Abstract
Retirement age and practice patterns before retirement are important for making accurate workforce predictions for orthopaedic surgeons. A survey of orthopaedic surgeons 50 years of age and older therefore was conducted by the American Academy of Orthopaedic Surgeons in cooperation with the Association of American Medical Colleges Center for Workforce Studies. The survey focused on three questions: (1) At what age do orthopaedic surgeons retire? (2) Do they stop working abruptly or do they work part time before retirement? (3) What are the major factors that determine when an orthopaedic surgeon retires? According to the survey, the median retirement age for orthopaedic surgeons was 65 years. Nineteen percent of orthopaedic surgeons worked part time before retirement. Decreasing reimbursement and increasing malpractice costs were consistently cited as factors that strongly influenced retirement plans. Career satisfaction was high and was the strongest factor that kept the respondents in the workforce. The option to work part time would have the most impact on keeping orthopaedic surgeons working past the age of 65 years.
Level of Evidence: Level IV Economic and Decision Analyses. See the Guidelines for Authors for a complete description of levels of evidence.
Introduction
Retirement age and practice patterns before retirement are critical factors in making accurate workforce predictions for orthopaedic surgeons [1, 5]. A previous study investigated attitudes about retirement of orthopaedic surgeons [6]. Other surgical specialties have been surveyed regarding retirement demographics and plans [2–4, 7].
The American Academy of Orthopaedic Surgeons (AAOS), in cooperation with the Association of American Medical Colleges (AAMC) Center for Workforce Studies, surveyed orthopaedic surgeons 50 years of age and older. The survey focused on three questions: (1) At what age do orthopaedic surgeons retire?; (2) Do they stop working abruptly or do they work part time before retirement?; and (3) What are the major factors that determine when an orthopaedic surgeon retires?
Materials and Methods
The AAOS, in cooperation with the AAMC Center for Workforce Studies, administered a four-page survey (Appendix 1) by mail to a random sample of 3001 members of the AAOS in the Active and Emeritus Fellows’ membership categories who were 50 years or older (18% of the fellowship). Distribution was by fax to a sample of 2015 and by mail to the remainder. Of the sample of 3001 members, 70% were Active Fellows and 30% Emeritus Fellows.
Data were analyzed by frequencies and descriptive statistics so no power analysis was done. Comments were coded into similar categories of responses for ease of analysis. The final sample included 1005 respondents for a response rate of 33.5% (Table 1). The 95% ± 5% confidence interval was 3%. Comparative analysis to the overall AAOS fellows 50 years and older showed the respondents to be representative of this population. One half of the respondents were between 55 and 70 years of age. Sixty-six women members (6.8%) responded to the workforce study, which is twice the percentage found in this membership category. The distribution of the respondents in subspecialty areas reflected the distribution of orthopaedic surgeons in the 2004 AAOS database. The only focus area that was larger than expected from the respondents was “disability/legal orthopaedics.” Seventeen percent of the respondents reported this category as a focus.
Table 1.
Demographics of respondents
| Demographic | Value |
|---|---|
| Total number of respondents | 1005 |
| Average age (years) | 63 |
| Number of male respondents | 939 |
| Number of female respondents | 66 |
| Respondents ≤ 55 years old (%) | 25 |
| Respondents ≥ 70 years old (%) | 25 |
| Respondents with MD degrees in the US (%) | 88 |
| Respondents ABOS certified (%) | 98 |
ABOS = American Board of Orthopaedic Surgery.
Results
Twenty-one percent of the respondents were retired (Table 2). Of the retired physicians surveyed, 14% retired at 65 years of age. Of the remaining, ½ retired younger than 65 years and ½ older than 65 years. Approximately ½ reported they retired when they expected to retire. Thirty-eight percent retired earlier than expected. Nine percent retired later than expected. Thirty percent of those surveyed had no plans to retire from patient care. The remaining practicing orthopaedic surgeons planned to retire from patient care at a mean age of 65.6 ± 6.0 years. The mean number of years of practice remaining was 6.2 ± 6.0 years for this group.
Table 2.
Results of the survey
| Parameter | Value |
|---|---|
| Practice patterns | |
| Full time active (%) | 59 |
| Part time active (%) | 19 |
| Retired (%) | 21 |
| Number of female respondents | 66 |
| Part time active (%) | 29 |
| Focus area for part-time respondents | |
| Surgical specialties (%) | 65 |
| Nonsurgical specialties (%) | 35 |
| Mean number of hours worked per week | |
| Full time | 57 |
| Part time | 21 |
| Practice setting for full-time respondents | |
| Private group practice (%) | 60 |
| Practice setting for part-time respondents | |
| Private group practice (%) | 36 |
| Active orthopaedist with part-time option (%) | 66 |
| Satisfaction | |
| Very or somewhat with medicine (%) | 84 |
| Very or somewhat with orthopaedic surgery (%) | 80 |
| Retirement plans | |
| Plan to retire at 65.6 years (%) | 60 |
| No plans to retire (%) | 30 |
| Retired | |
| When expected (%) | 53 |
| Earlier than expected (%) | 38 |
| Later than expected (%) | 9 |
| High practice viability | |
| Private group practice (%) | 65 |
| Academic practice (%) | 36 |
Of the AAOS members surveyed, 59% practiced full time and 19% practiced part time. Part-time practitioners are distributed across a broad range of practice settings (solo practice, teaching hospital, federal government, health maintenance organization). The option to practice part time is not universally available. For 
of the full-time surgeons, a part-time option was not available, but they were interested in having it as an option. An additional 43% reported there was a part-time option they were not using. One-half of those with a part-time option were considering using this option in the future.
