General practice
F ROM M I DL I F E T O R ET I R EMEN T
GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
Introduction
Over half of the current GP workforce is aged over 50,1 with a
significant cohort aged between 50 and 65.2 Half of all GPs who
retire do so after the age of 69.2 The large cohort of GPs who are
aged over 50 have considerable skill, knowledge and expertise and
form the backbone of general practice in this country.
H
ealth Workforce New Zealand use the term the ‘third age’ to refer to
the period of life following middle age; an age where many health
practitioners make a shift in career direction or engage in a period of
semi-retirement.3 The aim of this resource is to provide
some information for GPs to consider as they
enter their third age, and to assist those
making the transition from practice
to retirement.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
PART 1
KEY MESSAGES
Ensuring that general
practice in midlife will be
satisfying and rewarding
■■ Working part-time and
involvement in teaching
are both associated with
improved job satisfaction
among general practitioners.
An increasing number of doctors divide their time between several
different paid roles as a way of incorporating some variety into their
working life – having what is sometimes referred to as a ‘portfolio
career’. Working part-time, diversity of work, regular contact with
colleagues and involvement in teaching are all associated with
improved job satisfaction among general practitioners.4,5
M
any ‘third-age’ GPs find that taking on a teaching role helps to avoid
burnout and extend their careers. Taking on a teaching role can assist
with succession planning (see below) and research has demonstrated
that a large majority of GP teachers also feel that they themselves learn from
teaching, and that teaching makes the everyday work of general practice more
interesting.6,7
Other GPs introduce diversity in midlife by fostering a special clinical interest, or
by taking on non-clinical work such as medicolegal work, research or medical
administration. Retraining, or undertaking additional vocational training, is
also an option. One GP advised the College that a ‘…change to Rural Hospital
Medicine has re-enthused me such that I love medicine again. It also made me
realise that we in medicine have many more choices than most of our patients.’
Diversity can also be achieved through taking on leadership or clinical
governance roles within a GP’s own practice. For example, GPs in this cohort
might become involved in a restructure of practice arrangements and take on
more of an advisory role in the organisation. Alternatively GPs might volunteer
to lead or pilot a new initiative.
There are also opportunities for GPs to take on representative roles, for
example through involvement with a PHO or network initiative, or by becoming
involved in College or Medical Council of New Zealand committees and
THE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERS | AUGUST 2015
■■ Reducing your hours or
taking on a teaching role
might help you to avoid
burnout and extend your
career.
■■ There are a number of ways
you might be able to reduce
your clinical commitments
without this also reducing
your patients’ ability to
access services.
■■ If you feel that reducing
your clinical hours might
be unsafe, then you should
consider developing a
succession plan.
■■ New Zealand law allows
employees to request flexible
working hours.
■■ If you take on a non-clinical
role, you will likely have to
maintain your registration
with the Medical Council,
but in some cases you may
be able to minimise your
recertification requirements
and costs.
■■ Ageing is associated with
changes in cognition. These
changes shouldn’t impact on
an older doctor’s ability to
practise medicine, but may
mean that they should work
in a slightly different way than
before.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
faculties. The College also regularly seeks GPs willing to represent general
practice on various Ministry of Health and other Government advisory groups.
If you are interested in making a change to your career, your PHO or DHB might
have suggestions for you – while the College is always keen to recruit more
teachers. You might also consider advising the College of your professional
interests, as we usually seek representatives for advisory groups by emailing
members of relevant professional interest groups. To advise the College of
your professional interests, go to the College website, log on as a member, go
to professional interests in the blue/grey panel, and select the topics you are
interested in.
Adapting to a career change without reducing patient access
to care
Taking on a new role or new duties, or working part-time, can often be done
without reducing patients’ ability to access services. Partnering with another
GP to job-share might be an option for some doctors, while others might look
at handing over some duties to a practice nurse or nurse practitioner colleague.
