A survey of anesthesiologists aged 60 years and older in Korea: current status, challenges, and future strategies

Article information

Anesth Pain Med. 2025;20(1):86-97
Publication date (electronic) : 2025 January 25
doi : https://doi.org/10.17085/apm.24053
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
2Department of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
3Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
Corresponding author: Hong Seuk Yang, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon 24253, Korea Tel: 82-33-240-5594 Fax: 82-33-251-0941 E-mail: hsyang@hallym.or.kr
This study was presented at the 2023 annual congress of Korean Society of Anesthesiologist.
Received 2024 April 21; Revised 2024 July 25; Accepted 2024 September 24.

Abstract

Background

As the global population ages, medical professionals are also aging. This study investigates the status of Korean anesthesiologists over the age of 60.

Methods

Anesthesiologists aged 60 and older, residing and working in Korea, were invited to participate in this study via e-mail from February to March 2021 and by mail from June to August 2021. The survey consisted of 40 questions covering 10 topics, including health status, residence, work style, and economic status. Depending on the type of question, answers were ranked on a scale of 1, 2, and 3, with the most preferred response being selected.

Results

A total of 63 responses were received, resulting in a response rate of 26.5%. Among the respondents, 56 were currently practicing as anesthesiologists and reported satisfaction with their clinical practice and life status. On average, they treated 24 patients per day without experiencing significant discomfort or inconvenience in their roles as senior physicians. Twenty-four respondents acknowledged physical discomfort related to aging, and nine expressed cautions regarding age-related changes. Fifty-two respondents indicated that reeducation for advanced medical practice as anesthesiologists was necessary.

Conclusions

Senior anesthesiologists in Korea are primarily working in secondary and tertiary hospitals and are satisfied with their current life status. A comprehensive evaluation of reeducation programs for advanced clinical practice and retirement strategies for senior anesthesiologists is needed to address the growing number of aging physicians in the workforce.

INTRODUCTION

Population aging has become a global phenomenon due to advances in healthcare, leading to rapid aging in both the general population and occupational groups. The employment rate of adults aged 65 years and older is 19.2% in South Korea. The rate is expected to increase gradually, with the proportion of employed individuals over the age of 65 surpassing 40% in Korea. Such trends will likely affect the dependency ratio and labor force participation among the older population [1-3].

A 2018 survey conducted by the Korean Society of Anesthesiologists (KSA) found that of the 5,269 anesthesiologists in Korea, 299 (5.7%) were aged 60 years or older. The aging of the physician workforce, alongside the aging population, can influence the healthcare environment and patient care. The aging of physicians, along with their subsequent retirement, can affect both their physical and mental health and pose challenges in acquiring up-to-date knowledge and judgment due to ongoing medical advancements. Additionally, their ability to cope in emergencies may diminish, further impacting healthcare settings [4,5]. Furthermore, these changes can influence the economic activities of the elderly, the supply and demand of the healthcare workforce, and the quality of education in medical institutions [6].

While aging is not regarded as a physical or mental abnormality, many physicians are inclined to leave medicine or change fields as they age. Such transitions may decrease the healthcare workforce and influence workforce distribution. Physicians possess valuable knowledge and experience that increase with age, making aging physicians essential not only for patient care but also training future generations and enhancing the medical care system and public health administration [4,5].

Despite individual differences, aging generally presents challenges by impacting judgement and competence due to declines in physiological functions and diminished coping abilities, both mental and physical, regardless of profession. Anesthesiologists are expected to adapt with age; however, adaption may not always be achievable. Physical and mental health can be significantly influenced by factors such as smoking, alcohol consumption, and presence and severity of comorbidities, including hypertension, diabetes mellitus, visual and auditory impairments, and cognitive decline [4-7]. A Canada survey reported a worsening decline in coping abilities and an increased incidence of malpractice among aging anesthesiologists [8,9]. Consequently, most physicians contemplate retirement as they enter their 60s. However, the decision to retire, whether early or late, can stem from various personal issues, such as health concerns and financial burdens [10,11]. Additionally, globally, the retirement age is expected to increase, along with longer life expectancy [12]. The statutory retirement ages of physicians vary by country, similar to other occupations. For instance, in the United States, the average retirement age is 63.3 years. Some countries have established specific retirement ages for physicians [4,13].

To address these issues, we conducted a survey targeting anesthesiologists aged 60 years and older in the KSA in 2021 [14]. We plan to revisit this survey by incorporating additional areas of focus, including reeducation, communication with younger anesthesiologists, and economic strategies post-retirement. Participants were asked to complete a survey regarding their current professional status, including whether they were on a career break, engaging in clinical practice, or pursuing another profession.

The purpose of this study was to identify and analyze the current status and challenges faced by aging anesthesiologists, thereby providing guidelines to assist both older and younger anesthesiologists in navigating the future aging society.

