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12 Jul 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA

Recently, a colleague, friend and mentor passed away and I was left bereft. It is difficult when any close colleague passes away, but strangely easier when they’ve already retired rather than succumbed ‘while in the saddle’. As always, this prompted some reflection and how this colleague managed the latter stages of their career and how we as colleagues supported them. Critical in end-of-career planning being positive and productive is the insight and willingness of the senior doctor to participate in this process and to recognise its importance. There is a growing body of literature which examines how doctors approach the end of their career and their views about this. In short, there is room for improvement.

As a physician I am aware, as suggested in the literature, that it is harder to recognise marginal loss of cognitive capacity compared to a loss of dexterity for a surgeon. Any surgeon would find abhorrent (I imagine) the prospect of doing harm and avoidable mistakes while operating within the full view of an operating team. I have witnessed heartless and even hostile ends to careers when gormless administration disrespects senior colleagues and abruptly ends a career based on perceived risk. The failure here is in the discussion with and preparation of that doctor to an end of their career.

I am concerned that institutions and practices do not prepare well enough for the end of doctors’ careers. Some of us are very happy to hang up the shingle and ride off into the sunset. Some of us will prefer to transition to a different role – but these roles need to be developed and appropriately recognised and resourced. It is crucially important that this discussion and active transition of senior clinicians to statesman/woman roles occur more often so we continue to have the benefit of the senior clinician’s wisdom and experience, but there is respectful recognition of declining capacity in some respects. I would much prefer for the profession to manage this process rather than administrators whose motivations and sensitivities will be different.

The other aspect to this discussion is helping doctors decide what they themselves might want to do if they cease seeing patients. Several doctors have spoken to me expressing their discontent after finishing clinical work, wanting to continue some useful undertaking related to medicine. They’d felt poorly prepared for the transition and unclear on the options available. The Medical Board of Australia has a very wide definition of ‘practice’ which can include administration, teaching or consultancy-type work. I recall a surgeon who had retired from clinical practice who was one of my anatomy tutors at university. Most students saved their questions for him because he always gave such an articulate, helpful answer with clinically applicability threaded through. We loved him! I’m quite certain my experience and learning of anatomy would have been poorer without this surgeon. Hopefully he enjoyed teaching us. Thank goodness he was happy to do this and was provided the opportunity.

I’ve occasionally witnessed senior doctors also take on research leadership roles, or policy/administration roles as they progress out of clinical practice. Unfortunately though, many doctors are not aware of these options and they would benefit from guidance. Advocacy needs to be undertaken to expand these opportunities for senior clinicians and the profession clearly needs to be strong in supporting our colleagues throughout their career.

Hopefully no one would argue against the notion of respecting our senior colleagues with a role that preserves their stature and relevance/contribution to medicine. We definitely can do better as a profession in managing this evolution of practice and assisting our colleagues with what can be a difficult transition for some. End-of-career planning is something the AMA could help with to a greater extent. I’ve witnessed this evolution from a distance and now much more closely and I’m convinced our professional association can have a very positive influence in the life of doctors in doing this. There is also a nice synergy in helping doctors as they start their career as a medical student and doctor-in-training – throughout their practicing life – but also being present towards the end of their career with a helping hand.

 


Published: 12 Jul 2019