GPs not too shy about
retiring earlier
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Incentives will have to
be found to
discourage GPs from
retiring early and
thereby retain their
invaluable experience
in primary care, write
Ronan O’Connor and
Maureen Kelly
THERE HAS BEEN INCREASED CONCERN over the past 5-10
years regarding a future manpower crisis in Irish general
practice. This predicted shortfall of GPs is set against a
background of an increasing population base, changes in
healthcare practices with a shift from secondary to primary
care, the feminisation of the general practice workforce and
the aging cohort of current GPs.
Workforce planning in any discipline needs to be informed
about workers’ retirement aspirations and factors that would
influence these decisions. With respect to general practice
internationally and especially in Ireland, systematic information regarding this is limited.
Current statistics show a sizeable proportion of GPs are
coming to retirement in the next 10-15 years. A study in
20031 revealed that 85% of GPs working in the General
Medical Services (GMS) in the former Western Health Board
area were aged 50 or over. There is UK-based evidence to
show that GPs are retiring earlier, in line with wider societal
trends.2-4 A small number of studies has been conducted in
the UK to try to discover what the retirement intentions of
the current GP workforce are. In one such survey of 1,427
GPs, with a mean age of 48 years, only 14.8% replied that
10 FORUM July 2005
they would definitely continue working until normal retirement age. Fifty-one percent stated that they would either
probably not (26%) or definitely not (25%) continue to the
normal retirement age.3 A similar study in Scotland5 found
that 71% of GPs aged 55 or over planned to retire at or
before the age of 60. It was in this context that it was felt
important to formally establish the views of Irish GPs regarding retirement and early retirement.
Objectives
This study had three objectives:
• To discover what GPs considered the ideal age to retire
from the GMS
• To determine the factors that would influence them to
retire from the GMS early (defined as retiring before the
age of 60)
• To ascertain what factors would encourage GPs to work
beyond the age of 65.
Methods
A two-page questionnaire was designed based on previous
publications in this area.2-5 It was initially piloted with a
small group of GPs and modifications were made. The questionnaire asked GPs at what age they would like to retire
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Table 1
from the GMS, to rank the factors that would influence them
to retire before the age of 60 and to indicate and rank the
factors that would encourage them to work beyond the age
of 65 (see Table 1 for the list of factors). Demographic
details such as age, gender and type of practice were also
recorded.
Results
The response rate was 81% (n = 180). Of these 68% (n
= 123) were male, 23% (n = 42) were female and 8% (n =
15) did not identify their gender. Not all respondents
answered every question but percentages reported are based
on the total sample of 180. Percentages are rounded to the
nearest whole number and therefore may not always total
100%.
There was a significant difference in the proportions of
males and female GPs in the different age groups. Sixty-one
percent of male GPs (n = 74) were over 50 years of age
while 33% (n = 14) of female GPs fell into this category.
Overall, 54% (n = 97) of practices were single-handed, 42%
(n = 75) were mixed urban and rural, 32% (n = 58) rural
and 18% (n = 32) were urban practices.
A total of 20% of respondents wanted to retire before the
age of 60 years, with a further 36% wanting to retire at 60
(see Table 3). This yields a total of 56% of the total sample
wanting to retire at or before the age of 60.
Comparing these by gender, there was a significant difference between the proportions of males wishing to retire
before the age of 60 (13%, n = 16) and females (40%, n =
17) Only 7% of the total sample wished to work beyond the
age of 70 (n = 13), the majority male (n = 11).
Table 4 shows the ranking of factors that would prompt
early retirement. Overall, the three highest-ranking factors
are potential ill health, having adequate financial security
and job stresses.
Table 5 indicates the factors that would encourage GPs to
work after the age of 65. For both males and females, the
Factors influencing retirement
decision
Which of the following factors would influence you to retire
before 60 years of age? (Please rank 1-7 with 1 being the
most important and 7 the least)
• Job stress
• Ill-health
• Dissatisfaction or disillusionment with work
• Adequate financial security
• Desire to pursue other interests
• Ability to devote more time to family
• Other (please specify)
Which of the following factors might entice you to work in
the GMS beyond 65 years of age? (Please rank 1-6 with 1
being the most important and 6 the least)
• Flexible working hours
• Part time working hours
• No out-of-hours
• Support for sabbatical
• Increased pension
• Other (please specify)
most important factor is that they would have no out-ofhours cover, with the possibility of being involved in
part-time work being the second most commonly cited
factor.
Discussion
This study set out to determine the retirement intentions
of Irish GPs and the factors that might influence these.
Overall, 56% of GPs wanted to retire at or before the age of
60.
Limitations of this study include a small sample size and
excluding GPs working exclusively in private practice. A fur-
Table 2
Age distribution of respondents
Age
% of total
(n = 180)
<30
% of males
(n = 123)
% of females
(n = 42)
% of gender unknown
(n = 15)
1 (n = 1)
1 (n = 1)
0
0
30-39
14 (n = 26)
11 (n = 14)
29 (n = 12)
0
40-49
28 (n = 50)
28 (n = 34)
38 (n = 16)
0
50-59
43 (n = 78)
50 (n = 61)
33 (n = 14)
20 (n = 3)
60-70
7 (n = 13)
11 (n = 13)
0
0
Age and gender not indicated
7 (n = 12)
Table 3
Replies of GPs to the question ‘What is your ideal age of retirement?’