MATERIALS AND METHODS

This survey study received approval from Hallym University, Chuncheon Sacred Heart Hospital’s institutional review board (IRB no. 2024-03-002). The study included anesthesiologists aged 60 years and older who were registered in the KSA as of March 2021. A total of 402 anesthesiologists aged ≥ 60 years in this age group were registered in the KSA. Of those, 103 who were excluded due to death and 61 were excluded because their e-mail, telephone number, and postal address were unavailable. Finally, 238 valid subjects were included, and survey questionnaires were mailed to them between February 1 and August 31, 2021. For those who did not respond within two months, the questionnaires were resent by post, and we waited for an additional two months for their responses. Thus, this survey was sent twice to the 238 subjects. Both e-mail and postal services were facilitated by staff members in the KSA.

The survey consisted of 10 items spread across 40 questions. The first survey was distributed on February 1, 2021, via e-mail. The second survey was mailed to 95 members on June 16, 2021, due to changes in addresses confirmed by e-mail responses. Each time, we waited for two months for responses. By August 31, 2021, we received responses from 63 subjects, representing a response rate of 26.47%. These responses were subsequently analyzed. The questionnaires, detailed in supplementary file 1, covered demographics, working types and environments, life satisfaction status, income, involvement in education and medical advisory services, patient care environments, challenges associated with aging, health conditions and effects, and the necessity of retraining.

Statistical analysis was conducted as follows. Responses were collected and analyzed using the Google survey program. Demographics, clinical practice characteristics, and the frequency of other survey responses were summarized using descriptive statistics (i.e., percentages or frequencies) in univariate analyses. The number of anesthesiologists answering each item varied, so percentages were based on the number of respondents for each item rather than the total number of 63 respondents. Bivariate analyses, including comparisons of survey responses across provider age groups (60–65 years, 66–70 years, 71–75 years, 76–80 years, and greater than 81 years), gender, and work region, were performed using Fisher’s exact test due to small sample sizes. A two-sided P < 0.05 was considered statistically significant. All analyses were performed using SAS, Version 9.4 (SAS Institute).

RESULTS

Demographics

A total of 63 respondents (52 males; 11 females, 53 from the first survey and 10 from the second survey) completed the entire survey, yielding a response rate of 26.5%. The age and gender distribution are summarized in Table 1. Due to limited number of overall responses and the absence of gender differences in specific questions, they were analyzed together.

Demographics and Gender Distribution of Survey Respondents

Working type and environment

Regarding the current working type, 19 respondents (30.2%) held positions as university hospital professors, 20 respondents (31.7%) were employed hospitalists, 9 respondents (14.3%) were private physicians, 4 respondents (6.3%) worked in nursing hospitals, and 1 respondent was retired. Additionally, 4 respondents (6.3%) were involved in medical insurance and public health administration, while 6 respondents (9.5%) were on a complete leave of absence. Of the total respondents, 52 (82.5%) were currently working as physicians (Table 2).

Current Employment Types of Physician Respondents

Of the 62 respondents, 28 (45.2%) had 36–40 years’ working experience, 14 (22.6%) had 31–35 years of working experience, and 11 (17.7%) with 41–45 years of working experience (Fig. 1A). Concerning the length of working time in the current workplace among 59 respondents, approximately half (n = 26, 44.1%) had worked at their current workplace for at least 15 years (Fig. 1B). Additionally, in terms of working type, 25 respondents (50.0%) worked eight h daily, 10 respondents (20.0%) were on-call anesthesiologists without nighttime duties, and three respondent (6.05%) were on-call anesthesiologists regardless of day or night (Fig. 1C). For daily working hours, 32 respondents (50.8%) reportedly work more than 8 h, while 15 respondents (23.8%) worked between 6 and 8 h, respectively (Fig. 1D). Regarding working days per week, 34 respondents (60.7%) worked five days, 11 respondents (19.5%) worked two to three days, and 6 respondent (10.7%) worked for six days (including Saturday).

Fig. 1.

Working type and environment of the respondents. (A) Working experience. (B) Working at current workplace. (C) Working type. (D) Working time.

