More doctors are continuing to practise past the age of 65 in Switzerland. Are pensioners the answer to the country’s doctor shortage? According to specialists, it might be one option, but it’s not the solution.
The American paediatrician Leila Denmark is a legendary figure in medicine. Born in 1898, she continued practising until she was 103. She is also known for contributing to the development of the whooping cough vaccine. Dr Denmark died in 2012 at the age of 114.
When he began studying medicine, Roger had his career all planned out. “I’d work as much as possible for thirty years, then retire early to enjoy a hard-won salary.” Today, the 68-year-old Basel resident continues to work at his family practice office. Of course, he is working “somewhat less”, but he’s “more motivated than ever” and will doubtless continue to work for years to come.
Roger is far from an exception in Switzerland. “The age of doctors is clearly on the rise in our country,” notes Christoph Bosshard, vice president of the Federation of Swiss Physicians (FMH). “This increase is especially evident among doctors aged 60 and over,” he says.
The most recent data published by FMH is quite clear, especially with regards to general practitioners working in the outpatient sector. In 2016, the average age was 54.6 compared to 52.6 in 2008. The number of doctors (in the same category) aged 65 to 69 has more than tripled in eight years, increasing from 279 to 854. A similar rise has occurred in the number of doctors aged 74 and over
(2008: 48 people; 2016: 134 people). The increase is even more drastic for physicians between the ages of 70 and 74 (288 doctors in 2016 compared to 82 to 2008).
The thorny question of succession
“Of course, doctors working past the retirement age don’t continue to work full time,” says Christoph Bosshard. Indeed, the fact that it is now easier to practise medicine part time (for example as part of a group practice) partially explains the increase in the number of senior-aged physicians. It should also be noted that many doctors, once they’ve reached a certain age, decide to leave curative medicine in favour of other sectors, such as insurance consulting. “You’ll probably have a hard time finding a 60-year-old doctor working in the A&E Department,” jokes the vice president of FMH. “Medicine is such a wide discipline that there are many ’calmer’ options available to doctors when they approach the end of their careers.”
But why are more and more doctors continuing to treat patients even after they earn the right to a well deserved retirement? “The fact that people are staying healthy for longer should be taken into account,” says Christoph Bosshard. However, according to the FMH’s research, one of the main reasons why 60-year-old and even 70-year-old GPs continue to work is the trouble they have with “turning over their practice” to the next generation. Rather than giving their “baby”, as well as their clients, to a stranger, doctors often prefer working until they find a suitable successor.
Indeed, the fact that it is now easier to practise medicine part time (for example as part of a group practice) partially explains the increase in the number of senior-aged physicians.
The FMH doesn’t object. After studying the skills of doctors over the age of sixty, it concluded they presented no increased risk to their patients. On the contrary, Christoph Bosshard points out that senior-aged physicians have many advantages over their younger colleagues. In addition to their vast practical and theoretical experience, they have a “strong network, which is very important in our line of work”.
An exception from the Swiss Council of States
The average age of doctors working in the hospital sector has increased as well, rising from 41.5 in 2008 to 43.2 in 2016. Although the number of hospital physicians aged 60 and over is increasing, there are far fewer than in the outpatient sector. Of course, the fact that it is in theory impossible to continue working in the public sector past the age of retirement helps explain this difference.
A tall tale? “In reality, it is possible to obtain exemption, at least in the canton of Vaud,” says Antonio Racciatti, human resource director at CHUV. This extension, which allows a doctor to work until the age of 70, implies the approval of “the hospital board of directors as well as the Swiss Council of States”. In 2016, the establishment had only 11.5 full-time equivalents aged 65 and over among its managing physicians (excluding visiting physicians), 0.6 among its chief residents, and 1.4 among its visiting physicians. This number has remained low and relatively stable over the past few years.
“They are mostly highly qualified specialists that are continuing to practice at CHUV until their replacements are hired, or they’re colleagues involved in ongoing research projects,” says Antonio Racciatti. Christoph Bosshard reports the same phenomenon in private hospitals. There are more doctors over the age of 65 (some of which have transferred from public establishments) since the retirement age is not as regulated as in the public sector. However, “these doctors are mostly the ’bigwigs’ in their fields, which confers a certain notoriety to their clinics”.
Focusing on training young doctors
According to the human resources director at CHUV, the employability of senior-aged physicians will become more and more of an issue in the not-too-distant future. Given that the shortage of specialists has become a pressing problem, the use of older doctors could constitute a “temporary solution”. Antonio Racciatti notes that in many other business sectors in Switzerland, policies to keep seniors in the labour market have been implemented (see inset). Why is this not the case in Switzerland’s
medical field, given that France has already implemented
Nevertheless, the human resources director warns that even if Switzerland decides to move in this direction, it should only be “a temporary solution”. In the long term, the way to solve the doctor shortage is to train students. “Training is precisely where we need to take advantage of the experience and knowledge of older practitioners,” argues the director. “Their skill, multi-disciplinary approach to health and their networks make them ideal mentors.”
Magdalena Rosende, an occupational sociologist and author of a thesis on the medical profession in Switzerland (read inset), also believes it is crucial to implement targeted actions to increase the number of young physicians.
Whether it’s the vice president of FMH or the director of human resources at CHUV, one thing is clear – no one wants to pressure older physicians to continue working at all costs. “That would be dangerous,” warns Christoph Bosshard. ⁄
A widespread phenomenon
“Doctors aren’t the only ones who continue working past the legal retirement age,” says Magdalena Rosende. “Data from the Federal Statistics Office indicate this phenomenon affects all sectors in Switzerland,” says the occupational sociologist and author of a thesis on the medical profession in Switzerland. The same trend is being seen throughout Europe, but our country is among those with the highest rate of employed seniors, after the Scandinavian countries. Working (or not working) after the age of 65 is linked to factors that “vary widely between fields and individuals”. In some sectors, people in their sixties mostly choose to work for economic reasons, while in others, the prestige related to their profession pushes some to delay retirement. “It’s possible that this second reason applies to some doctors,” says Rosende.