OBJECTIVE: This study examined patterns of work and retirement among older pediatricians, including the determinants of part-time work and retirement, as well as extended participation in the pediatrician workforce.
METHODS: A mail survey regarding recent and expected workforce participation was distributed to American Academy of Pediatrics members who were aged ≥50 years. A total of 1158 (72%) responded, 1114 (70%) of whom were included in these analyses. Analyses examined levels of engagement in medicine, retirement plans, and differences between men and women and primary care pediatricians and pediatric subspecialists.
RESULTS: Providing or planning to provide patient care past age 65 was reported by 45% of the respondents. Engaging in part-time work was increasingly more common with age and may represent a step toward retirement for many. In this sample, women were more likely to work part-time (32% vs 18% of men) and less likely to work past age 65 (26% vs 57% of men). When compared with primary care pediatricians, pediatric subspecialists worked more hours per week (59 vs 53) but spent a smaller percentage of their time on patient care (63% vs 82%).
CONCLUSIONS: Part-time work and reduced work hours in anticipation of retirement are options that are used and desired by older pediatricians. Results of this study suggest that making provisions for gradual reduction in work hours or other forms of phasing out of the workforce could benefit the practice of pediatrics by extending the career length of the most experienced pediatricians.
Although 65 is generally regarded as “normal” retirement age in the United States, many professionals choose to work beyond this age.1 Rather than exit abruptly from the workforce, many older adults are choosing to reduce their working hours in anticipation of retirement. Reducing work hours in lieu of retirement may be a way to accommodate simultaneously the need for work reduction because of personal health issues, family caregiving demands, or relief from work stress while addressing the desire to maintain employment for financial reasons or intellectual stimulation. Phased retirement is becoming a more common way to exit the workforce,2 and many current full-time workers express a desire to retire gradually.3
Previous research has noted substantial growth in part-time work among both established practicing pediatricians and recently graduated pediatric residents, particularly women.4,5 Little is known regarding whether this pattern is reflected in work participation among pediatricians who are aged ≥50 years. Understanding patterns of work and retirement among older pediatricians has the potential to aid in anticipating and preparing for future shifts in the pediatric workforce. In this article, we examine (1) the ages at which pediatricians retire, (2) whether characteristics such as gender and being in primary care pediatrics versus a pediatric medical or surgical subspecialty matter, (3) the factors that influence retirement decisions, and 4) the degree to which older workers work part-time.
A cross-sectional survey was conducted by the American Academy of Pediatrics (AAP) in conjunction with the Association of American Medical Colleges and 7 other medical associations. * Questionnaires were mailed to 1600 AAP pediatricians aged ≥50 between February and May 2006. For maximization of the number of older pediatricians who participated in this study, surveys were sent to members of the AAP Senior Section, which is open to AAP members who are aged ≥55 years (n = 730) and 870 randomly selected US members of the AAP who were ≥50 and not in the senior section. Repeat questionnaires were mailed up to 3 times to those who did not respond initially. Responses were collected from 72% (n = 1158) of the AAP members, a response rate that compares favorably with other recent surveys of pediatricians.6 Respondents were asked to report their work status by choosing from among 5 options: full-time, part-time, retired, temporarily not active in medicine, or never active in medicine. After exclusion of 20 respondents who were either temporarily inactive in medicine or had never been active in medicine and 24 who did not report their work status, the sample size for this study was 1114 (70%). Tests that compared sample respondents with all AAP members who were aged ≥50 revealed that the respondent population was older (mean age: 68) than the target population of all AAP members who were aged ≥50 (mean age: 60; P < .001). A larger proportion of the respondent population was male (73%) compared with the target population (66%; P < .001). Sampling weights that adjusted for age and gender were calculated to compensate for the oversampling of Senior Section members and for differential nonresponse. These weights, used for all analyses reported here, allow the data to reflect the appropriate proportional representation of AAP members who were aged ≥50.
