Some professions foster expectations that individuals cultivate their work identity above all other aspects of life. This can be problematic when individuals are confronted with the expectation that they will readily terminate this identity in later-career stages as institutions seek to cycle in new generations. This study examines the relationship between work identity and retirement by examining multiple generations of academic physicians.
This study used a multimethod qualitative design that included document analysis, participant observation, focus groups, and in-depth interviews with academic physicians from one of the oldest departments of medicine in North America.
This study illustrates how participants were predisposed and then groomed through institutional efforts to embrace a career trajectory that emphasized work above all else and fostered negative sensibilities about retirement. Participants across multiple generations described a lack of work-life balance and a prioritization of their careers above nonwork commitments. Assertions that less experienced physicians were not as dedicated to medicine and implicit assumptions that later-career physicians should retire emerged as key concerns.
Strong work identity and tensions between different generations may confound concerns about retirement in ways that complicate institutional succession planning and that demonstrate how traditional understandings of retirement are out of date. Findings support the need to creatively reconsider the ways we examine relations between work identity, age, and retirement in ways that account for the recent extensions in the working lives of professionals.
Although work is often considered a critically important facet of personal identity for professionals (Bothma, Lloyd, & Khapova, 2015; Abbott, 1988), acculturated work identity can contribute to a later retirement and may facilitate a situation where retirement becomes a point of tension, both personally and institutionally. Contemporary manifestations of retirement in North America are raising new challenges (McDonald & Donahue, 2011; Szinovacz, Martin, & Davey, 2014), underscoring the need to better understand strategies to support multiple aspects of later-career transitions (Moen, Kojola, & Schaefers, 2016; van Dalen, Henkens, & Schippers, 2009). This study examines how the formation of work identity inspires perceptions of retirement among a subset of professionals from different stages in their careers. By selecting to investigate academic physicians as a subset of the professional workforce, this study provides a more nuanced investigation of factors that encourage or forestall the longer working lives of individuals with a strong work identity.
As highly skilled and autonomous professionals with a deep commitment to their institutions, academic physicians are an ideal population for examining the relationship between work identity and retirement. The all-consuming nature of an academic physician’s career requires extraordinary dedication and involves a complex set of choices in order to reconcile multiple roles in both personal and professional life (Brown, Fluit, Lent, & Herbert, 2011; Sabel & Archer, 2014). Despite evidence emphasizing the importance of personal, social, and psychological losses associated with retirement from medicine (Cruess, Cruess, Boudreau, Snell, & Steinert, 2014; Silver, Hamilton, Biswas, & Williams, 2016), research on physician retirement has predominantly focused on the consequences of physician shortages (Satiani, Williams, & Ellison, 2011; Lomas, Stoddart, & Barer, 1985). Less is known about physician reluctance to retire and its relationship to institutions.
Prior research points to an aversion to retirement and tendency to inadequately prepare for the identity shift and diminished sense of self that coincides with retirement among other professionals such as lawyers (Shelton, 1992), academics (Dorfman, 2002), and business executives (Byrnes & Taylor, 2015). Higher status professionals and individuals in more autonomous professional positions tend to retire later or be more hesitant to fully retire, relative to individuals in lower status or less autonomous work roles (Kubicek, Korunka, Hoonakker, & Raymo, 2010; van Solinge & Henkens, 2012). Delayed retirement has been attributed to higher status professionals’ later entry into the labor market (Singh & Verma, 2003), greater job satisfaction (Kubicek et al., 2010), greater commitment to work (Topa, Moriano, Depolo, Alcover, & Morales, 2009), and feelings being valued by the organization (Armstrong-Stassen & Schlosser, 2011).