Most respondents (n = 43, 68.3%) indicated that they worked with others, while 16 respondents (25.4%) worked independently, and others (n = 4, 6.3%) provided no response. Among the 55 respondents who reported issues with other healthcare providers, the proportions of their relationship with co-workers were classified as excellent (n = 18, 32.7%), good (n = 20, 36.4%), and average (n = 17, 30.9%). The proportion of respondents working with another anesthesiologist was 44.4% (n = 28). Among those who reported issues (4 stage; excellent, good, average, and poor) with other healthcare providers (n = 55, 87.3%), the relationship rating remained the same: excellent (n = 18, 32.7%), good (n = 20, 36.4%), and average (n = 17, 30.9%). Of the 32 respondents, 13 (40.6%) reported having no problems with other medical staff, excluding healthcare providers. The proportions of respondents who reported issues related to income (salary), personal relationship, and generation gaps were 15.6% (n = 5). Out of 30 respondents, 9 (30.0%) stated they had no problems in their relationship with younger anesthesiologists (attending physicians and residents). However, 6 respondents (20.05%), 4 respondents (13.3%), and 3 respondents (10.0%) reported problems related to medical expenses, salary, and working conditions, respectively. In response to a question regarding whether those problems were related to age, most respondents answered “no”, while 11 respondents (23.9%) out of 46 answered “yes”. Among those who perceived it as a problem were working as physicians, accounting for 77.0% (n = 17 out of 22).

Life satisfaction

Of the 31 respondents, 10 (32.3%) had no complaints regarding their current economical and health status. The reasons for dissatisfaction included income, working condition, and communication with colleagues. Additionally, 4 respondents (12.9%) indicated they did not like their job. Regarding satisfaction with income and workload, 21 respondents (36.8%), 19 respondents (33.3%), and 6 respondents (10.5%) of the 57 respondents reported being satisfied overall, satisfied, and highly satisfied, respectively (Fig. 2A). One respondent (1.8%) stated that they wanted to work at a different place due to dissatisfaction.

Fig. 2.

Satisfaction and patient care environment of the respondents. (A) Life satisfaction. (B) Income satisfaction. (C) Number of patients care. (D) Specialty preferences. ICU: intensive care units.

Income

In response to the question regarding the current primary source of income, 45 respondents (72.6%) out of the 62 reported that their income was derived from medical practice, while 12 respondents (19.4%) received a pension. Among the 61 respondents, 29 (47.5%), 16 (26.2%), 14 (23.0%), and 2 respondents (3.3%) rated their income as highly satisfied, satisfied, average, and unsatisfied, respectively (Fig. 2B).

Involvement in education and medical advisory services

With respect to current job title, 26 respondents (50%) out of 52 were practicing medicine. There were 12 respondents (48%), 4 respondents (16.0%), and 6 respondents (24.0%) out of 25 who were providing education to healthcare providers, future healthcare providers (medical students and nursing students), and the public, respectively. Regarding involvement in advisory services, 20 respondents (80%), and three respondents (12.0%) providing advice on patients and medical legal services. Additionally, 14 respondents (70%) out of 25 were involved in hospital management or administration.

Patient care environment

Among 54 respondents, 26 (48.1%) cared for approximately 10 patients, followed by 10 respondents (18.5%), 6 respondents (11.1%), and 3 respondents (5.6%) who cared for 11–20, 21–50, and at least 50 patients, respectively. Nine respondents (16.7%) reported that they did not care for patients at all (Fig. 2C).

Respondents were asked which area they would choose if they continued practicing medicine between anesthesia and pain management. Most respondents (n = 32, 53.3%) out of the 60 selected anesthesia; 4 respondents (6.7%), 4 respondents (6.7%), 6 respondents (10.0%), and 1 respondent (1.7%) selected pain management, pain management of the patients in intensive care units (ICUs), both anesthesia and pain management, and both anesthesia and pain management of patients in ICUs, respectively (Fig. 2D). The reason for their choice was that they specialized in anesthesiology and pain medicine, accounting for 63.2% (n = 36 out of 57). Among the 18 respondents who chose other fields, the reasons for wanting to pursue different area outside anesthesiology and pain medicine included a desire for free time, accounting for 27.8% (n = 5). Three respondents (16.7%) expressed a wish to work in fields other than anesthesiology and pain medicine. When asked what they would do if they transitioned to another field, 34 respondents (58.6%) out of 58 indicated they had no intention of moving, while 6 respondents (10.3%) wanted to quit all jobs and 6 respondents (10.3%) wanted to volunteer.

Difficulty with the aging process

When asked whether there was any discomfort while working in anesthesiology and pain clinics as they aged, 45 respondents (76.3%) out of 59 reported no discomfort, whereas 14 respondents (23.7%) indicated they experienced discomfort. Regarding discomfort caused by physical abnormalities due to aging, four respondents (16.7%) out of 24 experienced difficulties performing on-call duties. A few respondents noted challenges in examining ultrasound images or secure venous access due to reduced eyesight or difficulties in performing procedures, such as lumbar puncture. One respondent (4.2%) reported that they become fatigued quickly when providing care for many patients (Table 3). To address these problems, 6 respondents (22.2%) out of 24 refrained from performing any procedures requiring fine maneuver, 4 respondents (14.8%) worked only during daytime, 3 respondents (11.1%) purchased additional helpful devices (e.g., a video laryngoscope), and 2 respondents (7.45%) used magnifying glasses.

