The retirement problem no one is planning for: the great health transfer

Scary number alert: $315,000. That is the amount of money that Fidelity Investments reports that the average 65-year old couple will spend on healthcare in retirement.

Here is another number that no one is planning for: 23. That means that by 2030, 23 states, compared with only four today, will have a physician shortage. That means that even if you have the $315,000 to spend on healthcare in retirement, you may find “the doctor is out” sign hanging in your physician’s office window.

Most of us will need our doctors more in older age. According to the CDC, nearly 80% of Americans over age 55 years old are managing at least one chronic condition. Almost half of those nearing, or in retirement, have two chronic conditions, while nearly 20% have three-plus chronic conditions, e.g., arthritis, diabetes, hypertension. In fact, data show that only infants, from birth to age 1, visit their doctor more than people 65-years old and older. 

Why are doctors leaving their practices? For many it’s about demographics. Just like the rest of us, doctors are aging too. Already the average physician age is about 53 years old. The Association of American Medical Colleges reports that about half of doctors are over the age of 55. Over the next decade, an estimated 40% of physicians will be over 65 years old. This means more than two of every five active physicians will reach age 65 within the next 10 years.

Moreover, compared with their boomer colleagues who were more likely to work past retirement, a robust 60% of younger Generation X doctors are reporting that they plan to retire by age 60.

Doctors cite poor quality of life and stress as reasons for their early departure. The pandemic certainly crushed many providers and has led to burnout. Generation X physicians in their 40s and early 50s were more likely than boomers to report that their current work life was not making the grade. In short, 43% of middle-aged doctors, compared with 31% of doctors over age 55, were reporting lower levels of professional fulfillment. Moreover, 47% of mostly Gen X doctors indicated dissatisfaction with their level of personal fulfillment compared with 36% of practicing boomer physicians.

That dissatisfaction is translating into action and the pandemic is not the only reason for discontent. One survey of physicians in Massachusetts indicated that one in four doctors plans to leave medicine in the next two years and that staffing shortages and related administrative demands, e.g., hospital system metrics, paperwork, and meeting insurance requirements, were the most cited source of workplace stress. 

There does not appear to be a smooth transition plan in place, making the great health transfer not just a healthcare system evolution but a personal retirement problem. A 2021 survey from MGMA and Jackson Physician Search reports that two-thirds of administrators do not have a formal plan for physician succession while another 16% did not know if their system had a plan. 

Where are the doctors going? Many physicians are simply moving on. If not retiring, some physicians are choosing to take extended leave or refocusing their careers on research. Others are moving to concierge practices that limit the number of patients that each doctor cares for and thereby limits workload and related stress.

Large hospital systems may bank on the power of their brand, patient passivity, and assume that patients will simply stay with the ‘practice’ or ‘system.’ Data show that most of us trust our doctor more than they trust the healthcare system or even their physician’s hospital.

Paraprofessionals may also be thought to fill the gap for routine care. Perhaps, but can paraprofessionals in practice replace the authoritative advocacy role a physician often plays for a patient within a healthcare system or make an urgent case to an insurer?

Some organizations may plan on the power of big data to empower another physician to simply take over as your care provider. Even if the additional patients that will be assigned to that physician does not increase their desire to make an early exit from medical practice, your numbers don’t tell everything about you. Over time, your doctor has come to know you — what your key concerns are; what motivates you; how your lifestyle or and your family situation affects your overall well-being, etc. 

Healthcare costs are a staple concern in retirement planning. However, given demographic shifts in the medical profession as well as healthcare-industry restructuring, understanding where, and from whom, you will be accessing quality personal care that fits your unique health conditions, just when you most need it most, must now be part of an overall longevity plan that extends well beyond money.

Here are things you can do: ask, connect, and choose.

• Ask your doctor about their retirement plans. They may be surprised at the question, but there are few things as personal or as important as your healthcare.

• Connect to others in your physician’s practice. Getting to know more providers in a practice may offer alternatives should your doctor move on.

• Choose wisely. Many people choose where to live in retirement based upon visions of vacations past and brochure images of retirement living. Attractive ideas, but when the fun is interrupted by health problems, be sure that you have identified more than a local ER and a doctor, but have instead have a relationship with a practitioner that has experience in the one, two, or more conditions you are managing.