Within academic medicine, evidence points to a general aversion to retirement (Onyura et al., 2015; Silver, Pang, & Williams, 2015) and generational differences in attitudes toward work and life outside of work (Bickel & Brown, 2005; Howell, Servis, & Bonham, 2005). Although physicians’ retirement age is projected to continue to increase in the next several decades (Pong, 2011), less is known about factors that influence the age at which physicians retire (Kirch, Henderson, & Dill, 2012; Rayburn, Strunk, & Petterson, 2015). Furthermore, this literature has yet to explore the relationship between work identity and retirement from the perspective of individuals at different stages of their careers. Examining challenges associated with the various expectations of different generations of physicians has been identified as a key area for future work (Harrington & Ladge, 2009; Ibbott, Kerr, & Beaujot, 2006; Pong, Lemire, & Tepper, 2007).
Work Identity and Retirement From Academic Medicine
Several theoretical frameworks speak to the potential impact of strong work identities and institutional structures on role transitions such as retirement. In particular, role theory suggests that the loss of work-related roles can have negative implications for individual well-being (Wang, 2007; Thoits, 1992). Individuals who have been highly invested in their work roles, and whose self-worth may be associated with that role, find the role exit associated with retirement difficult (Ashforth, 2001; Riley & Riley, 1994). Identity theory asserts that social structures help inform the way individuals perceive themselves, in part by creating boundaries associated with certain roles (Stryker & Burke, 2000). Social behaviors are affected by the ways in which structures influence an individual’s self-perception (Mead, 1934). Thus individuals may select into an occupation like medicine based on the sense that it suits their interests and disposition, in turn the medical establishment defines conditions for acceptance and promotion, and the physician develops a receptivity to cues regarding his or her behavior.
The academic physician is the backbone of the medical system. In addition to other roles, they are responsible for treating patients, producing medical research, and teaching future physicians. Due to the importance of their multiple roles, the retirement choices that academic physicians make have significant implications for institutional succession planning within hospital systems (Farthing, 2013; Hariharan, 2014). Delayed or sudden retirement may have detrimental repercussions when it comes to maintaining continuity in patient care and in terms of patient safety (Moore, Wisnivesky, Williams, & McGinn, 2003). Decisions about when to retire can also have implications for medical research and education (Bahrami, 2011).
The formation of academic physicians’ identities and devotion to academic medicine can be well articulated through the concept of “greedy institutions,” which suggests that some institutions require total commitment from their members, thus enabling the prioritization of institutional demands over participation in other, nonwork spheres (Coser, 1974). The “greedy institution” of academic medicine is ultimately constituted of individuals whose loyalty and passion for the medical enterprise is deeply personal and who characterize their careers as far more than just a job.
In contrast, the work-life balance framework places equal weight on the competing demands from work and home environments while also noting the employer’s responsibility to support employees as they seek a healthy balance (Lewis, Gambles, & Rapoport, 2007). This framework emphasizes the importance of setting boundaries to protect personal and family time (Brown et al., 2011), particularly for women (Mobilos, Chan, & Brown, 2008; Gjerberg, 2003) and for individuals in later-career stages (Gander, Briar, Garden, Purnell, & Woodward, 2010). Building on the work-life balance framework, the work-life integration framework promotes a more comprehensive approach to workforce management as it addresses the growing work-life needs of all employees without the prescription of an ideal means of reconciling multiple life roles and responsibilities (Harrington & Ladge, 2009). This framework also presents an alternative means of moving beyond the dichotomous and restrictive construct of work-life balance (Morris & Madsen, 2007).
For individuals with a strong work identity, retirement can be understood as a threat to their sense of self. The loss of a work identity imposed by retirement may precipitate a period of grief, and the period of liminality experienced during the transition to a new, postwork self has the potential to be a stressful and personally painful period (Conroy & O’Leary-Kelly, 2014; Nuttman-Shwartz, 2004). This may be particularly acute for individuals who have worked continuously on an upwardly mobile career path due to the loss of status and social connections at work (Oliffe et al., 2013). Institutionally, the delayed retirements that result from a strong acculturated work identity may have a destabilizing effect on institutions and often have negative implications for less experienced workers as they attempt to progress in their careers (Carrière & Galarneau, 2011).
