Mandatory Retirement for Gastroenterologists: A Viewpoint

1University of Alberta, Edmonton, Alberta; 2University of Manitoba, Winnipeg, Manitoba; 3Dalhousie University, Halifax, Nova Scotia Correspondence: Dr ABR Thomson, University of Alberta, Division of Gastroenterology, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8. Telephone 780-492-6490, fax 780-492-7964, e-mail alan.thomson@ualberta.ca Received and accepted for publication July 17, 2007 THE CASE AGAINST MANDATORY RETIREMENT By Alan BR Thomson Through the course of our careers, some shorter and some longer, we have all experienced a most welcome decline in many workplace barriers, such as prejudice relating to sex, sexual orientation, ethnic background and religion. Sexual equality in medicine has benefitted both our profession and our patients. In academia, while equity has not uniformly been achieved, major steps are being made to provide the encouragement and adaptation of more flexible work conditions and promotion standards. Our society is making strides in the areas of racial equity and sexual orientation, and this has permeated through our medical profession. Progress is slow, but we have our civil rights, protected in the Canadian Bill of Rights, and with time, patience and people of good will, ‘we shall overcome’. Despite social progress, there remains one lasting workplace prejudice – age. The laws of the land state that you cannot express prejudice against a person based merely on his or her age. Defining age can be complex. Should the definition merely reflect a number of chronological years or, alternatively, a biological process reflecting a change in a persons’ mental and physical prowess? From our own practices, we recognize the octogenarian who is a ‘successful ager’ and someone deserving of aggressive modern medicine. And then there are those who are ‘old’ in their fifth decade. Mental and physical capacities may decline at various rates in different people – there are senior physicians who may have forgotten more than some of us ever knew! In a procedure-oriented specialty such as gastroenterology, manual dexterity may decline in the advancing years, but again this is so highly variable, and does not suddenly deteriorate when the clock strikes three score and five years. Even if manual dexterity decreases, older physicians may capably contribute as consultants and teachers. While it may be difficult to agree on the definition of ‘aging’, it is unfortunately all too easy to define ‘ageism’, discrimination against older persons. The Conference Board of Canada has recently stated, “Mandatory retirement is an anachronism. Age discrimination must be tackled to help ensure that older workers are not denied opportunities to work because of their age” (1). What are some of the arguments for forced retirement? Impaired functioning, time to do something different, need to make room for younger folks? Some of our senior gastroenterology colleagues are even more productive now than they were in their more youthful times. Some hold Canadian Institutes of Health Research grants, publishing several papers a year, receiving teaching awards, and bringing maturity, wisdom, experience and mentoring to the profession. Where is the evidence that the productivity of academics falls with age, or that they are simply a cherished relic of our academic departments? But of course, there may be older clinicians – just as there may be younger clinicians – who should have retired years ago. The issue is performance, not age. If the annual reappointment process that many institutions have for active medical staff is sufficient to evaluate competence at age 45, why is it not good enough at age 65? Special tests of competence for sexagenerians are prejudicial, unless they are applied to persons of all ages. The design of such assessment tools is difficult, but that difficulty does not justify prejudice. At the level of the institution, it may be argued that compulsory retirement enhances their ability to plan. But few physicians choose to work into their later years, and already there is the uncertainty brought by early retirement, departures and death. At a personal level, planning for one’s eventual retirement is important, channelling considerable intellect, enthusiasm and drive from our medical practices, to the development of other pursuits that are often postponed or denied due to the many years of commitment, dedication and focus on careers and patients. Life is all about choices. Some good choices and some bad. But what we choose to do in those senior years – and when and how we plan to do it – should be our choice. Protect our tenure, let us retire with dignity. The third quietly whispered yet rogue justification for forced retirement is the need to capture the salary or the endoscopy/ward resources to use for younger clinicians. While it is important to bring on junior staff, is that any justification to take away what older physicians have spent years fostering? If it is acceptable for community practitioners to maintain their practices, why wouldn’t it be so for academic physicians? Perhaps for some of you with 15, 20 or even 25 years left in your work life, all of this talk about age prejudice and the right to work may seem to be totally irrelevant. Perhaps that is why, decades ago, some of us agreed to sign what were then obligatory clauses about compulsory retirement. Perhaps some of you will be sympathetic because age prejudice is illegal, immoral and senseless, particularly at a time when there is a shortage of physicians. It might be of interest to know that mandatory retirement is forbidden in approximately one-half of the Canadian provinces. Many prestigious and enlightened Canadian universities have no mandatory retirement (University of Toronto in Toronto, Ontario; McGill University in Montreal, Quebec; Laval University in Quebec City, Quebec; the University of COMMENTARY