Cleland Jennifer, Porteous Terry, Ejebu Ourega-Zoe, Skåtun Diane
Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Centre for Health Care Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK.
Med Educ. 2020 Sep;54(9):821-831. doi: 10.1111/medu.14157. Epub 2020 Jun 2.
Health care delivery and education face critical potential shortages in the foreseeable future in terms of retaining doctors nearing the time of retirement - doctors who have experience-based knowledge to pass onto the next generation. Retirement decisions are driven by a combination of macro-related, job and individual factors. This is a constantly shifting space; findings from earlier studies do not always help us understand the retirement decisions of contemporary cohorts of doctors. To address these issues, and identify new knowledge to inform approaches to retaining expertise, we aimed to identify and explore what may keep an older doctor in the workforce ('stay') factors and ('go') factors that might prompt retirement.
We invited doctors aged 50 years or over from diverse areas of Scotland to participate in qualitative, semi-structured interviews. Initial analysis of interview transcripts was inductive. The embeddedness theory of Mitchell et al encompassing the dimensions of 'link,' 'fit' and 'sacrifice,' was used for subsequent theory-driven analysis.
A total of 40 respondents participated. In terms of 'link,' retiring could feel like a loss when work links were positive, whereas the opposite was true when relationships were poor, or peers were retiring. Considering 'fit,' intrinsic job satisfaction was high but respondents had less confidence in their own abilities as they grew older. However, the data foregrounded the inverse of the notion of Mitchell et al's 'sacrifice'; for UK doctors, staying in work can involve sacrifice because of tax penalties, work intensity and arduous demands.
Retirement stay and go factors seem enmeshed in the cultural, social and economic structures of health care organisations and countries. Systems-level interventions that address ultimate causes, such as sufficient staffing, supportive systems, non-punitive taxation regimes and good working conditions are likely to be most effective in encouraging doctors to continue to contribute their knowledge and skills to the benefit of patients and learners.
在可预见的未来，医疗服务与教育面临着关键的潜在短缺，尤其是在挽留即将退休的医生方面——这些医生拥有基于经验的知识，能够传授给下一代。退休决策受宏观、工作和个人等多种因素共同驱动。这是一个不断变化的领域；早期研究的结果并不总能帮助我们理解当代医生群体的退休决策。为解决这些问题，并确定新的知识以指导挽留专业人才的方法，我们旨在识别并探究可能促使年长医生留在工作岗位的因素（“留下”因素）以及可能促使他们退休的因素（“离开”因素）。
我们邀请了来自苏格兰不同地区、年龄在50岁及以上的医生参与定性的半结构化访谈。访谈记录的初步分析采用归纳法。随后的理论驱动分析使用了米切尔等人的嵌入性理论，该理论涵盖“联系”“契合”和“牺牲”三个维度。
共有40名受访者参与。就“联系”而言，当工作联系积极时，退休可能会让人感觉是一种损失，而当人际关系不佳或同行退休时则相反。考虑“契合”方面，内在工作满意度较高，但随着年龄增长，受访者对自身能力的信心有所下降。然而，数据凸显了米切尔等人“牺牲”概念的反面；对于英国医生来说，继续工作可能会因为税收惩罚、工作强度和艰巨要求而涉及牺牲。
退休的留下和离开因素似乎与医疗保健组织和国家的文化、社会和经济结构相互交织。解决根本原因的系统层面干预措施，如充足的人员配备、支持性系统、非惩罚性税收制度和良好的工作条件，可能最有效地鼓励医生继续贡献他们的知识和技能，以造福患者和学习者。