Ideal retirement age
% of total
(n = 180)
% of males
(n = 123)
% of females
(n = 42)
% of gender unknown
(n = 15)
50-54
3 (n = 6)
1 (n = 1)
7 (n = 3)
13 (n = 2)
55-59
17 (n = 31)
12 (n = 15)
33 (n = 14)
13 (n = 2)
60
36 (n = 64)
38 (n = 47)
31 (n = 13)
27 (n = 4)
0
61-64
2 (n = 4)
2 (n = 3)
2 (n = 1)
65-69
14 (n = 26)
18 (n = 22)
10 (n = 4)
0
7 (n = 13)
9 (n = 11)
0
13 (n = 2)
20 (n = 36)
20 (n = 24)
17 (n = 7)
33 (n = 5)
70 or over
Unanswered
FORUM July 2005 11
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Table 4
Ranking of factors that would prompt early retirement
Factors
% of total
(n = 180)
% of males
(n = 123)
% of females
(n = 42)
% of gender unknown
(n = 15)
Potential ill-health
38 (n = 68)
37 (n = 46)
40 (n = 17)
33 (n = 5)
Adequate financial security
15 (n = 28)
21 (n = 26)
5 (n = 2)
0
Job stress
15 (n = 27)
18 (n = 22)
7 (n = 3)
13 (n = 2)
Family commitments
7 (n = 12)
3 (n = 4)
17 ( n = 7)
7 (n = 1)
Pursue other interests
6 (n = 10)
5 (n = 6)
10 (n = 4)
0
Job dissatisfaction
6 (n = 10)
3 (n = 4)
12 (n = 5)
7 (n = 1)
13 (n = 24)
11 (n = 14)
10 (n = 4)
40 (n = 6)
1 (n = 1)
1 (n = 1)
0
0
Combination of above factors
Other
Table 5
Factors that would encourage GPs to work beyond 65
Factors
% of total
(n = 180)
% of males
(n = 123)
% of females
(n = 42)
% of gender unknown
(n = 15)
No out-of-hours
33 (n = 47)
33 (n = 40)
43 (n = 18)
7 (n = 1)
Part-time
26 (n = 47)
26 ( n = 32)
19 (n = 8)
47 (n = 7)
Flexible hours
8 (n = 15)
11 (n = 13)
2 (n = 1)
7 (n = 1)
Increased pension
6 (n = 11)
7 (n = 8)
5 (n = 2)
7 (n = 1)
2 (n = 3)
2 (n = 2)
2 (n = 1)
0
17 (n = 30)
15 (n = 19)
21 (n = 9)
13 (n = 2)
8 (n = 15)
7 (n = 9)
7 (n = 3)
20 (n = 3)
Support for sabbaticals
Combination of above factors
Other
ther weakness is that we looked at retirement aspirations,
which may not actually predict behaviour. However a
strength of the study is the achievement of a response rate
of 81%. We believe that this emphasises that when a study
is considered to be important and relevant, GPs will
respond.6
Factors influencing the decision to retire differed somewhat between our male and female respondents, with
female respondents citing family commitments more often
than male respondents. This is in keeping with other
research.3 Female GPs in general would prefer to retire earlier. This needs to be taken into consideration in workforce
planning, particularly as there are more female GPs entering into the profession.
Factors which would encourage GPs to continue to work
up to and beyond the age of 65 include no out-of-hours and
part-time or flexible commitment. Again these echo findings
in the UK.3,7
Facilitating GPs to remain in the workforce would ensure
their vast experience could be retained. A survey in Scotland
suggests that GPs would be interested in continuing to work
on post-retirement retention schemes.5 These GPs indicated
that they would like to pursue additional activities including
teaching medical students and general practice registrars as
well as others such as nurses and underperforming doctors.
They were also interested in being involved in audit and in
practice administration as well as a limited number of surgeries.
Further work is needed in this relatively understudied area.
In particular the question of how best to include the option
of part-time work, flexible hours and limited or no on call
12 FORUM July 2005
into the GP contract needs to be considered. Furthermore,
in order to properly plan for future manpower needs, a comprehensive and systematic study of the career pathways and
intentions of Irish medical graduates needs to be conducted.
Resources should urgently be provided to support such a
study.
Dr Ronan O’Connor, Western Training Programme in General
Practice and Dr Maureen Kelly, Western Training Programme
in General Practice and Department of General Practice,
National University of Ireland, Galway
Acknowledgments
The authors would like to acknowledge the assistance of Dr Genevieve
McGuire, Dr Pat Durcan and Dr John D Keane in the design and planning of
the study, Aoife Berry for secretarial assistance and the Writers Group,
Department of General Practice NUI, Galway for comments on the paper.
We would also like to thank all those who responded to the questionnaire.
References
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3: 20.
2. Scottish General Practitioners Committee. The reality behind the
rhetoric: a survey of the views of general practitioners in Scotland on
morale, service provision and priorities for improving primary care.
Edinburgh: BMA Scotland, February 2001.
3. Davidson JM, Lambert TW, Parkhouse J, Evans J, Goldacre MJ.
Retirement intentions of doctors who qualified in the United Kingdom in
1974: postal questionnaire survey. J Public Health Med 2001; 23 (4):
323-8.
4. Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and
retirement intentions among General Practitioners in England. BMJ 2003;
326: 22-25.
5. Chalmers M, Colthart I, McKinstry B. Scottish General Practitioners’
willingness to take part in a post-retirement retention scheme:
questionnaire survey. BMJ 2004; 328:329
6. Boynton PM. Administering, analysing and reporting your questionnaire.
BMJ 2004; 328: 1372-1375
7. Luce A, van Zwanenberg T, Firth-Cozens J, Tinwell C. What might
encourage later retirement among General Practitioners? J Management in
Medicine