Retirement is ideally a personal choice, and incentives to work longer are probably not the way to stop workforce shrinkage
When is it time for an oncologist to retire?
Older doctors may, understandably, find it harder to stay on top of things as the pace of change in new technology and clinical evidence accelerates.
“I think for medical oncologists and perhaps, to an extent, radiation oncologists, it’s very important to stay up to date with clinical trials and the evidence,” says Professor Christobel Saunders, a surgical oncologist and James Stewart chair of surgery at the Royal Melbourne Hospital.
“If possible, you should travel to meetings, or you find out what’s going on at meetings, and you understand the complexities of up-to-date molecular biology and the biological underpinnings of cancer treatment. I don’t see why you couldn’t keep up to date at any age, but clearly things like travelling to conferences becomes more difficult.
“It’s an important part of what you do – although you don’t have to do it.”
The different skills sets required in the different branches of oncology may also be relevant, she says.
“As a surgeon, my personal view is that we probably do reach an age where some of the technical complexities, and particularly the very long and complex surgery, become more difficult – not for everybody, but for most of us. As you get older, it can be a physically demanding job,” she says.
“I think it just takes its toll on the body. It is physically tiring to remain operating for long periods of time, particularly for very complex cases, and I don’t know that it’s necessarily good for our health or the patient’s health.”
Currently, there’s no regulatory barrier to continuing to practise. AHPRA does not conduct age-based assessments or specify a retirement age. Doctors can continue to practise so long as they comply with the MBA’s registration standards and requirements of the National Law.
“I think if you have a mandatory retirement age, that’s ageism,” says Professor Craig Anderson, director of the George Institute’s neurological and mental health division. “If you’ve got adequate energy, capacity and intellect and you’re enjoying it and there’s adequate support from colleagues, that’s fine.
“I think AHPRA’s general mandate is a good thing, but it’s a bit light – AHPRA only really gets involved when there’s a problem.”
Since 2017, however, the MBA has been eyeing mandatory health checks for doctors aged 70 and over.
“I’ve definitely seen instances where … people could perhaps have thought about giving up some of the more technical things that they do.”
Professor Christobel Saunders
The board has, in principle, accepted an advisory group recommendation that from age 70, doctors should have a confidential health check, including “cognitive screening”, once every three years. They should also have a formal performance review process, that would come with CPD credit.
Should legal obstacles stand in the way of mandating health checks, the MBA would consider further research into any age-related risk posed by doctors over age 70 continuing to practise.
“There is strong evidence that there is a decline in performance and patient outcomes with increasing practitioner age, even when the practitioner is highly experienced,” the board says.
While the MBA sounds like it means business, the proposal is still only under consideration.
Professor Anderson says it’s important to remember that change and deterioration do not generally occur rapidly.
“It’s going to manifest in very subtle ways like fatigue, or maybe errors in documentation, putting the wrong date of birth on a script pad, or forgetting to put something in by the due date,” he says.
But he warns oncologists not to count on colleagues flagging any changes in behaviour, since approaching someone to express their concern can be difficult and seen as intrusive.
“I think it’s always difficult to talk to people, but hopefully we have good enough professional and personal relationships that there’ll be someone who can suggest that,” Professor Saunders says.
“But I’ve definitely seen instances where that hasn’t happened and people could perhaps have thought about giving up some of the more technical things that they do.”
Testing cognitive and other abilities has sometimes been suggested as an alternative to a mandatory age for retirement.
“Just because they occasionally get a report … doesn’t mean that all older people shouldn’t be working. You’ve got to be really careful about the unintended consequences.”
Dr David King
Queensland GP Dr David King, who has done assessments for AHPRA, says testing brings “problems with validity, accuracy and reliability”.
“But we do know from evidence in the case of elder GPs, although they’re more experienced, they can get a bit behind with new knowledge. I’m getting towards that stage where I’m struggling to keep up with new technology and change myself.”
In general practice, the pace of change increased during the pandemic, with telehealth and e-prescribing two areas that challenged older GPs.
“A number of people are notified who are in their 70s, some even into their 80s. Some decide to retire before we can actually get to visit them because they realise they’re no longer up to it. There are many reasons: with many of them, their record-keeping is an issue, or they’re one-finger typists and they’ve tried to have dual systems with written notes and someone else transcribing.
“And just because they occasionally get a report about incidents in older people doesn’t mean that all older people shouldn’t be working. You’ve got to be really careful about the unintended consequences,” Dr King says.
During the pandemic, several of Dr King’s recently retired colleagues contributed by working in respiratory clinics, on public health phone lines, supporting clinicians and helping write guidelines.
“I think it’s good to keep them as a potential surge workforce and to have mechanisms in place for them to be able to stay on, but it does really need to be a personal decision.”
Professor Saunders says there are ways to plan for a gradual retirement rather than be forced to make a sudden exit from the profession.
“Of course, there are other things you can do and many surgeons do actually have a very staged retirement process,” she says. “Commonly, they’ll say they’ll cut down on their operating; maybe start doing more simpler cases; most will start talking about their on-call commitments as they get older. “And then they’ll eventually transition to just seeing patients in clinics and then eventually they retire and that’s a very common pathway.”
