [42].…”

“…Early retirement is referred to in this study as either retirement that occurs earlier than the physician had planned [16] or to an exit from their profession at a relatively early age (i.e., younger than age 65) as compared to peers [17]. On time retirement refers to the conventional age of retirement, that is, at or around age 65 [18].…”

Lost to the NHS: a mixed methods study of why GPs leave practice early in England

“…Although current evidence points to an impending crisis in the recruitment and retention of GPs in the UK, 12 – 14 this is by no means a new phenomenon, 15 – 17 nor one which is unique to the UK workforce. 18 – 20 In 2001, a survey carried out by the BMA revealed that one-quarter of GPs wanted to quit, 21 while a number of surveys, carried out before and since, have continued to monitor GP training, retention, and recruitment, particularly in relation to contractual reforms, job satisfaction, and burnout. 15 , 22 – 26 Much research has been carried out on factors associated with stress, anxiety, depression, and burnout among doctors in the UK and abroad.…”