Later careers – stemming the drain of expertise and skills from the profession

We are facing a workforce crisis: the Royal College of Physicians’ (RCP’s) 2016–17 census showed that 45% of advertised appointments to consultant posts were unsuccessful, primarily due to a lack of applicants.

We simply need more doctors. The increase in the number of medical school places is welcome, but these future doctors will not enter the workforce until 2023 at the earliest. In the meantime (as RCP surveys this year have shown) teaching, training and research are the first casualties of rota gaps because frontline medical services are prioritised.

In her recent blog, The perennial winter: solving the workforce crisis, RCP president Professor Jane Dacre suggested a few small steps that could be taken to help solve the problem. One step addressed the need to encourage physicians to remain in the workforce for as long as possible, in light of worrying census data on physicians’ retirement plans. In the face of the current crisis, it makes no sense that highly qualified and knowledgable physicians who could work are discouraged from doing so by pension rules and inflexible working practices. And many older physicians clearly do want to continue practising medicine: 5% of all consultants have retired then returned to work.

It makes no sense that highly qualified and knowledgable physicians who could work are discouraged from doing so by pension rules and inflexible working practices.

Dr Harriet Gordon, director of the RCP's Medical Workforce Unit

It seems that, after the initial euphoria of leaving the medical on-call has faded, many retired physicians simply do not have an answer to the question ‘What’s next?’. This suggests that there is an appetite for a more gradual retirement, with flexible working beyond the current retirement age.

The RCP has a key role in making sure that older doctors remain engaged. Such engagement will have benefits for the doctors, for the medical community and, most importantly, for patients. We are therefore developing guidance on later careers for doctors and hospitals, and will publish a later careers toolkit that will help to strike a balance between doctors’ professional and personal lives, to the benefit of everyone. It begins with a discussion, at around age 55, about a doctor’s plans for both the next few years and when they reach 60.

We will publish a later careers toolkit that will help to strike a balance between doctors’ professional and personal lives, to the benefit of everyone.

The RCP guidance will also encourage reflection on pre-retirement goals (such as how to best apply specialist skills that the doctor has acquired over 30 years or more), which is important to allow time for the recruitment, training and mentoring of a successor.

Keeping older physicians in medicine

Having spoken to physicians who have recently retired, many of them are interested in taking a greater role in teaching and training. Others have ideas about improving management. We desperately need their ideas and experience, and a more flexible working pattern will allow them to reflect on and pursue such activities.

At an RCP workshop on later careers, we found that revalidation and CPD were the greatest deterrents to older physicians remaining in work. Our forthcoming later careers toolkit will clarify the General Medical Council’s (GMC’s) requirements for revalidation and CPD, and how the RCP can help physicians to meet them. More can also be done locally: some hospitals organise useful training days and can help to reduce the burden of appraisal.

Over the next decade the number of consultants reaching 60 years of ages will rise. It is therefore timely to look at how this group can continue to work, both for their own benefit and for the benefit of the medical community. The RCP aims to stem the drain of expertise and skills from the medical profession. Physicians have played an essential role in extending both length and quality of life; it is therefore our responsibility to make sure patients and the profession benefit from what older doctors have to offer.

Dr Harriet Gordon is the director of the RCP's Medical Workforce Unit.