Recent changes to New Zealand law make it easier for a skilled nurse to
provide comprehensive care, including the prescribing of medicines, to some
patients.* Research has found that nurse prescribing for patients with diabetes
is safe, clinically appropriate and popular with both patients and practitioners.8,9
Adapting to a new way of working might also free up time for other things. For
example, using secure video to communicate with patients and nursing staff
at a rest-home might be a more efficient way of managing conditions ranging
from cuts and bumps to ongoing diabetes care and the onset of confusion.
Other new models of care can include telephone triage, online provision of
some services and patient portals.
Compliance requirements and compliance costs
‘…a change to
Rural Hospital
Medicine has
re-enthused
me such that I
love medicine
again. It also
made me
realise that we
in medicine
have many
more choices
than most of
our patients.’
Taking on a role such as that of a medical teacher usually requires maintaining
clinical competence and preserving at least a part-time clinical role. The
Medical Council also requires that doctors hold a current practising certificate
to practise medicine, and this may have an impact on you if you decide to move
full-time into a non-clinical medical administration or management role. This is
because the Medical Council’s definition of the ‘practice of medicine’10 is broad,
and includes reporting or giving advice where this makes use of your medical
*
In July 2014 the Medicines Amendment Act 2013 and Misuse of Drugs Amendment
Regulations 2014 came into effect. These amendments named nurse prescribers as
‘authorised prescribers’ (the same category as doctors). The amendments also allow
registered nurses to prescribe if they are doing so under the authority of a GP.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
knowledge and where there could be an issue of public safety. However,
the Medical Council does have an option that allows doctors to maintain
registration for the purpose of ‘non-clinical practice’. Choosing this mode of
registration means that you will not be able to provide care to individual patients
(so will not be permitted to write prescriptions), but if your work poses a low risk
of causing harm then recertification requirements will be minimal.
Doctors who decide to move into a management, administration, policy or
purchasing role may consider becoming a Fellow, Associate Fellow, or Affiliate
of The Royal Australasian College of Medical Administrators (RACMA).
If reducing clinical commitments means that you earn less than $60,000 per
annum, then the College will discount your annual subscription fee.11 The
Medical Council also allows you to claim a rebate on your practising certificate
fees if you only earn a minimal income from your medical practice. To claim
a rebate from the Council, attach a low-income declaration form to your
practising certificate application.†
Ageing and changes in cognition
Dr Steven Lillis, a Hamilton GP who is a medical adviser to the Medical Council,
has recently reviewed the literature on the effects of ageing on doctors. He
found that the ageing brain is associated with greater reliance on ‘crystallised
intelligence’ as opposed to ‘fluid problem solving’. ‘Crystallised intelligence’ is
the use of skills, ability and knowledge that is overlearned, well practised and
familiar. ‘Fluid problem solving’ is generally used for solving novel problems
and is slow and deliberate. There is significant variability in how individual
brains change with increasing age, but commonly our crystallised intelligence
tends to remain fairly stable while our fluid problem solving can often decline.12
What should this mean for the older doctor? Dr Lillis’ conclusion was that the
normal changes in cognition associated with the ageing brain shouldn’t impact
on an older doctor’s ability to contribute meaningfully to health care – but may
mean that the doctor should work in a slightly different way than before.
Dr Lillis has suggested that making doctors aware of potential cognitive change
should help them to self-regulate their own behaviour. This could, for example,
involve reminding yourself to be deliberate in reviewing all relevant patient
information before making a decision. Dr Lillis has also suggested that ageing
doctors should aim to spend more time with each patient, and preferably avoid
working in an urgent care environment. Working as part of a team, rather than
in isolation, is also likely to be of benefit.13
†
A copy can be downloaded from http://www.mcnz.org.nz/assets/Forms/Low-incomedeclaration.pdf.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
PART 2
KEY MESSAGES
Planning for retirement
■■ Planning for your retirement
early can make the transition
out of practice easier, and
potentially safer for your
patients.