This multimethod qualitative study utilized document analysis, participant observation, focus groups, and in-person interviews to explore conceptions of work-life identity and retirement from multiple generations of academic physicians. All data were collected from the University of Toronto Department of Medicine (DOM), one of the oldest and largest departments of medicine in North America. All procedures were conducted according to standard protocols approved by the University of Toronto Research Ethics Board.
We performed document analysis of new faculty orientation materials used between 2008 and 2014 by searching for terms related to “work-life balance” or “family” and tracking changes over time in the approach to these concepts as well as the number of slides devoted to them in each year’s orientation booklet. We then used interpretive analysis by examining patterns found in the documents to observe indicators of support for the development of nonprofessional spheres (Bernard, 2011). In addition, direct participant observation was performed by both authors during a new faculty orientation and faculty development committee meetings attended by the lead author from March 2014 through June 2015. Participant observation of physician identity formation was performed by examining processes through which the institution groomed participants and modeled the attributes of an ideal academic physician (Reeves, Kuper, & Hodges, 2008; Spradley, 1980). The decision to hold seven focus groups and more than 50 interviews was determined by the lead author in collaborative discussions with the DOM faculty development committee.
Focus groups were used to obtain a preliminary understanding of academic physicians’ views on work-life identity and perceptions about retirement. We conducted seven focus groups between June and September 2014. We used stratified purposive sampling to ensure inclusion of gender, work experience (9 early and 16 later career), rank (12 assistant professors, 6 associate professors, and 7 professors), and academic stream (5 educators, 7 clinicians, 8 researchers, and 5 administrators). Participants worked at eight university-affiliated hospitals in Toronto, Ontario, Canada and represented 12 different divisions of the DOM. Ten of the 25 focus group participants were women. Focus group questions concentrated on respondents’ beliefs associated with the concept of retirement and general strategies for successful late life career transitions relevant to academic physicians. Each focus group included three or four participants and was led by one facilitator. All discussions were audio recorded and transcribed. The authors independently reviewed the transcripts and notes from all of the focus groups and met multiple times to discuss, contrast, and deliberate the themes using thematic analysis to examine transcripts and notes (Braun & Clarke, 2006; Fereday & Muir-Cochrane, 2008). The authors utilized an inductive coding approach emphasizing the patterns that emerged directly from the data (Boyatzis, 1998), rather than using predetermined code templates. This allowed the themes to emerge organically from the data and then become broader categories for examination (Rice & Ezzy, 1999).
To obtain a more in-depth understanding of participants’ views of their work-life identity and perceptions about retirement, the lead author conducted in-person semi-structured interviews with 53 academic physicians between September 2014 and April 2015. Stratified purposive sampling was used to ensure inclusion of work experience, gender, medical speciality, academic stream, and rank. At least two individuals from each of the 19 divisions within the DOM were interviewed. Interviews were conducted until saturation was reached, or little new information was expected to be learned from additional interviews (Guest, Bunce, & Johnson, 2006; Pope, Ziebland, & Mays, 2000). Interviewees ranged in age from 27 to 76 years, and 23 of the 53 participants were women. Interview questions focused on participants’ career trajectories in academic medicine and perceptions of work-life balance and retirement. All interviews were audio recorded, transcribed, and anonymized, and any identifying information was removed by the lead author. The exact ages and identifying features of participants are not reported to protect confidentiality.
Interview transcripts were inductively analyzed using open coding. Both authors read each transcript and identified a set of themes relevant to work identity and retirement with careful consideration of context (such as years of work experience) and intervening conditions (such as marital status and family). To improve the validity of findings and to confirm authors’ interpretations with quoted participants, we used written memos to provide a record of the analytic process. In addition, member checking (Creswell & Miller, 2000; Sandelowski, 1993) was performed by presenting summary thematic analyses to eight academic physicians who corroborated the authors’ interpretations of the data.
