Does Physician Retirement Affect Patients?

A Systematic Review

Kenneth Lam, MD; Cameron G. Arnold, MBChB; Rachel D. Savage, PhD; Nathan M. Stall, MD; Lynn Zhu, PhD; Wei Wu, MSc; Katrina Piggott, MD; Susan E. Bronskill, PhD; Paula A. Rochon, MD, MPH

Disclosures

J Am Geriatr Soc. 2020;68(3):641-649. 

In This Article

Abstract and Introduction

Abstract

Objectives: Older patients that have aged with their doctors will likely experience their physician retiring. It is unclear if this interruption in continuity of care leaves patients at risk for adverse events or whether a new physician improves care. We sought to identify and synthesize findings from all articles examining the association between physician retirement and patient outcomes.

Design: Systematic review. We searched English-language articles cataloged in Medline, Embase, Cochrane, and PsycINFO, from database inception to May 4, 2018.

Participants: Any patient whose physician (generalist or specialist) retired.

Intervention: Physician retirement, defined as voluntary practice closure, death, or departure.

Measurements: Articles were categorized as anecdotes, qualitative studies, or quantitative studies. Each patient outcome was indexed under one of 11 themes (eg, adverse event, difficulty accessing care) and classified as favorable, neutral, or unfavorable. Patient outcomes included but were not limited to clinical (eg, death), resource utilization (eg, hospitalization), treatment plan adherence (eg, access to medications), and patient satisfaction (eg, expressed frustration). Two reviewers independently assessed study quality.

Results: Of 2099 articles screened, 17 met inclusion criteria: 12 anecdotes, 2 qualitative studies, and 3 quantitative studies. Most patient outcomes described were unfavorable. These included feelings of loss, difficulties with transition to a new provider, adverse clinical outcomes, and increased use of high-cost services. The quality of qualitative studies was high, but that of quantitative studies was poor or moderate.

Conclusion: Current evidence from qualitative studies suggests physician retirement affects patients unfavorably and that patients are vulnerable during this transition of care. High-quality quantitative research is lacking to identify whether this disproportionately affects older adults and whether physician retirement has significant consequences for the broader healthcare system.

Introduction

Physicians retire every year, whether through voluntary practice closure, illness, death, or departure to other opportunities. This natural and perennial turnover of the healthcare workforce inevitably disrupts continuity of care, yet how and to what extent this impacts patients is not well understood. When physicians retire, patients may lose a familiar and trusted medical opinion and seek care in emergency departments (EDs) or walk-in clinics that can lead to unfavorable clinical outcomes, the use of unnecessarily high-cost health services, and fragmented care.[1] This situation may be especially problematic for complex, multimorbid, and frail older patients whose preferences and history are best understood by a provider with whom they have a long-term established relationship.[2] Alternatively, physician retirement may have a neutral or favorable effect on patients. There is an association between years in practice and decreased knowledge, less adherence to guidelines, and worse patient outcomes such as mortality.[3,4] As individual physicians notice their competence declining, they may choose to retire out of concern for patient welfare,[5] and care may continue unchanged or even improve under an incoming provider.

Given the uncertainty surrounding this topic, we conducted a systematic review of the published literature to identify how physician retirement impacts patients. Our objectives were to characterize patient outcomes affected by physician retirement, assess whether the effect of physician retirement on patients was favorable, neutral, or unfavorable, and evaluate the quality of evidence supporting these findings.

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