The shift in demographics—toward older populations of physicians—is well documented across much of the globe. This shift has raised not only concerns about the well-being of individual faculty members and their healthy transitions to retirement but also awareness of the need for institutions to consider the health of their faculty; human resources planning; and organizational capacity for patient care, education, leadership, research, and innovation. These areas, and importantly, patient care outcomes can all be affected by the transition decisions of late-career academic physicians. Thus, it is becoming imperative that academic organizations generate research to inform the community’s understanding of both individual and institutional needs relating to late-career and retiring faculty members. Shining light on faculty members’ late-career experiences and transitions affords the academic medicine community the opportunity to better understand the complex relationships between individuals across the career continuum and the academic health care institutions in which they practice. To date, limited empirical work has been done in this area. The two reports in this issue of Academic Medicine by Skarupski and colleagues1,2 build on what research is available, expose some new areas for consideration, and raise new lines of inquiry for researchers interested in studying late-career faculty and faculty transitions. In this commentary, I aim to situate Skarupski and colleagues’ findings relative to what the academic medicine community knows—and does not know—about late-career faculty members, the institutions that employ these faculty, and the complex relationships therewith. Specifically, I explore the following: the demographics of those considering retirement, the connection between identity and retirement decisions, the alignment between institutional and faculty member needs, institution preparedness, mentoring, and theoretical constructs and areas for inquiry that may inform future investigations.
Who Is (Not) Thinking About Retirement?
In one of their two reports, Skarupski and colleagues present the results of a study in which they surveyed full-time faculty members 55 or older working in U.S. medical schools accredited by the Liaison Committee on Medical Education.1 Skarupski and colleagues were interested in the specific needs of those currently considering retirement. Notably, they found that less than half of the respondents between 55 and 64 were thinking about full-time retirement, and these respondents anticipated retiring at an average age of 67. Faculty members who were 65 or older anticipated retiring at an average age of 71.1 This finding raises questions about whether retirement may be a shifting goal for some—with anticipated exits getting postponed as faculty members age.
An important question to consider is whether faculty members who are 55 or older are the only ones thinking about retirement. Inclusion of younger faculty members in future surveys may be important—and enable explorations of other factors (in addition to age) that individual faculty members consider when thinking about retiring. The University of Toronto conducted a survey about retirement planning in academic medicine, including all full-time faculty, and a significant proportion of respondents were under 55 (data unpublished). Indeed, almost 50% of the respondents were 50 or younger, and the mean age of respondents was 51.45 years (standard deviation, 9.98). In addition, the respondents’ collective comments suggested that younger faculty who are thinking about and planning for their retirement early in their careers might be distinct from those faculty who presently fall into the “late-career” category. These respondent demographics and comments suggest exercising caution in implementing programs and/or policies that may address the current, but perhaps not future, needs of faculty members planning the last parts of their careers.
Physician Identity and Late-Career Decision Making
Previous investigators have examined the centrality of the academic physician identity and its relationship to decisions about whether to retire. Researchers have drawn on psychological theories—specifically social identity theory3 and identity process theory4—to frame how individuals for whom work and personal identities are strongly bound can struggle with discontinuing work. Work from the University of Toronto showed that considerations about retirement were characterized by multiple identity threats (e.g., concerns about competence, self-esteem after retirement, loss of meaning and belonging).4
Further evidence for the centrality of academic physicians’ identity concerns is presented in Skarupski and colleagues’ study of full-time faculty who are 55 or older.1 Their survey participants expressed a desire to remain connected to the academic health care community that had shaped and reinforced their identity. Faculty respondents wanted symbolic ways, such as library access and emeritus status, to maintain their connection. Notably, these findings align with previous research that indicates that an important aspect to the desire to remain connected may be that a faculty member’s professional identity has been all-encompassing, and, as a result, faculty may not feel they belong to other communities.4 Skarupski and colleagues’ findings indicate that institutions also recognize the importance of maintaining ties; the faculty development and faculty affairs leaders they surveyed identified that their schools provide a number of these tangible benefits to retired faculty.2
About a third of the 2,000+ faculty responding to Skarupski and colleagues’ survey of faculty 55 or over indicated interest in continuing to work in education or teaching (39%) and research or scholarship (30%). Skarupski and colleagues’ respondents also wanted health insurance, email, part-time teaching opportunities, and ongoing lab space. Beyond considering these ongoing benefits as gestures that hold symbolic value, institutions can view them as opportunities to harness the immense knowledge and experience held by these late-career and retiring/retired members of the academic community. Institutions may also consider ways in which they can foster generativity through roles involving mentoring, teaching, and the like. These kinds of valued roles can serve to enhance the psychological well-being of late-career faculty while also supporting institutional mission.4 Whether these ongoing connections to a community are components of a gradual retirement process—or whether they remain possible even after formally, fully retiring—may depend on institutional factors including funding structures and other resources.