Despite indications of a bottleneck for career advancement within academic medicine, retirement was described as a dreaded concept. Participants in this study were predisposed and then groomed through institutional efforts to reject work-life balance or work-life integration as worthy goals at all career stages. Reflections about retirement stirred up concerns about the reticence to retire among later-career academic physicians and the perceived work ethic of the younger generation. Findings pointed to an institutional context that promoted a career trajectory that conflicted with traditional understandings of retirement.
The Bottleneck for Career Advancement
Irrespective of their years of experience, almost all participants acknowledged a disinterest in thinking about their personal retirement and a generally negative association with the term. Yet all were also able to articulate institutional challenges that arose when individuals in later-career stages failed to retire. One mid-career interviewee put it simply:
We can’t bring new people in if we don’t remove people at the other end because we don’t have the space or the resources.
Another later-career interviewee explained:
… Our world around retirement in the hospital environment has changed because we used to have the ability to change people’s job status at age 65. In fact, at age 75 you lost your hospital appointment… It actually created a fair amount of resentment for some individuals but the advantage from an administrative point of view was, it forced us to renew. One of the challenges we’re facing now is wanting to renew in areas and in an era of limited resources, we can’t renew if people are still here…There are people who quite literally intend to die here working.
Many participants echoed this sentiment, commenting on how common it was for individuals to be quite literally waiting for someone to die in order to receive job or a promotion, referencing the bottleneck created in the medical system when one generation refuses to relinquish the reins to the next. Concerns regarding continuity in patient care and workload were also raised on many occasions. One participant from the earlier career focus group sessions commented on the difficulties of covering for very senior physicians who “should have retired” and ended up dying at work, remarking that:
It’s very selfish and it creates havoc.
A later-career interviewee referred to a different situation where there was no succession planning in place, explaining:
We unfortunately had two senior physicians continue to work and then died in close order. It took us two years to recover from that. We had patients writing letters because they couldn’t access care. It has implications for the system and for patients as well.
It was clear that staying on too long in academic medicine not only had negative consequences for succession planning but also that it can have repercussions in terms of personal legacy. One later-career interviewee explained:
I can tell you there are some people that have made outstanding contributions to our enterprise, but they’re staying too long, and they are going to be remembered, not for their great contributions, but they’re going to be remembered as people who stayed too long, and it’s really unfortunate.
More Work, Less Balance
Though themes of work-life balance and work-life integration arose in numerous ways during the course of this study, the “life” component was often framed by participants as less important. What emerged, among participants at all career stages, was the notion that life outside of work was something to be managed so as not to impede work. Document analysis indicated that, institutionally, discussions of work-life balance tended to be framed under broader themes such as “time management,” which featured advice for how to juggle home and parenting responsibilities without negatively affecting numerous work roles. The concept of “work-life balance” was referenced repeatedly in conversations at faculty development committee meetings. However, the actual messages conveyed emphasized efficient time allocation in the overall context of scholarly productivity and tended to be prescriptive about how to create more time for work rather than descriptive of attempts to negotiate time for life outside of work.
During the new faculty orientation, when the presentation included mention of faculty members’ outside life, the advice, particularly for parents, was not to compare their lifestyles or parenting arrangements with nonacademic physician families. Faculty were advised instead to “define normal for your family—there are no rules,” with suggestions for methods of outsourcing household duties, chores, and childrearing as a part of responsible allocation of academic physicians’ quite limited time. In providing advice to the newer faculty members, one speaker shared how she managed competing time commitments by establishing a personal rule to never take her children to their doctor’s appointments. This emphasis on a separate “normal” for academic physicians and their families was observed to be a method of socializing participants into the standards and values required by their careers, which did not always align with norms or practices outside of the academy.
Focus groups and interviews provided evidence supporting an outright rejection of the idea that works and life can or should be balanced or integrated. Thus the normative concept of “balance,” as equality between professional and personal life commitments and time allotment, was depicted as less applicable to the lives of academic physicians. One man from the early-career focus groups simply stated that,
I don’t know if you really draw a line between your life and work…I don’t think I have a balance, no. I work more.
