Demographic shifts over the next 20 ;years will produce fundamental change in Australia’s society and economy. The ageing of the “baby boomer” generation and population growth will place an unprecedented demand on health services, which will need to be met by the resources of a shrinking pool of employed younger people. The health care workforce will also be caught in the grip of this changing demographic landscape. It is widely anticipated that retirement among ageing clinicians will result in workforce shortages within the next 5 ;years.
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This article uses a special extract from the past four Australian Bureau of Statistics (ABS) Census surveys to examine trends in the work practices and retirement patterns of general practitioners, medical specialists and registered nurses. These historical data can help us predict future workforce attrition and inform our workforce planning.
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The ageing of the medical workforce provides a direct benefit to the Australian community through the accumulated experience of senior health professionals. However, it also creates some very significant workforce planning issues. For example, if the baby boomer cohort of nurses leaves the workforce at the same rate as previous generations, all but a handful will have retired within the next 15 ;years. This reflects a loss of more than half the current workforce. As the oldest baby boomers turn 59 ;this year, we are on the cusp of this rapid attrition from the nursing workforce. The decline in nursing undergraduate commencements over the 10 ;years to 2003 ;will only exacerbate the emerging shortage.
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Baby boomers also represent just over half the GP workforce, although they may move more slowly from the workforce as they tend to retire later.7 However, by 2001, those remaining in the workforce typically worked fewer hours.3–6 In part, the ageing of the GP workforce reflects an increasing proportion of medical graduates choosing to enter specialty disciplines.5 This will also be influenced by the longer training period now undertaken by GPs, although, in our analyses, trainee GPs are grouped in the same category as fully qualified GPs.
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Baby boomers also make up about half of the specialist population. One reason specialists have a higher average age is the length of training required. Nonetheless, there is a need to examine potential shortages in individual specialties, as ageing is not homogeneous (for example, the average age of emergency medicine specialists in 2002 ;was 41 ;years, compared with 54 ;years for general surgery).
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One important question these data raise is “why do doctors and nurses leave the workforce at different rates, and are there lessons to be learned to influence future workforce needs?”
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Although the census data do not directly answer this question, the wider literature on retirement provides some useful indicators. Three of the most significant factors are the available income replacement rate (from superannuation, pension and private investments), flexibility of working arrangements, and health status.
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Most nurses are employed within the hospital system and have access to employer superannuation, although women with children may have a lower accumulated balance because of broken employment patterns. Also, female nurses are eligible for the aged pension at a younger age than men.10,11 Although nurses on average earn less than GPs, this is consistent with earlier retirement, as they require less income to generate the same proportion of their pre-retirement earnings.
Hospital-based nurses approaching retirement are less likely to have the same flexibility of working hours as the self-employed and may choose to retire rather than continue shift work. The literature points to physically demanding and stressful work and health problems as determinants of early retirement, with back injuries being one of the most important.
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Finally, most nurses are female and women tend to leave the workforce earlier.13 Wives are on average younger than husbands, and may shorten their working life to align their retirement with that of their spouse.14 However, although women are observed to retire earlier in general retirement studies, we found no difference in the rate of attrition of male and female nurses in this study.
GPs are more likely to be male, have higher earnings and be self-employed. Higher earnings on the job and number of years of education decrease the probability of job exit.12 Job satisfaction is also important in reducing doctors’ intentions to retire.
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GPs, usually self-employed and without compulsory superannuation, may not have developed an awareness of the need for retirement savings until later in life. People under 45 ;are less likely to save for retirement, and even in the top income quintile (top 20%), a third do not save.16 In retirement, they are unlikely to qualify for more than a small part-rate aged pension, and not until aged 65 ;if they are male.11 Therefore, for GPs without significant income producing assets, the fall in income from their pre-retirement earnings (the substitution effect) can be significant and provides an incentive to continue to work.8,17 In addition, they do not face a mandatory retirement age and are able to continue to work flexibly at reduced hours, thus increasing the likelihood of working longer.9
However, although a relatively large number of older GPs work beyond traditional retirement age, several drivers may lead to shorter working life in future generations. Firstly, there are more female GPs, and they are more likely to retire earlier than men and to reduce their hours of work. Secondly, if asset accumulation is a driver, then future generations of GPs are more likely to be proactive about superannuation and retirement savings.
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What effect do the retirement patterns of doctors and nurses have on the wider economy? The health workforce was about 450 ;000 ;in 2001, comprising 6% of the total workforce, with more than half being doctors and nurses.18,19 With such large numbers, and higher than average incomes, the retirement patterns of the medical and nursing workforce will noticeably affect the future labour market and taxation revenue.
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GPs already have retirement patterns that conform to the Treasury ideal — gradual retirement and working beyond traditional retirement age as a solution to an emerging labour force shortage and to fund the future health costs of an ageing population.20,21 However, there are more than 200 ;000 ;nurses in a profession from which early retirement is typical. It is important to increase labour force participation of older nurses and, in particular, we need to examine how nurses could be encouraged to stay in the workforce longer. Addressing workplace safety and health issues, or increasing the flexibility of shift work, may be as important to workforce longevity as economic incentives. For example, the creation of less physically demanding jobs, such as practice nursing in a general practice clinic, may provide positions which are attractive to nurses considering retirement.
Policy makers face a critical challenge to ensure workforce needs are met over the next 20 ;years. The need will be particularly acute for nurses, but whether the later retirement patterns for GPs will continue is not certain. There are several policy implications. There is a need to encourage ongoing employment among older clinicians (albeit at reduced hours), continued participation of younger workers, and continued improvement of labour productivity. For example, incentives for older workers might include concessional taxation. The policy response will be crucial to ensure that the Australian health workforce is adequate to meet the growing community demand of the 21st century.
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More information : http://www.mja.com.au
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