Respondents were asked to report the number of hours that they worked during their most recent complete week of work. Furthermore, respondents were asked what percentage of their workweek was spent performing patient care, including clinical practice, related office work, communications with hospitals/physicians regarding patients, and other related activities. Respondents rated both the viability of their practice and their satisfaction with medicine as a career on 5-point scales. Given the subjective nature of these 2 items, responses to each item were dichotomized. In the case of viability, scores were dichotomized to reflect the extent to which pediatricians considered their practices to be viable (1 = extremely viable/very viable, and 0 = somewhat viable/marginally viable/not at all viable). For the satisfaction variable, responses were dichotomized to distinguish between indications of satisfaction (very satisfied/somewhat satisfied) and lack of satisfaction (neither satisfied nor dissatisfied/somewhat dissatisfied/very dissatisfied).
Additional questions asked about retirement plans (age when they plan to retire), age at retirement, and work history (having ever taken a sabbatical or worked part-time). Demographic information about the respondents' education, finances, health, marital status, and number of dependents was also collected. Respondents who reported their current work status as “retired” were also asked whether they had tapered their work hours in anticipation of retirement.
Several statistical techniques were used to analyze the data. Logistic regressions were used to predict both retirement and part-time status. Dichotomous predictor variables that have been previously related to work choices and practice characteristics were included in the models4,5,7: age >65, female gender, married, poor health (defined as reporting health as “fair” or “poor” rather than “excellent,” “very good,” or “good'), international medical school graduate, having dependents, and practicing a pediatric subspecialty. For examination of the associations between these predictors and part-time work, a multivariate logistic model was estimated in which all predictors were entered simultaneously. The process was repeated to examine the associations between retirement and the dichotomous predictors. Some of the analyses reported in this article examined only the responses of practicing pediatricians (n = 779) or retired pediatricians (n = 335). The number of cases varied slightly across analyses as a result of differential item response. P < .05 was considered statistically significant for all analyses. This project was approved by the AAP's institutional review board.
As shown in Fig 1, 88% of pediatricians between ages 50 and 54 were working full-time. Approximately 11% of pediatricians aged 50 to 54 were working part-time. The number of pediatricians who were either working part-time or retired was higher among those aged 55 to 64, but the majority in this age range remained employed full-time. Part-time work became more common than full-time work with age. For example, Fig 1 shows that among pediatricians aged 65 to 69, 27% were working part-time and 47% were working full-time. Among those aged 75 to 79, the proportion who were working full-time dropped to only 15%. Part-time work was most common among pediatricians between the ages of 70 and 74; 35% of respondents in this group reported a current work status of part-time. Fewer than half of participants in each age group ≥65 reported working full-time; the number who were working full-time dropped to 25% by age 70. Among respondents aged ≥75, more than half reported that they had fully retired from medicine.
As shown in Table 1, retirement was more common among those who were older than 65 (43% vs 3%; odds ratio [OR]: 21.85; P < .001), were in poor health (36% vs 12%; OR: 2.08; P < .05), had no dependents (22% vs 12%; OR: 0.69; P < .05), or were practicing primary care pediatrics rather than a pediatric medical or surgical subspecialty (13% vs 7%; OR: 0.53; P < .05).
Currently Active Pediatricians Aged ≥50
Table 2 provides an overview of pediatricians in this sample who were currently active in medicine. Those who were working full-time reported working an average of 55 hours per week. There was no significant difference between the number of hours worked by men and by women; however, pediatric medical and surgical subspecialists reported working more hours (59) than primary care pediatricians (53). As depicted in Table 2, 23% of the actively practicing respondents reported that they were currently working part-time. Current part-time work was significantly more common among female pediatricians (32%) than male pediatricians (18%). On average, pediatricians who were working part-time reported working 29 hours per week. Female part-time pediatricians reported working more hours (34) than male part-time pediatricians (26). An additional 24% of respondents who were currently working full-time indicated that they were willing to work part-time in the future. More female than male full-time pediatricians were willing to work part-time. Furthermore, many respondents (81%) indicated that the availability of part-time work would influence their willingness to work later into life.
On average, pediatricians in this sample reported spending 76% of their time on patient care. Percentage of time spent on patient care was approximately equal for male and female pediatricians but significantly higher among those who were identified as being in pediatric primary care (82%) than among pediatric medical and surgical subspecialists (63%). Most pediatricians in this sample (60%) rated their practices as currently viable; women were less likely to report having a viable practice than men. Most (90%) respondents were satisfied with medicine as a career. There were no significant differences in satisfaction between men and women or pediatric subspecialists versus primary care pediatricians.