A woman from another of the early-career focus groups echoed this sentiment when she explained,
Work can be part of life and vice versa. So, not sure about the balance… obviously, we are in a profession where we feel—where it’s more than a job and so it is actually a lot of who we are and what our life is, I would say. So it’s not really about trying to achieve a balance in the same way.
For many, the goal was not to integrate, maintain, or strive for parity between separate work and personal spheres. Individuals with and without partners or children emphasized the importance of their work in the overall picture of their lives and expressed the belief that their relationship to work was different from that of others outside of academic medicine. The primary challenge for many was time management with regard to familial relationships. An earlier career academic physician reinforced the idea that balance and integration didn’t quite capture her experience as she explained with a somewhat bleak humor that,
As an academic physician, your life is, quite honestly, dedicated to your work and to the hospital and the work that you are doing there. The tiny little bit which is left is just, at least in my case, is running home to make sure the kids are alive, and they are still carrying on.
Within the context of thinking about planning for their retirement, later-career participants explained that their careers had always been the dominant part of their life plan. An interviewee with many decades of experience who chose not to have children stated,
Some of my friends think I spend an inordinate amount of my life working, so it seems to bother them. I’m less bothered by it.
Across the board, participants expressed a disinterest in thinking about a time when work activities would desist. A woman from a later-career focus group expressed the sentiment that her life had a constant focus on work:
...your kids are getting older and, naturally, they leave home. So, this tiny little bit that we missed at home becomes less and less important, and you focus more and more [on] your job.
Other academic physician parents echoed this difficulty in juggling parenting responsibilities with their careers, even when they were physically present for events like birthday parties, soccer games, or family meals. One interviewee cried as she contemplated having to leave medicine. She explained how after decades of experience, she learned that time at home is important for passively working even during down time or family activities:
The peacefulness of home sometimes solves a lot of my work problems because…I never turn work off. It’s always going…It never turns off because if it turns off, you can’t take advantage of these things [solutions to work problems] that occur at the time. If you shut it off, then you’re not accessible.
She explained her confusion around the concept of work-life balance and integration while articulating a sense of agency over her life choices and a resistance to retiring:
Do you live to work or work to live? People have asked me that and I never understood that stupid expression. I live and I work because…I work because I live. There’s no two here…My life is richer because I have a great family and my life is richer because I have a fabulous job that I love…I can disappoint any group. At any point in time, I am disappointing some group here. There isn’t any balance…but I wouldn’t end it or trade it for the world.
Several participants described how work provided them with an irreplaceable sense of satisfaction and personal well-being. Others discussed the addictive nature of their work and how medicine brought both monetary and non-monetary rewards that were incomparable with and more satisfying than anything else in their lives. In discussing retirement or the period of time when they would stop working, many mentioned that they did not have a strong sense of financial security despite their high earnings because they had not saved money for retirement. A majority acknowledged a sense of imbalance during their working years whereby no time was spent planning for or thinking about investing for retirement because they had been so focused on work.
When prompted to discuss potential retirement activities, many described an interest in findings ways to continue to be engaged with medicine. Few were interested in discussing non-medical activities they might do in retirement. Many explained that there had been no time to develop hobbies or interests outside of medicine. As one woman from one of the later-career focus groups said,
Most of your life is dedicated to your job. And I think it’s true for myself and probably for many of my colleagues, we don’t have hobbies, we don’t have anything else that I could relate on that.
Even among the few who enjoyed outside interests or hobbies, the idea of “achieving” more outside of work proved challenging. As one later-career interviewee explained,
I do sports and activities and hobbies, but I must say that with a very intense work schedule we have had over the past several years with leadership positions, grants, and so on, I have started to think about - okay, when am I going to reduce one thing and try to have more time for the other things? For me it’s starting to be on my mind, how am I going to achieve this?
