Retirement intentions of consultant psychiatrists

AIMS AND METHOD

Through a postal survey we sought to determine the current retirement intentions of consultant psychiatrists working in Scotland.Consultants were asked their likely date of retirement, whetherthey might return as a locum and what might induce them toretire later.

RESULTS

Full data were returned by 180 consultants. The mean plannedage at retirement was 58.0 years. Women intended to retiresignificantly earlier than men. Most respondents could be persuadedto retire later through changes in services, conditions orjob content; only 7% regarded their proposed retirement dateas immutable.

CLINICAL IMPLICATIONS

Early retirement among consultants is likely to contribute toan even more seriously understaffed service. It is necessaryto seek national and individual changes to the factors thatgive rise to early retirement in psychiatry.

Introduction

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Introduction

The high number of unfilled consultant posts in psychiatry inthe UK has recently prompted escalating concern about recruitmentof doctors into the specialty. It is widely predicted that,both in Scotland and south of the border, new mental healthlegislation will exacerbate existing shortages through itsimpact on consultants’ workloads, and that there willnot be suitably qualified applicants for any additional consultantposts that may be created.

It is a general criticism of medical workforce planning thattoo little attention is paid to retention and retirement (Atherton & Murray, 2000).In psychiatry, we have had the gloomyprognostications arising from a survey of psychiatrists whoretired early during the mid-1990s (Kendell & Pearce, 1997) and a survey in 2001 of consultants over 50 years of age bythe College Research Unit (Mears et al, 2002, 2004), whichreported a mean planned retirement age of 60 years. We undertooka survey of senior psychiatrists working in Scotland to ascertainviews about recruitment and to elicit intentions about retirement.This paper focuses on the responses to our enquiries aboutretirement.

Method

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Method

Following a review of relevant literature, a questionnaire wasdesigned to obtain information from psychiatrists in Scotlandabout recruitment and retention which might aid workforce planning.The first brief section collected demographic data includingdate of birth, grade and sub-specialty. The second sectionrelated to recruitment into psychiatry and will be reported in a separate paper. The third, and relatively brief, sectionasked about retention and retirement intentions. Psychiatristswere asked to state their most likely retirement date, fromwhich their probable age at retirement was calculated. Theywere asked (in a yes/no forced choice format) whether any of the following might induce them to retire later than the likelydate they had given:

reduction in workload;
pay increase;
chance to work part-timewithout effects on pension;
sabbatical/career break opportunities;
change of job content;
increased staffing levels;
other.

There was space to expand on responses to items 5, 6 and 7.Again in yes/no forced choice format, psychiatrists were askedwhether they considered it likely that they would return todo locum work after retirement.

Questionnaires were posted in the summer of 2003, accompaniedby a covering letter explaining that we were conducting a surveyrelating to staffing levels on behalf of the Scottish Divisionof the Royal College of Psychiatrists. The questionnaires weresent to all members of the College who appeared on the Collegelists as working in Scotland at that time. Respondents wereasked to return the questionnaire to the Scottish Divisionoffice. A reminder was sent in the subsequent routine Collegemailing (a stamped envelope was not enclosed on either occasion).To obtain the most exact denominator with regard to consultantnumbers, we used figures from the Scottish Division workforce survey, which was completed in September 2003.

Results

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Results

Although all grades of psychiatrists on the College list weresurveyed, we describe only the retention and retirement responsesfrom consultants. Of 387 psychiatrists believed from Collegerecords in September 2003 to be in consultant posts, 212 (55%)responded. Of these, ten had retired already and 22 did notgive a date of birth from which their likely age at retirement could be calculated. Analysis of data on predicted age at retirementwas thus confined to 180 respondents. Other responses are givenas percentages of valid respondents; most, but not all, respondentsanswered all of the forced choice questions.

Responses to the question ‘What is your most likely retirement date?’ are shown, in collapsed age bands, in Table 1.Over 90% of working consultants had a proposed retirement date.Excluding the ‘don’t know’ responders, andconducting a 3x2 ${chi}$ ² comparison of the retirement intention cellsin Table 1, female consultants intended to retire significantlyearlier than males ( ${chi}$ ²=10.8, d.f.=2, P=0.004). A Mann-Whitneycomparison of female and male consultants’ proposed retirementages yielded an identical P value. The mean proposed retirementage of all respondents was 58.0 years (s.d.=2.7), and 45% proposedto retire within the next 10 years (i.e. before 2014).

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Table 1. Most likely age at retirement among consultant psychiatrists working in Scotland

The percentages of consultants responding in the affirmativeto factors that might influence them to retire later are givenin Table 2. Only 13 respondents (7%) responded negativelyto all the suggested inducements, indicating that their retirementdate was essentially immutable. In the free text sections, whenconsultants were asked what changes in their job might inducelater retirement, the most common responses were ‘less managerial/administrative work’ (n=25) and ‘havingtime to develop a special interest’ (n=13). When askedabout which staff increases might keep them working longer,the most common responses were more psychiatrists (most stipulatedconsultants) (n=67), more nurses (n=56), more psychologists(n=45) and more social workers (n=24). When asked if returningafter retirement to do locum work was likely, 86 consultants(41% of eligible respondents) replied that it was.