As shown in Table 2, 45% of currently active pediatricians in this sample provided patient care or expected to provide patient care past age 65. Although, as described already, men and women spent an equal percentage of their work time providing patient care, men and women varied in the average age at which they stopped providing patient care. There is a significant gender difference in that female pediatricians were less likely to provide or expect to provide patient care past age 65 than male pediatricians. Similarly, although 15% of practicing pediatricians provided or expected to provide patient care past age 70, this number was higher among male pediatricians (19%) than among female pediatricians (6%). Table 3 shows the percentage of active pediatricians who indicated that various factors were very important in influencing their decisions to continue practicing. For both men and women, the most commonly selected reason was career satisfaction.
As shown in Table 4, part-time work was more common among practicing pediatricians who were older than 65 (54% vs 17%; OR: 7.17; P < .001), women (33% vs 18%; OR: 3.57; P < .001), in poor health (49% vs 22%; OR: 3.11; P < 0. 01) graduates of US or Canadian medical schools (24% vs 16% among international medical school graduates; OR: 0.48; P < .01), and had no dependents (38% vs 20%; OR: 0.74; P < .05).
Experiences of Retired Pediatricians
In this study, retired female pediatricians reported a mean retirement age of 62 and retired male pediatricians reported a mean retirement age of 68. As shown in Table 5, many pediatricians were working past the expected retirement age: 49% of respondents reported working, either full-time or part-time, past age 65; 24% of respondents reported working past age 70. Working past age 65 was more common among men (57%) than among women (26%). More men than women also worked past 70, but the difference did not reach significance. Retiring from pediatrics does not always mean leaving the workforce entirely. Among retired pediatricians, 12% reported that they were currently working for pay in a nonmedical field.
As depicted in Fig 2, of the retired pediatricians in this study, 59% of the men and 76% of the women reported having phased into retirement through some combination of working part-time or tapering their hours. Having worked part-time or having both worked part-time and tapered work hours was reported by 64% of female and 42% of male retired pediatricians. An additional 17% of retired male pediatricians and 12% of retired female pediatricians reported having tapered their work hours but not having worked part-time. Among the retired pediatricians who did not taper their hours before retirement, 35% reported that they would have delayed retirement had flexible hours or part-time work been an option (result not listed in tables).
As shown in Table 6, increasing regulations, decreased autonomy, and on-call responsibilities are the most frequently reported factors influencing pediatricians' decisions to retire. On-call responsibilities was the most frequently reported factor influencing retirement decisions among men, whereas it was only the ninth most frequently reported factor among women. Personal health and family responsibility were factors influencing retirement decisions reported more frequently by women. Factors such as occupational safety issues and increased competition within specialty were rarely reported by either men or women as influencing retirement decisions.
Extending Careers Beyond 65
Of the pediatricians in this sample, nearly half worked full-time past age 65 and one quarter worked full-time past 70, indicating that it is common for pediatricians to work through their 60s and beyond. This demonstrates that they continue to practice medicine well after what is considered “normal” retirement age and beyond the mean retirement age for the United States.8
Among pediatricians who are now aged ≥50, men remain active in the field of pediatrics until later in life than women. Women both retire earlier than men (mean age: 62 for women vs 68 for men) and stop providing or plan to stop providing patient care earlier than men (only 28% of women provide or plan to provide patient care past age 65, as opposed to 54% of men). Many pediatricians choose to work part-time as they age. Many more indicate that having part-time hours as an option would make them willing to postpone retirement. A willingness to postpone retirement when flexible work options are available has been noted in populations of older workers not limited to doctors; and older workers in highly skilled positions, who have a high income and who have a higher level of education, have been found to be more likely to use flexible work options in this way.2,3
Part-time Work as a Step Toward Retirement
The growth in part-time work among younger pediatricians has been demonstrated previously.4,5 This study extends those findings to show that part-time work is also common among pediatricians aged ≥50, suggesting growing preferences for part-time work options across the age spectrum of pediatrics. Part-time work and reduced work hours in anticipation of retirement are also options that are both used and desired by older pediatricians.