Intergenerational Conflict and Retirement From Medicine
Several of the more senior participants voiced concerns that their younger colleagues’ demands for a greater “work-life balance” were indicative of a lack of devotion to medicine. Younger participants did not perceive themselves as prioritizing work/life balance or demonstrating a lesser commitment to medicine. However, when discussing retirement, many of the more experienced participants cited the challenges and negative implications for their patients that would result if they did retire and leave them in the hands of purportedly less attentive and dedicated younger physicians. Participants tended to use their own experiences when they were early-career academic physicians as a metric against which to measure dedication, hard work, and productivity. For some, this metric demonstrated the need for them to delay retirement. As one more senior interviewee mused:
… probably like everybody I don’t think they work as hard as I did… people just wouldn’t start now and do what we did… These aren’t gonna be people that’ll take care of us when we’re sick down the road, another twenty years. You’re gonna have to get sick nine to five… I think there’s a generational thing right, and I don’t know if it’s work-life balance, or they label it that, or um, I see it in the medical students, I think they’re definitely more entitled…
Some participants connected this shift in priorities to changes in structural and institutional best practices and work culture, noting that these shifts have also occurred within the culture as a whole. One later-career interviewee noted changes in the demographics of early-career academic physicians:
The 35-year old we’re hiring today…They have kids by the time they start. They tend to have a life. They tend to have a set of expectations that is more modest. Again, this is not a group that is going to work to death.
There was a general sense that no one felt comfortable with their level of financial preparedness for retirement, but financial concerns were often linked with fears about being replaced. Many lamented about the fact that they did not have an employer-sponsored pension or had not planned far enough in advance to save a sufficient amount of money to maintain their lifestyle. Among the more experienced participants, there were clear fears about having an “expiration date” and discomfort with the notion of being replaceable.
Some participants expressed a somewhat contradictory awareness of their own desire to remain in academic medicine and avoid retirement while still acknowledging threats to institutional needs regarding succession planning. In spite of a general acknowledgment of the need to make room for new physicians and tackle existing challenges for institutional succession planning, several participants described a “less-committed” younger generation as a key reason for continuing to work. One mid-career participant explained that many of her more senior colleagues see it as their “duty” to remain working. She described how tensions between the generations serve as a disincentive for retiring:
…a lot of the newer recruits don’t necessarily see the value in the senior guys. That causes a lot of friction and conflict. That adds to that clinging in there... They don’t necessarily want to share with some of the young people who are coming in if the young people don’t show them the respect...which is commensurate with their level of expertise… It’s a lot of conflict. It’s a perceived attack and defensiveness and, “He’s out of touch,” and, “They don’t have the experience.”… The residents work a lot less hours and you end up covering the ward on your own because they’re all off doing other stuff whether it’s kids at day care or it’s their day off. They’ve taken a day off because it’s their birthday or… [the tension is] like World War III …
Although prior research presents conceptualizations of retirement that emphasize the choice workers make when deciding to withdraw from work (Beehr, 2014; Wang & Shultz, 2010), the findings presented here suggest that professional identity can generate a profound reluctance toward making decisions about retirement. For many participants, withdrawal from work at a later stage in the life course was a decision that filled them with dread in ways that were inevitably tied to their strong work identity. A central tenet in the articulation of intergenerational conflict within medicine has focused on the younger generation’s interest in finding balance between work and duties or interests outside of work, whereas more senior generations maintain a stronger commitment to work (Foley, Myrick, & Yonge, 2013; Heiligers & Hingstman, 2000; Tufan, Kılıç, Tokgöz, Howe, & Yaman, 2010). Across the multiple generations of participants and through the diverse data sources that were analyzed for this study, a commitment to work over other spheres of life was clearly articulated.
Academic physicians are individual agents whose talents, achievements, and dedication guide the medical system. In many ways they are the institution. Results from this study show support for the “greedy institutions” theory through evidence indicating that academic medicine resonates as all-consuming. The institution is demanding in terms of required commitment from physician members, who, in turn, seem to embody these values so well that disengagement in their later careers seems impossible and/or undesirable. For many of the participants who were approaching traditional retirement age, it was apparent that the institution had consistently demanded total commitment from them in ways that had distracted them from saving for retirement and engaging in family commitments or other spheres of interest. Academic medicine is for life, much like other affective ties that continue throughout the life course. And yet, there was an implicit expectation, evidenced through participant observation, focus groups, and interviews, that later-career participants would embrace retirement.