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Table 2. Inducements to retire later

Discussion

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Discussion

As part of a larger questionnaire about recruitment and retention,the section on retirement intentions was not extensive. Theresponse rate of 55%, although within the usual range for postalquestionnaires, was not high; it is hoped that reasonably generalisableconclusions can be based on the useable responses from 180consultants. Within these limitations, the survey provides usefuldata for psychiatric workforce planning in Scotland. The mostnotable findings were:

the young average age of predicted retirement (58 years);
that45% predicted retiring within the next 10 years;
that femaleconsultants intended to retire younger than theirmale counterparts;
that there was a range of factors that might induce laterretirement,with only 7% indicating that their retirement datewas immutable.

The age of retirement among psychiatrists does mirror more generaltrends in workforces to retire earlier (Draper et al, 1997).The medical workforce may be exhibiting a steeper trend thanother employees. Davidson et al (1998, 2001) posed the samequestions about retirement to UK medical graduates in two surveys.In 1995, when asked if they intended to work in the NationalHealth Service until normal retirement age, 23% predicted earlyretirement; in 1998, the corresponding figure was 51%. Posinga similar question to all consultants over age 50 years workingin north-west England in 1998, Atherton & Murray (2000)found that 49% intended to retire early. French et al (2004)recently reported an average planned retirement age of 60 yearsamong consultants from various specialties in Scotland. TheCollege Research Unit’s survey of consultant psychiatrists,conducted in 2001 (Mears et al, 2002, 2004), found that themean planned retirement age was 60 years. Our own survey, conductedonly 2 years later, indicated a mean age of 58 years. To enablethe data of Mears et al (2002) to be compared with our findingsgiven in Table 1, the percentages of consultants in the Mearsstudy categorised by predicted or actual retirement age werearound 20% for retirement age 55 years or less, 45% for age56-60 years and 35% for age over 60 years. The consultantswere aged over 50 years, and thus were to a degree selectedas possibly later retirers because they were still working.However, our own data may well suggest an acceleration in earlyretirement, unless they reflect a specifically Scottish phenomenon.

When consultant workforce planning is based on an anticipatedcareer of 30 years, a 33% retirement rate would be expectedover a 10-year period. Our predicted 45% retirement rate duringthe next 10 years equates to an average consultant career spanningonly 22 years. It is unlikely that workforce planners in psychiatryare factoring such a low figure into their equations, withparticular implications for consultant staffing during the fairly immediate future.

Although Mears et al (2004) found that female respondentsintended to retire earlier than males, other studies have not reported earlier retirement plans among female consultants.However, two large studies which looked at gender differences(Davidson et al, 1998, 2001) asked their respondents whetherthey intended to practise ‘until normal retirement age’. This might have led to male and female respondents interpreting ‘normal’ retirement ages differently, as more womensaid they would indeed intend to continue to a ‘normal’retirement age, which they might have construed as 60 years.

In psychiatry, with our relatively high numbers of female consultants, earlier retirement among women clearly impinges significantlyon our workforce. The reasons for this difference may includewomen wishing to retire early owing to family commitments,wishing to retire contemporaneously with an older spouse, orbeing less likely to be the principal wage earner, making retirementless financially disadvantageous. One study did find female consultants to be less satisfied with their posts than theirmale counterparts in child and adolescent psychiatry (Littlewood et al, 2003)and another found female psychiatrists to be morestressed than males (Rathod et al, 2000). These gender differencesmerit further scrutiny.

It should not be assumed that the decision to retire is a negative reflection upon one’s chosen career. Indeed, the evidencesuggests that retirement is beneficial to mental health andwell-being, perhaps especially within higher socio-economicgroups (Salokangas & Joukamaa, 1991; Drentea, 2002; Mein et al, 2003).Mears et al (2002, 2004) accurately summarised that for each person there will be ‘complex, multidimensionaland highly individual’ factors feeding into the decisionabout retirement age.

The most positive finding in our study, that few consultantshad made an immutable decision about retirement, should beviewed against this backdrop. At least one factor may wellinduce many of us to work for longer, and the 40% of respondentswho might be influenced by a pay increase may postpone retirementnow that the new consultant contract is in place. There areother common issues which can be tackled centrally, and haveemerged as sources of stress and dissatisfaction in other studies,notably excessive bureaucracy and paper-work (Kendell & Pearce, 1997;Rathod et al, 2000; Davidson et al, 2001; Mearset al, 2002, 2004) and the burden of overly demanding workloads(Kendell & Pearce, 1997; Atherton & Murray, 2000;Davidson et al, 2001; Mears et al, 2002, 2004; Pajak etal, 2003; French et al, 2004). However, given the ‘highlyindividual’ factors that give rise to decisions aboutretirement and the prohibitive costs of employing growing numbersof locum consultants (Mears et al, 2004), it would seem tobe a good use of time for managers of psychiatric servicesacross the country to sit down with their more mature consultantsand discuss whether and how the latter might be induced towork beyond their currently planned retirement date. The alternativeseems likely to comprise a service that is seriously short of consultants, with some of the gaps being filled by expensiveretired locums.

Acknowledgments

This project was funded by the Scottish Division of the RoyalCollege of Psychiatrists. The secretarial work was done byLana Hadden. We are grateful to all respondents.

References

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