Is it ethical for older, financially independent docs to continue working?

[VagabondMD]

It sounds silly as a headline, and admittedly I am playing devil's advocate, but one can make an argument that older, financially independent docs are limiting opportunities for younger docs, especially in fields where there is an over supply of workers or where supply approximates demands. This is another side, perhaps, of the question of whether it is ethical for docs to retire early. This headline question is probably not applicable to primary care because one can ethically justify that any able bodies person should be working, and there are, no doubt, other fields where the demand significantly exceeds the supply of docs.

Five years ago in radiology, young docs out of training were having a difficult time getting jobs. (This has corrected itself, and we currently see supply and demand approximately being balanced).

At that time, my position in my group was that we should continue to hire, even if it dilutes our compensation in the short run, in order to protect the newly trained docs and the stability of the field, have the ability to recruit high quality candidates that will meet future needs, and prepare ourselves for a time in the future when we might have trouble hiring for need. There were a couple of people in the group that blocked this effort, and our staffing has been up and down since, with very lean staffing at times over the last couple years, until this summer.

There are only a certain amount of patient encounters in my field, a fixed pie, and adding more docs will not increase the pie, only reduce the share per person, on average. So should the older, financially secure docs work less (or even retire early) to allow the recently trained docs to get jobs and flourish?

[Donnie]

I think physicians historically have a sub-1% unemployment rate, so I wouldn't worry too much about oversupply of doctors.  If anything, a sub-1% unemployment rate suggests too few doctors.

[Hatton]

Another thought provoking thread started by the Vagabond.  Perhaps older financially secure docs should retire.  I am not sure how much room would be made for the youngsters however.  Most older OB/GYNs who should be retiring are not financially secure enough to do so.  At least this is my observation.

[G]

Vagabond, I love it.  Perhaps not in radiology, but for every EM/FP doc that retires or quits they may fill that spot with 1-3 mid-levels.  Don't forget that with all those extra bodies, more bureaucracy will be required, increasing downstream employment.  And from anecdotal experience, mid-levels fresh out of school working at the urgent care increase ED referrals, requiring more staffing in the ER!  We're talking logarithmic job creation!

[jhwkr542]

No, it's not unethical for them to keep working. It is unethical if they have not kept up to date with their trade and are using old criteria/guidelines. I've seen that in path since there's always new entities/criteria/discoveries. And these are the people who are grandfathered in so they don't have to recertify...

[RogueDadMD]

I'll ask the counter question that is asked here in all these situations -- would this ever be a concern in other fields?

I don't really know the answer. However in sports, older players are considered "blocking" younger ones all the time, but older players can be locked into a position because of a contract. Teams will play a bad player making a ton of money solely because they have to pay them either way (ie Albert Pujols, by some metrics the worst player in all of baseball this year).

Not sure about income being a reason to force someone out of a job -- it would have to be an individual decision as no external agency could officially decide if someone is FI. However in medicine it's hard to fire the older person in favor of the young up and comer -- we tend to revere the senior people, not denigrate them as they do in others fields.

[q-school]

Do the young ones want to work full time?
Another question is why your colleagues blocked your recommendation? Did they think you had already made your money and your focus was on lifestyle? Or were they afraid of long term downturn in income and afraid to commit to that even at expense of more frequent calls?

It seems you have found a way to go part time. For the most part, there is always a need for experienced docs. Moc may have more to do with capacity reduction than ethics in the future.

Congrats!

[AR]

Vagabond's post raises some interesting questions but the one he asks is clearly not one of them.

There's nothing unethical about competent docs continuing to work.  Regardless of their age or financial situation.  I can't believe anyone would seriously think that.

[WallStreetPhysician]

Vagabond MD wrote:

It sounds silly as a headline, and admittedly I am playing devil’s advocate, but one can make an argument that older, financially independent docs are limiting opportunities for younger docs, especially in fields where there is an over supply of workers or where supply approximates demands. This is another side, perhaps, of the question of whether it is ethical for docs to retire early. This headline question is probably not applicable to primary care because one can ethically justify that any able bodies person should be working, and there are, no doubt, other fields where the demand significantly exceeds the supply of docs.