The factors most frequently cited affecting retirement plans were increasing malpractice costs, increasing regulation of medicine, and insufficient reimbursement. The most common reasons keeping respondents actively practicing orthopaedic surgery were high career satisfaction, followed by financial needs and a part-time option or flexible scheduling. Career satisfaction was high in full-time and part-time respondents, with more than 80% reporting high satisfaction with the practice of medicine and specifically the practice of orthopaedic surgery.
Discussion
Retirement age and practice patterns before retirement are critical factors in making accurate workforce predictions for orthopaedic surgeons [1, 5]. The AAOS, in cooperation with the AAMC Center for Workforce Studies, surveyed orthopaedic surgeons 50 years of age and older. The survey focused on three questions: (1) At what age do orthopaedic surgeons retire?; (2) Do they stop working abruptly or do they work part time before retirement?; and (3) What are the major factors that determine when an orthopaedic surgeon retires?
One major limitation of our study is that the response rate to the survey of 33% calls into question selection bias. It is difficult to obtain higher response rates to a four-page survey without incentives. The demographics of the respondents matched the AAOS database except there were more women respondents. This similarity in demographics indicates we had a representative sample. The other major limitation is that the survey was designed by the AAMC with no definitions of terms such as financial viability and no questions specific for orthopaedic surgeons. It will be interesting to compare the orthopaedists’ response with the responses in other specialties surveyed by the AAMC. Additional study should focus on exploring options for part-time orthopaedic employment for those 50 years of age or older. The rising importance of increasing malpractice costs and reimbursement issues require careful monitoring.
At what age do orthopaedic surgeons retire? We found practicing orthopaedic surgeons planned to retire at an average age of 65 years. However, 30% of those surveyed had no plans to retire, which would increase that age once all respondents retired. The retired orthopaedic surgeons surveyed retired at a median age of 65 years. However, only 14% retired at age 65 years. In the survey by Ritter et al. [6], the average retirement age was 66 years, which is slightly higher than the age found in our survey.
Do orthopaedic surgeons stop working abruptly or do they work part time before retirement? Currently, 19% of orthopaedists 50 years of age or older work part time. This option is not factored into current workforce studies [5]. This part-time option may be more popular in the future as it becomes more universally available and used. The part-time orthopaedists in our study worked 20 hours per week often in a nonsurgical oriented subspecialty such as disability or legal orthopaedics.
What are the major factors that determine when an orthopaedic surgeon retires? Increasing malpractice costs, decreasing reimbursement issues, and increasing regulation of medicine are factors in orthopaedic surgeons retiring before the age of 65 years. High career satisfaction may keep orthopaedic surgeons practicing beyond the age of 65 years. The survey is limited in not further exploring these broad categories. In the survey of Ritter et al. [6], changes in healthcare and increasing malpractice costs made up only 12% of the reasons for retirement, a lower percentage than in our survey [6]. The difference in the two surveys may reflect the increasing importance of these factors during last 7 years.
Federal law prohibits mandatory retirement or withdrawal of operating privileges based on age [2]. Greenfield and Proctor [2] found, in a survey of the American Surgical Association, 50% of surgeons had no retirement plans, which is a higher percentage than in our study. The majority surveyed favored withdrawal of privileges based on peer review or disability rather than age [2]. The level of activity declined between 60 and 70 years as it did in our survey, but in their survey, 18% performed surgery beyond the age of 70 years [2]. The average age of retirement for general surgery fellows increased from 60 years in 1984 to 63 years in 1995 [3, 4]. A far smaller survey of neurosurgeons found an average retirement age of 60 years [7]. Reasons for retirement included decreasing personal satisfaction and financial rewards, a desire to pursue other activities, and local rules mandating retirement [7]. These studies attempted to survey age-related differences in verbal and performance intelligence quotients [2]. Our study made no attempts to assess cognitive abilities. Greenfield and Proctor [2] and Rovit [7] cited competence assessment should be an area of future study.
This survey of orthopaedic surgeons 50 years of age and older resulted in a planned and an actual average retirement age of 65 years. Nineteen percent worked part time before retirement and this part-time work currently is not factored into workforce studies [5]. Increasing malpractice costs and the increased regulation of medicine are major factors in the decision to retire and these factors are a growing concern. Career satisfaction with medicine and orthopaedic surgery remains very high.
Acknowledgments
We thank Edward S. Salsberg, Director of the Center for Workforce Studies for the AAMC, for developing the survey and for valuable input into the manuscript. Reprinted with permission from the American Academy of Orthopaedic Surgeons.
Appendix A
Survey of Orthopaedic Surgeons Over 50 Questionnaire
Footnotes
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
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