The academic physicians in this study established their own norms to modify and protect their personal lives while asserting the dominance of their professional commitments. However, they did not employ strategic boundaries to divide life from work when they thought about work-life balance and contemplated retirement. Rather, what was reflected in participants’ experiences were varying strategies for negotiating multiple roles. These strategies included paying others to manage household obligations and restricting or eliminating hobbies or other activities outside of medicine even though these choices may have contributed to a more difficult transition to retirement later on, as prior research has shown that hobbies and nonwork interests are important for adjusting to retirement (Mike, Jackson, & Oltmanns, 2014; van Solinge & Henkens, 2008).
Negative sensibilities about retirement manifest among different generations of academic physicians in ways that pointed to intergenerational conflict as a barrier to later-career transitions. Even as senior academic physicians acknowledged the potential threat to institutional stability caused or exacerbated by the reluctance of members of their generation to retire, they themselves treated their own retirement as merely an unfavorable potential option. The simultaneous presence of multiple generations within the same institution may engender similar dynamics as are generally noted in intergenerational conflict in families. To consider academic medicine an institution that serves as a replacement to family relationships would be hyperbole. Yet, there was evidence of affective connections, similar to how many people orient themselves around family and home life, that were functionally created through the institution’s emphasis on commitment to patients, research, colleagues, and medicine itself. A form of role ambivalence often plays out in relations between adult children and their parents with all of the frustrations, joys, power struggles, and love that such a relationship often entails (Luescher & Pillemer, 1998). The irreconcilable differences crucial to ambivalence, as conceived by Silverstein, Gans, Lowenstein, Giarrusso, and Bengtson (2010) in the context of intergenerational conflict within families may, in this particular milieu, be borne out of the inherent contradictions necessary for the functioning of academic medicine. That is, the socialization of early-career academic physicians and prioritization of work above all other responsibilities, which makes a transition out of medicine unlikely at the end of a career without a concomitant suffering of loss of identity and meaning. The reluctance toward retirement that the process of professionalization engenders may be seen in the complex, and at times difficult, relationships that form between younger and more senior academic physicians as each group attempts to reconcile the transition into and out of power over the career course.
Later-career transitions can be complicated by a lifetime of prioritizing work and making complex choices to reconcile multiple roles in both personal and professional life (Brown et al., 2011; Sabel & Archer, 2014). Evidence from this study supports prior theoretical frameworks including identity theory (Stryker & Burke, 2000) and role theory (Ashforth, 2001; Riley & Riley, 1994) by suggesting that participants’ high degree of personal investment in their work roles was linked to the challenges they associated with retirement. Findings corroborate prior research suggesting that physicians’ professional obligations often conflict with personal and family life (Myers, 2001), leading to challenges such as divorce and burnout, particularly for women physicians (Dyrbye, West, Satele, Sloan, & Shanafelt, 2011; Langballe, Innstrand, Aasland, & Falkum, 2011; Shanafelt et al., 2013). In addition, findings are consistent with prior research on other professionals (Dorfman, 2002; Shelton, 1992; Topa et al., 2009) in exhibiting a general hesitation toward retirement. Yet unlike in other sectors, where part-time work or lateral shifts may be possible (Cahill, Giandrea, & Quinn, 2006), academic medicine was depicted as an all-or-nothing engagement.