Alignment (or Lack Thereof)
Alignment of the needs and interests of the individual and the institution is a key theme of Skarupski and colleagues’ work.1,2 Unique to academic medicine is the tripartite mission that underpins most faculty members’ roles as clinician, teacher, and scholar/researcher. Additionally, for many, there is the role as leader. Both the faculty member and the institution must consider the distinct implications for each of these roles when a late-career faculty member is considering (or not considering) retiring. To illustrate, faculty respondents in the aforementioned study indicated interest in the ability to shift allocation of efforts, choosing teaching and research as the areas in which they would want to focus after moving to part-time work, presumably spending less time in clinical activities.1 The questions are (1) whether the institutional processes and structures that govern models of compensation have the flexibility to respond to such shifts in allocation of physician resources and (2) how these shifts and other retirement decisions will affect patient care and patient care outcomes.
Additionally, faculty and institutional leaders seem to have different perspectives on the factors that drive retirement. How individual faculty members experience their roles and responsibilities, plus the values inherent in the various cultures in which they work, all influence their decision making about this work. Less than half the faculty participants Skarupski and colleagues surveyed indicated they were planning to retire. Of those who were considering retirement, many cited a sense of burnout as a reason (37% of those between the ages of 55 and 64 years of age, and 19% of those 65 or over). Of interest is the mismatch between faculty members’ weighing of burnout and the greater proportion (57%) of faculty development/affairs leaders who felt burnout was a top reason faculty at their institutions were considering retirement. How might the academic medicine community better understand the contextual and cultural factors influencing burnout and retirement? How do specialty, department, institution, practice environment, roles, and other variables contribute to burnout? Research that examines the intersection of individual faculty members’ experiences and needs—along with those of the institution and the leaders acting as its agents—can help elucidate some of these tensions and inform strategies for addressing them.
Institutional processes and structures
The available research seems to point to inadequate or ill-suited institutional strategies for managing the projected demographic changes in academic medicine faculty. Cain and colleagues have examined the cultural barriers to successful retirement at the University of Massachusetts and outlined a framework for aligning needs relative to retirement policies, programs, and resources of individual faculty members and their institutions.5 They created a model that includes transition support across preretirement, retirement, and postretirement. Tracking and learning from the implementation and outcomes of frameworks and models such as this are vital.
Skarupski and colleagues state that there is an urgent need for late-career faculty members and institutional leaders to engage with one another to address the shifting faculty landscape. In their study of faculty affairs and faculty development officers, respondents reported that they most frequently communicated with faculty about retirement planning through preretirement workshops and personal meetings with faculty affairs deans.2 Less common methods included having a retirement office or dedicated personnel, offering customized group counseling, organizing meetings with department chairs, and giving presentations at department and chairs’ council meetings. How can the academic medicine community move toward more proactive approaches that support a gradual and mutually planned transition? Such approaches require innovative organizational structures and processes, along with flexible policies that meet faculty members’ and institutions’ needs without being resource-intensive. Institutions can build some processes into existing formal activities such as annual or regular performance reviews or promotions processes.6 Attention to retirement and transition planning should ideally begin early in each faculty member’s career and should explicitly recognize that various transitions occur over time. Coaching and mentoring, annual reviews, and individual career development plans all represent opportunities to engage with faculty about mapping the future (both personally and professionally) and should include financial guidance.5
Notably, Skarupski and colleagues asked participants about their mentoring/mentors (though they do not report the resulting data). Knowing how many respondents indicated that they had their own mentors would be interesting and useful, as, to date, very little information is available about mentoring and career development for mid- and late-career faculty. Janet Bickel focuses on this population in her article “Not Too Late to Reinvigorate: How Midcareer Faculty Can Continue Growing,”7 and she suggests that newly retired or emeritus faculty might serve as ideal mentors to midcareer faculty, providing mutually beneficial roles and relationships. Further exploration is required to better understand the mentoring needs of faculty across the career continuum, particularly the needs of faculty at later-career stages. Research could address whether models such as peer-group-based or more traditional dyadic mentoring formats might address late-career faculty members’ mentoring needs.