Five years ago in radiology, young docs out of training were having a difficult time getting jobs. (This has corrected itself, and we currently see supply and demand approximately being balanced).

At that time, my position in my group was that we should continue to hire, even if it dilutes our compensation in the short run, in order to protect the newly trained docs and the stability of the field, have the ability to recruit high quality candidates that will meet future needs, and prepare ourselves for a time in the future when we might have trouble hiring for need. There were a couple of people in the group that blocked this effort, and our staffing has been up and down since, with very lean staffing at times over the last couple years, until this summer.

There are only a certain amount of patient encounters in my field, a fixed pie, and adding more docs will not increase the pie, only reduce the share per person, on average. So should the older, financially secure docs work less (or even retire early) to allow the recently trained docs to get jobs and flourish?

Click to expand...

I don't think older FI docs (or any other doc for that matter) is ethically obligated to leave the workforce, so long as they maintain their skills and are competent physicians.

Watching the radiology and other healthcare job markets, I'm convinced that the stock market is one of the best bellwethers for the resident job market. When the stock market crashes, older docs delay retirement and the job market becomes very tight. Now that the market is at all-time highs and everyone's retirement accounts are flush with cash, people are retiring, opening up good jobs for residents.

-WSP

[Zaphod]

Rogue Dad, M.D. wrote:

I’ll ask the counter question that is asked here in all these situations — would this ever be a concern in other fields?

I don’t really know the answer. However in sports, older players are considered “blocking” younger ones all the time, but older players can be locked into a position because of a contract. Teams will play a bad player making a ton of money solely because they have to pay them either way (ie Albert Pujols, by some metrics the worst player in all of baseball this year).

Not sure about income being a reason to force someone out of a job — it would have to be an individual decision as no external agency could officially decide if someone is FI. However in medicine it’s hard to fire the older person in favor of the young up and comer — we tend to revere the senior people, not denigrate them as they do in others fields.

Click to expand...

I know you are just explaining this, so not directed personally to you. However, this is incredibly stupid and just the sunk cost fallacy. How does playing a worse performing player over another better one make it more valuable to the team? That moneys gone, put him on the sidelines.

[VagabondMD]

Zaphod wrote:

Rogue Dad, M.D. wrote:

I’ll ask the counter question that is asked here in all these situations — would this ever be a concern in other fields?

I don’t really know the answer. However in sports, older players are considered “blocking” younger ones all the time, but older players can be locked into a position because of a contract. Teams will play a bad player making a ton of money solely because they have to pay them either way (ie Albert Pujols, by some metrics the worst player in all of baseball this year).

Not sure about income being a reason to force someone out of a job — it would have to be an individual decision as no external agency could officially decide if someone is FI. However in medicine it’s hard to fire the older person in favor of the young up and comer — we tend to revere the senior people, not denigrate them as they do in others fields.

Click to expand…

I know you are just explaining this, so not directed personally to you. However, this is incredibly stupid and just the sunk cost fallacy. How does playing a worse performing player over another better one make it more valuable to the team? That moneys gone, put him on the sidelines.

Click to expand...

I think that in the case of Pujols, and other aged stars, there is the hope that he can return to past glory. In most cases, there is a steady decline in athletic skills at the professional level after a certain peak, and it has been clear for some time that Pujols is well down that road.

The NFL, in part aided by the non-guaranteed contracts, is probably the ultimate meritocracy. If the rookie can play the position better than the vet, the vet gets benched/cut, and the rookie plays. All veterans know that part of their role is to mentor their younger teammates, who might someday replace them.

[Craigy]

Obviously the answer to this question is no, it's not unethical, but it's a legitimate question to ponder and discuss.

I remember MJ would turn down the olympic basketball team to give other guys a chance.  Should Michael Phelps keep swimming every 4 years just because he's fast enough, even if it means another guy won't get the chance to be on the team?  Personally I think if he's fast enough, sure.  But there is a real, undeniable cost to that.

[Donnie]

Zaphod wrote:

Rogue Dad, M.D. wrote:

I’ll ask the counter question that is asked here in all these situations — would this ever be a concern in other fields?

