By Paige Twenter

There are countless projections about the worsening U.S. physician shortage, especially as the aging population grows and requires higher acuity care. Lots of attention is paid to supporting the medical student pipeline, but the healthcare industry might be overlooking the other end: retirements.

The AAMC reported in 2021 that physicians aged 65 and older accounted for 20% of the active patient care workforce, and those between 55 and 64 years old made up 22%. In 2023, physicians 65 and older were 23.4% of the active clinical workforce.

These data show that more than a third of currently active physicians will reach retirement age within the next decade — if they have not already.

This spells a problem not only for patients but also hospitals, many of which are already operating within tight margins. Failing to replace a vacant physician role can heavily cost an organization. For example, losing a family medicine physician who generates $1.5 million revenue could mean losing $130,000 each month. Since it takes 4.3 months on average to fill this role, the loss raises the calculated expense to $559,000.

Robin Anderson, MD, vice president and chief medical officer of primary care at Norfolk, Va.- based Sentara Health, and Isaac Myers II, MD, chief health integration officer of Louisville, Ky.-based Baptist Health, explained how their organizations are working to mitigate this problem.

At Sentara — which has nearly 30,000 employees across 300 sites of care in Virginia and North Carolina — about 50% of its physicians are 50 or older.

One of the system’s strategies is what it calls “Flexi roles.” These flexible positions, which are similar to shift work, support retired physicians who want to work, say, one day a week or every other month.

“A lot of our retiring folks don’t necessarily want to retire,” Dr. Anderson said. “They want to have a little bit more balance. They enjoy their work, but they don’t want to work crazy hours anymore.”

“We always are going to have times where we don’t have providers in our office for whatever reason,” she added, “and so they’ll pick up those shifts for us. They’re familiar with how Sentara works, how our EHR works, and so they can kind of fill in relatively seamlessly. It’s been great for us and great for them.”

Physicians who are nearing retirement often have a faster pace of work than those who are being onboarded, she said, so Sentara will sometimes bring in an advanced practice provider. The national physician shortage is also prompting the system to develop a team-based care approach in which retired physicians are replaced with nurse practitioners and physician assistants.

Dr. Anderson and Dr. Myers, the president of Baptist Health Medical Group, said independent physicians close to retirement often seek employment from their respective organizations.

With rising operation costs and decreasing reimbursement rates, “they don’t necessarily want to maintain some of the headaches of managing their own practice anymore,” Dr. Anderson said.

The health systems can also provide more resources into those independent practices so patients receive uninterrupted care, according to Dr. Myers.

Historically, physician contracts stipulated that the employee notify Baptist Health 90 days before retiring. That was not nearly enough time to find a replacement, so in 2022, the system launched the advanced notice of retirement program.

The program incentivizes physicians nearing retirement to tell the organization much sooner. Employees can give notice 12 or 24 months in advance, and Baptist will pay them about $35,000, or twice that for two years, for their notice.

Once given the heads up, leaders have at least a year to begin the recruitment process, the physician has fewer stressors about their transition to retirement, and the physician’s team and patients can plan for the upcoming change.

“That just worked extremely, extremely well,” Dr. Myers said.

Even though the annual stipend begins 24 months before retirement, some physicians have started the conversation five years in advance. Plus, these discussions are much more relaxed than they were previously.

“I had dinner just recently with a provider,” Dr. Myers said. “He was saying, ‘Hey, I’ll probably be doing this another four or five years, and I’ll be looking at retirement and getting involved in the early notice of retirement program.’ That probably wouldn’t have been a typical conversation before.”

Dr. Anderson and Dr. Myers also both voiced the importance of showing respect to the retiring physician. At Sentara, Dr. Anderson makes sure realistic expectations are set.

Cutting back hours does not automatically reduce a physician’s panel, she said. Attrition will naturally happen but maybe not as quickly as one would expect.

Other strategies include decreasing call time for late-career physicians and offering job shares.

With half of Sentara’s physician population close to retiring in 10 to 15 years, Dr. Anderson said, “We need to … make sure we have a workforce that we can sustain to take care of our communities appropriately.”