We all have to start thinking about retirement at some point, and
sadly, for some of us ill health can mean that retirement comes
more quickly than we had intended. The College’s 2014 workforce
survey indicated that 86% of respondents who had retired before
the age of 60 had done so because of ill health. It is therefore
worth planning for retirement even if the prospect seems a distant
one. A problem for many GPs is that there is a paucity of advice
and information about retirement. This part of the resource aims
to provide information that will help GPs as they transition from
practice to retirement.
Things to consider
There are many things that need to be considered when planning for retirement.
There are five different issues that the College considers are particularly
important in general practice:
■■
■■
■■
■■
■■
Ensuring that retirement will be satisfying and rewarding
Selling your practice
Handover of patient care
Patient records
Ensuring financial security.
Ensuring that retirement will be satisfying and rewarding
Ideally, we would all retire when we want to. However, ill health can bring
retirement forward for some, and a lack of retirement savings can mean
others have to work longer than they desire. At whatever age you retire,
leaving medicine can be difficult. Early retirement can be particularly difficult
when medicine has been your main source of satisfaction. In such cases, the
end of a career may bring an acute sense of psychological, intellectual and
emotional loss.14
It is important to always have active interests outside of medicine – not only is
this good self-care, but it can mean the transition away from practice is easier.
As discussed above, you might also consider working part-time towards the
THE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERS | AUGUST 2015
■■ Reducing your hours,
or reducing your clinical
commitments and taking on
some non-clinical duties,
might help to ease your
transition out of practice.
■■ If you are struggling to see
a way out of practice that is
safe for your patients, develop
a succession plan.
■■ Let your patients and
colleagues know about your
retirement in advance. Discuss
ongoing care with your
patients and agree with them
a plan for their future care.
■■ Transfer patient records
to an appropriate person
wherever possible. This could
be the patient’s new GP,
another practice, the patient
themselves, or the executor of
a deceased patient’s estate.
■■ Where there is no obvious
person to transfer records to,
you may have to store these
securely yourself for at least
10 years.
■■ Many superannuation
schemes have mechanisms
that will allow you to reduce
your hours without this having
an adverse impact on your
retirement entitlements.
■■ Make sure you have a
financial plan, and consider
seeking the advice of an
independent financial planner.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
end of your career, or look at reducing your clinical hours and taking on a nonclinical role such as teaching, medicolegal work or medical administration.
Easing gradually towards retirement through a transition to part-time or nonclinical practice might not be practical for GPs in rural or sole practice, who can
sometimes find it difficult to find a colleague willing to take over their patient
roll. A GP should be able to feel that it is safe for them to leave practice, and
should not feel trapped out of fear that they are abandoning their patients and
community. If you feel that your retirement might be unsafe, then you should
consider developing a succession plan. The New Zealand Rural General
Practice Network and the Medical Assurance Society (MAS) can both help
with developing a personalised succession plan, and your PHO should also be
able to provide you with suggestions.
Selling your practice
Professor Campbell Murdoch, Chair of the College’s Rural Faculty, suggests
that GPs should not regard owning a practice as owning an investment
that will increase in value over time, but should instead assess the value
in accordance with the salary and benefits that accrue over the span of
ownership.
Getting a good return when selling a practice can be assisted by allowing a
long lead-in time and by effective marketing. Becoming a teaching practice, for
example, is a good way to develop links with younger doctors who may later be
interested in buying a practice. It also allows them to develop an affinity for your
practice and the community. Selling the practice in stages over time is another
good way to bring in a successor who might not otherwise be able to afford to
buy a practice outright. Other alternatives include selling to a corporate body,
amalgamating with other local practices, closing the practice, or transitioning
ownership to a community-owned trust. The Medical Assurance Society can
provide excellent guidance and advice about your options.
Becoming
a teaching
practice, for
example, is a
good way to
develop links
with younger
doctors who
may later be
interested
in buying a
practice.