I don’t really know the answer. However in sports, older players are considered “blocking” younger ones all the time, but older players can be locked into a position because of a contract. Teams will play a bad player making a ton of money solely because they have to pay them either way (ie Albert Pujols, by some metrics the worst player in all of baseball this year).

Not sure about income being a reason to force someone out of a job — it would have to be an individual decision as no external agency could officially decide if someone is FI. However in medicine it’s hard to fire the older person in favor of the young up and comer — we tend to revere the senior people, not denigrate them as they do in others fields.

Click to expand…

I know you are just explaining this, so not directed personally to you. However, this is incredibly stupid and just the sunk cost fallacy. How does playing a worse performing player over another better one make it more valuable to the team? That moneys gone, put him on the sidelines.

Click to expand...

It's not exactly the sunk cost fallacy.  Each team has a finite amount of money.  Often that aged player is the best option available, even with diminishing skills.  Buying a marginally better player at a much lower cost may not make sense when you still need to pay the aged player anyway.  If the team didn't have the high priced player, they would have room to buy and develop cheaper talent.  This isn't an issue if contracts are not guaranteed.

Sunk cost fallacy would be continuing to give the aged player new contracts in hopes you will get a rebound in performance after years of poor performance when you paid the player a lot of money, thereby recouping lost value.

[Craigy]

Donnie wrote:

Zaphod wrote:

Rogue Dad, M.D. wrote:

I’ll ask the counter question that is asked here in all these situations — would this ever be a concern in other fields?

I don’t really know the answer. However in sports, older players are considered “blocking” younger ones all the time, but older players can be locked into a position because of a contract. Teams will play a bad player making a ton of money solely because they have to pay them either way (ie Albert Pujols, by some metrics the worst player in all of baseball this year).

Not sure about income being a reason to force someone out of a job — it would have to be an individual decision as no external agency could officially decide if someone is FI. However in medicine it’s hard to fire the older person in favor of the young up and comer — we tend to revere the senior people, not denigrate them as they do in others fields.

Click to expand…

I know you are just explaining this, so not directed personally to you. However, this is incredibly stupid and just the sunk cost fallacy. How does playing a worse performing player over another better one make it more valuable to the team? That moneys gone, put him on the sidelines.

Click to expand…

It’s not exactly the sunk cost fallacy.  Each team has a finite amount of money.  Often that aged player is the best option available, even with diminishing skills.  Buying a marginally better player at a much lower cost may not make sense when you still need to pay the aged player anyway.  If the team didn’t have the high priced player, they would have room to buy and develop cheaper talent.  This isn’t an issue if contracts are not guaranteed.

Sunk cost fallacy would be continuing to give the aged player new contracts in hopes you will get a rebound in performance after years of poor performance when you paid the player a lot of money, thereby recouping lost value.

Click to expand...

Also baseball is a pretty poor example of anything... Pujols definitely isn't the worst player in baseball even if the stats say so, players go through highs and lows, it's a part of what makes baseball baseball.  And professional sports in general since you're not dealing with a free market but instead a sports rulebook.

There's also a big cost to benching a player with a huge contract and huge fanbase.  It happens with pitchers sometimes but typically a batter has to go in the lineup due to rules, roster space, you name it.  Some big player contracts even limit a team's ability to bench a player unless there is some illness or injury.  Again, it's not the same as a CEO deciding to change suppliers or make a new hire.

[Kamban]

The issue is what is the definition of old doctors. Is it 65, the Medicare age. 67, the new social security age. Or even 50, the financially independent age for some.

As long as one cannot get a clear, well defined, reasonable cost medical insurance it would be foolish to retire before 65 unless one is truly loaded with cash. A 1.5 million in investments with 4 % withdrawal of 60K will not help if the medical insurance, copays and deductibles will eat half of it. And that is, if you can find someone to insure you.

Physicians are not like airline pilots with compulsory retirement age. They are more like supreme court justices in determining their own destiny. If they can or want to work past age 70 it is up to them, provided they can deliver competent medical care. If the patient wants to go to a fresh graduate they can do so. But if they prefer the older wiser doc, they can also do so.

Finally if the medical schools want to expand and churn out more physicians and if the people are willing to pay ungodly sums to become a doctor, they should also be prepared for unforeseen circumstances like non retiring doctors.