The great examining room in the sky

There is a clock ticking out there for all of us and I don’t mean the one with your name on it that the grim reaper is holding.

The BCMJ has published a few submissions in the past few months about the controversy surrounding mandatory retirement policy at various institutions, the most visible being VGH. The most recent piece I read was penned by a lawyer who provided a fair amount of useful information from the perspective of members of the UBC Faculty of Law. This author was writing in response to a BCMJ editorial written by Dr Tony Salvian (2005;47[4]:165), and like the previously published physician-authors, managed to land firmly on the side of the 65-year-old docs who were losing their privileged status in the facility they had practised in for so many years.

It’s clear that this action is based purely on a unilateral policy decision by the political appointees to the governing board of the facility and is triggered by nothing other than a birth date. The decision seems to run contrary to the usual Canadian mantra of “decision by consensus” and in fact is a philosophical hot potato that most other forward-thinking democracies on this planet have decided quite appropriately to drop.

Irrespective of the stated reasons for the policy, the affected docs are faced with a policy that tells them, “if you’re 65 it makes no difference that according to your peers your skills are excellent—in our opinion, the day you turn 65 you are no longer capable of doing the highly technical work you did so well 24 hours ago.”

This is likely not a huge topic of interest for all of you docs in your thirties and forties, but guess what—you’re going to blink your eyes and find yourself surrounded by grandchildren while blowing out 60 candles on your birthday cake and wonder how the hell you got there so fast.

This is all about freedom to chose what you want to do professionally as you near the end of your career and I feel deeply that if you want to and there are no health or other reasons why you shouldn’t, you should be able to decide yourself if you want to hang up your stethoscope and go play golf every day—or not.

There are some good reasons proclaimed by the talking heads at various hospitals both here and in the US who trot out various studies about the need to refresh the pool of young talented docs in the hospital hierarchy and the need to move talented docs with experience into leadership positions in the hospital. They also talk about declining skills, declining energy, and declining commitment to the administrative and teaching needs of the hospital, and I’m sure there are individuals who fit those characterizations; to suggest that every doc in the hospital who turns 65 fits any or all of those stereotypes is pure hogwash (I think I just dated myself by using that term).

Not many of us would disagree that a mandatory retirement age of 65 is unfair, likely illegal if an appropriate Charter challenge happens again (the late Dr Ewart Woolley discussed the previous unsuccessful challenge in a recent letter to the BCMJ [2005;47(9):475-476]), and almost certainly is going to exaggerate the huge professional resource planning problems we already have in this country.

However, there is another side of the mandatory retirement coin. There is a cohort of docs who are happy to head out the door by 65 if they haven’t already done so. This group seems to reflect the feelings of several other groups who are mandated out of jobs but seem happy to comply. The group that seems to be the happiest that they have mandated limits on their working life is senior commercial pilots employed by major carriers such as Air Canada. These professional aviators are forced to retire at age 60 and I have yet to have one tell me that he or she isn’t happy to do so. The reason for the warm anticipation they feel as they approach mandatory retirement is driven by very adequate pension provisions and the fact that they get to fly for free until they go to “the great hangar in the sky.” The docs who are happy to retire at age 65 (or earlier) interestingly do so because first of all, they want to, and apparently more importantly, because they can afford to (even though they have to pay for their own airfare).

The point of all this is that physicians should not have to work until they die or be forced to retire before they want to. The decision to work or not should be a personal decision (given that there are proper and prudent safeguards on the quality of their work). I don’t care what the actuaries and economists say, doctors should not have to work when they are 75 years old just to put food on the table, and this needs to be addressed in some way by our medical politicians.

Well, I don’t know about the rest of you but I can hear my clock ticking and I’m going retire on my own terms before some damn bureaucrat sends me a letter.

—JAW