Handover of patient care
The Medical Council requires that ‘When you are going off duty, make
suitable arrangements for your patients’ medical care. Use effective handover
procedures and communicate effectively with colleagues’.15 These basic
principles should guide the handover processes in the lead-up to retirement.
It is good practice to notify the PHO and any colleagues that might be
impacted in advance, and you may also want to personally notify long-term
patients of your intentions. Other enrolled patients should also be informed,
for example through a notice in the waiting room or in a practice newsletter. As
your retirement date draws closer, you will need to discuss ongoing care with
patients and agree with them a plan for their future care. If the practice has
been sold to another practitioner, or if a new GP is being employed to replace
you, then handover should be relatively straightforward. However, if the practice
is closing and there is no obvious candidate to provide ongoing care, then
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
handover can become more complicated. In these circumstances you should
make arrangements with your PHO – they should be able to assist you and
your patients to find a new GP.
Patient records
Prior to retiring, arrangements need to be made for the retention of patients’
records. Usually they should either remain with the practice or be transferred to
the patient’s new GP. They can also be passed directly to the patient (or, if they
have passed on, the executor of their estate).
FURTHER
INFORMATION
Medical Assurance Society
(MAS)
Medical Council of New Zealand
(MCNZ)
If your practice is closing, then it is possible that you will remain responsible
for at least a portion of your patient records. This is because it is probable that
at least some of the records will relate to patients you might not have seen for
some time, patients who have moved without providing a forwarding address,
or who have died and no family member has been in touch. In these cases, and
with any other records where there is no obvious person to refer records to, you
will remain responsible for retaining those records even after you have retired.
Sorted
The Health (Retention of Health Information) Regulations 1996 require that,
where you are unable to forward the records to an appropriate person, then you
as ‘the provider that holds health information’16 must retain patient information
for at least 10 years after you last provided care to the patient.17 If you are in this
situation, you might consider asking colleagues in the same practice to assume
responsibility for the records. Otherwise, you will likely have to arrange for the
records to be securely stored in your home or in some other facility.
EEO Trust toolkits
The Regulations state that information can be retained ‘in such form as the
provider thinks fit’ and ‘in different forms at different times’.18 This means that, if
you are unable to make any other arrangements, you can securely dispose of
hard-copies of any patient information that you can instead retain in electronic
form. You may also securely dispose of all patient information once the most
recent documentation is more than 10 years old, although you should consider
retaining any information that may remain relevant to a patient’s future care.
The Royal Australasian College
of Medical Administrators
New Zealand Rural General
Practice Network
New Zealand Medical Association
RNZCGP – Becoming a teaching
practice
RNZCGP – Membership
subscription categories and fees
MCNZ – Application for scope
of practice to be limited to
non-clinical practice
Ensuring financial security
Retirement income is one area where there is a wealth of advice. A website
maintained by the Commission for Financial Capability (‘Sorted’) provides
some good, clear information about financial planning for retirement. You
should also consider seeking the advice of an independent financial planner.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
At forums conducted by Health Workforce New Zealand in 2011, some doctors
raised concerns about the structure of superannuation schemes. There was a
concern that, to maximise the benefit on retirement, doctors needed to keep
their income high in the last few years of practice. However, many schemes do
actually have some flexibility with regard to working part-time. For example, if
you contribute to the Government’s Superannuation Fund, a drop in income will
not affect your superannuation if you keep your contributions into the scheme
at the same level. Alternatively, there is nothing stopping you from retiring and
receiving a superannuation benefit while also undertaking contract work on a
‘fee-for-service’ basis.19,‡
Traditionally, many practice owners have assumed that the sale of their practice
would provide the nest egg needed to fund their retirement. However, the
owner–practitioner model is becoming less common2 and it is becoming
harder for some GPs to sell their practices.20,21 MAS caution that, if you want
to sell your practice, you need to make sure that you start planning the sale at
least five years in advance. If you are a practice owner, then the MAS provides
advice to members on selling a practice that might be useful to you.