Other studies have reported that older workers in general would like alternative work schedules as a step toward or in lieu of retirement.2 For individuals who opt to reduce their hours before leaving the workforce, retirement is more of a process than an abrupt transition. This study's findings of part-time work among older pediatricians reflects a growing trend in which physicians and other older American workers choose, when possible, to phase out their jobs gradually rather than transition directly into retirement.2
Reasons for Retirement
Several factors were frequently reported as influencing retirement decisions. These included issues related to the practice of medicine, such as malpractice insurance and reimbursement, and personal reasons, such as stress, health, and wanting to pursue other interests. Most reasons were reported by a similar proportion of men and women; however, on-call responsibilities appeared as a top reason for men but not for women. This suggests that, at least for men, obligatory on-call time is a deterrent to remaining employed later in life; it also confirms other research indicating that older physicians, particularly men, find being on-call particularly burdensome.9,10 Family responsibility and poor health were more frequently endorsed as reasons for retirement by women than by men. Women pediatricians' frequent endorsement of family responsibility as a factor in retirement decisions is consistent with evidence that during middle age and late life, women (including women who practice medicine) often provide care for family members such as aging parents, an ill spouse, or young grandchildren.11,12
The limitations of this study require cautious interpretation of the results. Questions regarding retirement plans and retirement ages were self-reported and, in many cases, retrospective. It is possible that some individuals may inaccurately remember or misreport their retirement age. The item regarding practice viability provided no guidelines to assist respondents in rating their practice and is therefore highly subjective; however, collapsing viability into a dichotomous variable may help to compensate for its subjective nature. Similarly, respondents could self-define as part-time or full-time regardless of the number of hours they worked. Results regarding on-call duties also call for cautious interpretation, because retirees' on-call responsibilities before retirement are unknown. Furthermore, this information was gathered in early 2006, before a nationwide recession that may lead some doctors to remain in practice longer as the value of their assets and retirement savings change.
The sample was drawn from a list of AAP members. Although most pediatricians opt to become AAP members, not all board-certified pediatricians join the AAP or maintain their membership over time. Any systematic differences between pediatricians who join the AAP and those who do not or between those who maintain their membership in AAP after retirement and those who allow their membership to lapse after they retire could limit the applicability of this study's results.
As with any study involving older adults, results may be biased because of differential selectivity as a result of incapacity or death; therefore, our group of responders is likely healthier than pediatricians who are aged ≥50 overall. Longitudinal research would be necessary to show conclusively whether findings regarding age differences reflect intra-individual change rather than interindividual differences. Longitudinal research would also help in indicating whether those who work part-time after age 65 are also those who had a history of part-time work.
This study shows that working part-time and reducing work hours both are very common work patterns and work options desired by pediatricians who are aged ≥50. Pediatricians who are aged ≥50 are, on the whole, satisfied with their work and describe their practices as viable. They are likely to continue working past age 65, although many will begin to reduce their work hours as they approach retirement. The tendency for older pediatricians to begin part-time work, coupled with the trend for women to retire earlier than men, will likely have implications for future workforce projections and needs. As the field becomes increasingly more dominated by women, a reduction in the average retirement age may occur. This study's findings suggest that greater practice flexibility, such as making part-time work and other phased retirement options more readily accessible, may be a useful strategy for retaining older pediatricians in the workforce.
- Accepted July 30, 2009.
- Address correspondence to Alicia C. Merline, PhD, American Academy of Pediatrics, Division of Health Services Research, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail:
↵* The other medical associations were the American Medical Association, the American Academy of Family Physicians, American College of Cardiology, American College of Physicians, American College of Obstetricians and Gynecologists, American Society of Clinical Pathology, and the American Society of Plastic Surgeons.
Financial Disclosure: The authors have indicated they have no financial relationships relevant to this article to disclose.
What's Known on This Subject:
Little is known regarding the retirement patterns of pediatricians. Previous research showed increasing interest in part-time work among pediatricians, but it is unclear how many older pediatricians work part-time and whether this is associated with delayed retirement.
What This Study Adds:
This study shows that part-time work is common among older pediatricians and that pediatricians commonly work past age 65. The extended retirement patterns and the popularity of part-time work among pediatricians have implications for the pediatric workforce.
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- ↵Bowman MA, Frank E, Allen D. Women in Medicine: Career and Life Management. New York, NY: Springer; 2002
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