Arguably, the responsibility for ensuring that all faculty members have what they need to engage in thoughtful, informed discussions and planning with mentors and leaders in their institutions is shared—between individual faculty members and those who oversee the various practice contexts in which these faculty enact their roles. Faculty development and faculty affairs leaders can play key roles in establishing policies and programs, yet they are at a distance from the on-the-ground practice contexts that have distinct cultures; thus, those working within these areas (education/teaching, scholarship/research, clinical care, leadership) must also invest in this career planning and transitions work.
Establishing an Agenda for Late-Career-Faculty-Related Research
The use of theory is fundamental to any scholarly inquiry or empirical study undertaken to explain and better understand the area of late-career development and decisions about retirement. To date, theoretical framings have drawn on several theories that center on the individual faculty member’s experience, including identity process theory and generativity theory (Erikson), both of which we have used in our research at the University of Toronto.4 Another scholar—Silver—has applied social identity theory to the examination of late-career faculty.3 Identifying and using theories that could assist with studying and framing issues related to late-career and retiring faculty at an institutional or cultural level might include Pierre Bourdieu’s theory of practice8 or one of the many organizational theories that address the complex social structures within an organization.
Areas for Future Exploration
Preparedness (or lack thereof) at the individual faculty member level for late-career transitions is an increasingly well-understood area in the broader literature on retirement. A growing body of work published in Academic Medicine has added to academic physicians’ understanding of these issues4,5,7; however, the relationships between individuals and their institutions remain understudied, as do the practices, implemented at the institutional level, that are designed to address late-career transitions and to support late-career faculty who are preparing (or failing to prepare) for career transitions. Are there tensions between individual and institutional needs that preclude or delay action? If so, how are these tensions currently being understood and/or resolved? What factors preclude or limit action on the part of institutional agents? The academic medicine community needs research that delves into these areas. Uncovering and exploring obstacles/barriers to action is important so that the community can generate meaningful knowledge and effect positive change. Those in academic medicine may look for opportunities to borrow and learn from organizational research on how such tensions are managed in other sectors.
Notably, the majority of faculty responding to Skarupski and colleagues’ survey for late-career faculty were male, white, and married.1 Additionally, men constituted a larger proportion (82%) of the 65 and older category compared with the 55–64 category (62%). These findings raise the question, What will the landscape look like as current early- and midcareer faculty think about late-career practice and future retirement? What kinds of questions and what type of research will be needed to address an increasingly diverse faculty practicing in ever-evolving academic and health care environments?
Further study of late-career stages, especially work that engages faculty and institutional leaders alike, will enrich and benefit the entire academic medical community now and as others begin to plan career transitions and retirement.
The author thanks Betty Onyura, PhD, for providing feedback and suggestions for this Invited Commentary.
1. Skarupski KA, Welch C, Dandar V, Mylona E, Chatterjee A, Singh M. Late-career expectations: A survey of full-time faculty members who are 55 or older at 14 U.S. medical schools. Acad Med. 2020;95:226–233.
2. Skarupski KA, Dandar V, Mylona E, Chatterjee A, Welch C, Singh M. Late-career faculty: A survey of faculty affairs and faculty development leaders of U.S. medical schools. Acad Med. 2020;95:234–240.
3. Silver MP. Retirement and Its Discontents: Why We Won’t Stop Working, Even if We Can. 2018.New York, NY: Columbia University Press.
4. Onyura B, Bohnen J, Wasylenki D, et al. Reimagining the self at late-career transitions: How identity threat influences academic physicians’ retirement considerations. Acad Med. 2015;90:794–801.
5. Cain JM, Felice ME, Ockene JK, et al. Meeting the late-career needs of faculty transitioning through retirement: One institution’s approach. Acad Med. 2018;93:435–439.
6. Leslie K. Steinert Y. Faculty development for academic and career development. In: Faculty Development in the Health Professions. 2014.New York, NY: Springer.
7. Bickel J. Not too late to reinvigorate: How midcareer faculty can continue growing. Acad Med. 2016;91:1601–1605.
8. Varpio L, Albert M. AM last page. How Pierre Bourdieu’s theory and concepts can apply to medical education. Acad Med. 2013;88:1189.