‡
The requirements of the Government’s Superannuation Fund can be found at
www.gsfa.govt.nz.
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GENERAL PRACTICE FROM MIDLIFE TO RETIREMENT
References
1. Medical Council of New Zealand.
Workforce survey 2012.
2. The Royal New Zealand College of
General Practitioners. 2014 RNZCGP
workforce survey. Wellington: The
Royal New Zealand College of General
Practitioners; 2014. Available from: http://
www.rnzcgp.org.nz/assets/documents/
Publications/Workforce-SurveyRELEASED2_2.pdf
3. Health Workforce New Zealand. Update
on retention of doctors in the ‘third age’.
January 2012.
4. Joyce CM, Schurer S, Scott A, et al.
Australian doctors’ satisfaction with their
work: results from the MABEL longitudinal
survey of doctors. Medical J Aust.
2011;194(1):30–33.
5. Van Ham I, Verhoeven AAH, Groenier
KH, et al. Job satisfaction among general
practitioners: a systematic literature
review. European J of Gen Prac. 2006;
12(4):174–180.
6. Gray J, Fine B. General practitioner
teaching in the community: a study of
their teaching experience and interest in
undergraduate teaching in the future. Br J
Gen Pract. 1997; 47(423):623–626.
7. Sturman N, Rego P, Dick ML. Rewards,
costs and challenges: the general
practitioner’s experience of teaching
medical students. Med Educ. 2011
Jul;45(7):722–30.
8. Budge C, Snell H. Registered nurse
prescribing in diabetes care: 2012
managed national roll out. Project report.
August 2013.
9. Laurant M, Reeves D, Hermens R,
Braspenning J, Grol R, Sibbald B.
Substitution of doctors by nurses in
primary care. Cochrane Database Syst
Rev. 2005(2):CD001271.
10. Medical Council of New Zealand.
Definition of the ‘practice of medicine’.
Available from: https://www.mcnz.
org.nz/assets/Policies/DefinitionPracticeOfMedicine.pdf
11. The Royal New Zealand College of
General Practitioners. Annual subscription
fees (current to 31 March 2016). Available
from: http://www.rnzcgp.org.nz/assets/
documents/Membership/Subscriptionfees.pdf
12. Powell D. Profiles in cognitive ageing.
Cambridge, Massachusetts: Harvard
University Press; 1994.
13. Dr Steven Lillis, presentation to the
combined Medical Colleges,
November 2014.
14. Oxtoby K. How to retire. BMJ Careers.
March 2009.
15. Medical Council of New Zealand.
Good Medical Practice. Paragraph 45.
Wellington: Medical Council of New
Zealand; 2013. Available from: https://
www.mcnz.org.nz/assets/News-andPublications/good-medical-practice.pdf
16. Regulation 6, Health (Retention of Health
Information) Regulations 1996.
17. Regulation 5, Health (Retention of Health
Information) Regulations 1996.
18. Regulation 9. Health (Retention of Health
Information) Regulations 1996.
19. Health Workforce New Zealand. Update
on retention of doctors in the ‘third age’.
January 2012.
20. Topham-Kindley L. More GPs opt out
of practice ownership. NZ Doctor.
6 Oct 2011.
21. Topham-Kindley L. Property rites. NZ
Doctor. 19 June 2013.
ISBN: 978-1-927240-37-3
© The Royal New Zealand College of General
Practitioners, New Zealand, 2015.
The Royal New Zealand College of General
Practitioners owns the copyright of this work
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The Royal New Zealand
College of General Practitioners
Level 4, 50 Customhouse Quay, Wellington
PO Box 10440, Wellington, 6143
Telephone: +64 4 496 5999
Facsimile: +64 4 496 5997
[email protected]
www.rnzcgp.org.nz
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