Physicians currently face increased competition for employment in some locations (Hedden et al., 2014) at the same time that economic realities have contributed to delayed retirement (McDonald & Donahue, 2011; Szinovacz et al., 2014). Although findings from this study illustrate the very personal links between professional work identity and retirement, they also highlight challenges for institutional succession planning. Recent changes to later-life working norms, such as the abolishment of mandatory retirement and rapid increases to average life-expectancies, have moved faster than many institutions’ adjustments to their hiring, career progression, and promotion policies. This lack of attention has, as our study indicates, contributed to interpersonal and intergenerational conflicts within the institution and affects the career progressions of younger working cohorts, even as older workers also suffer from a lack of support as they create new norms at the other end of the working spectrum. These findings may shed new light to previously raised ethical questions about retirement in light of the abolition of mandatory retirement for physicians in North America. For example, do medical institutions have a responsibility to regularly replace physicians who are not at the very top of their game or who might leave or die in order to ensure patient continuity of care and develop cutting edge medical treatments (Clark & Ogawa, 1996)? Or does pushing academic physicians toward retirement to benefit the institution constitute an ageist or oppressive approach (Laws, 1995)? And while there is no government-sponsored physician pension plan in Canada, might this help give physicians reassurance of a regular postretirement income in a way that facilitates transitions from medicine for those later career physicians who remain working due to financial concerns?
This study supports the need for a nascent paradigm shift that moves from emphasizing the need for work-life balance or integration to a more nuanced understanding of the relationship between work and life outside of work in later-career stages for professionals, particularly within institutions that demand such total commitment. The evidence gathered throughout this study indicates that for professionals, such as academic physicians, retirement may be an outdated concept. Later-life transitions such as retirement ought to be understood as creatively negotiated rather than as fragmented.
These findings support other research highlighting the tendency for employers to opt for the easy way out of dealing with aging workers through exit strategies, despite the importance formulating strategies that promote active acting and recognize the benefits of older workers for organizations (Damman, Henkens, & Kalmijn, 2013; van Dalen, Henkens, & Wang, 2015). Alternate norms regarding retirement ought to be considered by the institution and through various strategies employed by professionals to prioritize their responsibilities at different stages of their careers. Findings from this study also highlight a need to more carefully account for the multiple contemporaneous positions professionals tend to hold and to recognize that the nature of their work necessitates a different orientation to life outside of work. This orientation cannot be rooted in a normative and generalized ideal of work, private life, and retirement. Instead, it needs to accommodate divergent and competing commitments in a way that embraces newer generations and fosters the achievement of later life goals.
Limitations and Suggestions for Future Research
Findings from this study may have relevance for academic physicians in other regions given notable similarities regarding work ethic, generational differences, and general demographic trends in Europe, the United States, and Canada (Brown et al., 2011; Fridner et al., 2011; Howell et al., 2005). Furthermore, although the location and context of the research site were beneficial to the study and the quality of data in a number of ways, there are some limitations and implications for future research that should be noted. Because findings from this study are based on analyses of a single institution, they should be interpreted as a prompt for future research within other medical institutions in other regions, including nonacademic medical institutions and among professionals from other highly autonomous and demanding occupations. Furthermore, participants in this study were all fully employed and thus we were not able to examine the implications of retirement on physician well-being. Future research should examine this to consider how the way one retires, whether it is by choice or forced due to institutional or health reasons, influences adjustment to retirement. Although gender did not emerge organically as a critical theme in interviews or focus groups with participants, prior research has brought attention to differences in the retirement experiences of women (Price, 2000; Silver, 2016, 2010), thus it may be an important factor to explore in future research on work identity and retirement in medicine.
From this critical examination of the norms through which work and life outside of medicine integrate to form a barrier to retirement, we argue that the separation implied in the notion of work-life balance or integration may not be as relevant to highly autonomous, skilled professionals such as academic physicians. Instead, many participants in this study expressed a desire to continue work and to delay or avoid retirement altogether. Institutional culture can discourage work-life balance by establishing a norm that work identity is all-encompassing. In turn, this work identity can exacerbate tensions between generations of professionals. Findings support the need for institutions to acknowledge and foster a creative recalibration that accounts for the recent extensions to the working lives of individuals and the complex relationship between work identity, age, and retirement.
We acknowledge funding from the Connaught New Researcher Award and thank the Department of Medicine, University of Toronto for their support of this project.