Discomfort with Age-Related Physical Abnormalities

Health condition and effects

When asked about physical abnormalities they experienced as they aged, 12 (20.0%) of the 60 respondents reported no symptoms, while another 12 (20.0%) had symptoms that did not affect their lives. In addition, 24 (40%) had symptoms that slightly affected their daily activities. Furthermore, 9 (15%) were cautious due to symptoms that interfered with their lives. Two respondents (3.3%) ceased working because symptoms significantly impacted their lives, and 1 (1.7%) considered quitting (Fig. 3A).

Fig. 3.

Health condition and effects. (A) Effects of aging. (B) Aging-related symptoms. (C) Aging-related abnormalities. (D) Symptom onset.

Of the 48 respondents with symptoms, 32 (66.8%) received medical treatment and examination, 27 (56.3%) were on medication, 14 (29.2%) led a normal life without issues, and 1 (2.2%) was admitted to a hospital for treatment. The causative organs of the symptoms included the cardiovascular system in 17 (37.6%) of the 45 respondents, and ophthalmology, endocrine, and metabolic system in 7 (15.6%) (Fig. 3B). Regarding aging-related abnormalities, most respondents (n = 25, 48.1%) out of 52 reported vision problems, followed by hearing problems (n = 14, 26.9%) and memory issues (n = 13, 25.0%) (Fig. 3C). Eight respondents (14.5%) out of 55 respondents stated that symptoms began more than five years ago, while symptoms started within the past one to two years in 19 (34.5%) and within three to five years in 16 (29.1%) respondents (Fig. 3D). Most respondents (n = 45, 86.5%) out of 52 respondents were self-aware of their symptoms, while 6 (11.5%) and 1 (1.9%) respondent were informed by colleagues and family, respectively. Regarding the association between the aging-related symptoms and medical practice, 49 (84.5%) out of 58 respondents indicated that their symptoms did not affect their medical practice, while 9 (15.5%) reported that they did. When asked how to address medical problems cause by aging process, 15 (40.5%), 9 (24.3%), 4 (10.8%), and 4 (10.8%) of the 37 respondents sought assistance from other anesthesiologists at the same clinic, different physicians, other individuals, and other healthcare providers (nurses), respectively. Six respondents (13.5%) indicated that they were considering complete retirement from practice due to these symptoms.

Of 61 respondents, 18 (29.5%) had undergone plastic surgery due to aging problems, and 18 (29.5%) were considering plastic surgery. Among the 30 respondents addressing physical problems related to the aging process, 17 (56.7%) dyed their hair, 4 (13.3%) underwent double fold eyelid surgery for ptosis, and 4 (13.3%) had undergone both the procedures.

Retraining and its necessity

In response to the question regarding the necessity of retraining in anesthesiology and pain medicine, 52 (82.5%) of 63 respondents indicated it is necessary. Thirty-six respondents (65.5%) believed retraining should be provided by KSA, while 8 (14.5%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) respondent indicated that training should be conducted by respective professional societies under the KSA, Korean Medical Association (KMA), Korean Academy of Medical Sciences (KAMS), and independently, respectively (Fig. 4A). Among 55 respondents, the proportions of respondents who were retrained every two to three years, once a year, and every four to five years were 43.6% (n = 24), 34.5% (n = 19), and 12.7% (n = 7) respectively (Fig. 4B). Regarding the training method, 25 (45.5%) of 55 respondents were retrained through society meetings (an academic training group), whereas 19 (34.5%) and 6 (10.6%) respondents received retraining via the Internet (e.g., webinar) and correspondence education, respectively. For retraining evaluation, 50 (79.4%) of 63 respondents stated that retraining is necessary on a regular basis without test held by society (e.g., webinar, simulation), while 4 respondents (7.0%) stated that it is not necessary.

Fig. 4.

Retraining and its necessity. (A) Necessity and authorities of retraining. (B) Retraining period. (C) Knowledge compared to young anesthesiologist. (D) Participation in knowledge exchange programs.

In response to the question, “Do you think that a shift in the teaching and learning processes is necessary as you age compared to young anesthesiologists?”, 46 (72.4%) of 63 respondents answered that it is necessary. For the question “Do you think young anesthesiologists’ knowledge is less, or that you have more experience compared to them?” 23 (38.3%) of 60 respondents indicated that they teach and learn from each other, while 12 (20.0%), 10 (16.7%), 7 (11.7%), and 8 (13.3%) respondents were teaching, learning, training, and not interested, respectively (Fig. 4C).

When asked about the necessity of programs that facilitate the exchange of new knowledge from young anesthesiologists and experience from senior anesthesiologists during the retraining courses, 32 (52.5%) of 61 respondents indicated that it is necessary, 25 respondents (41.0%) stated that it is necessary but difficult to implement, and 4 respondents (6.6%) indicated that it is not necessary. When respondents were asked whether they would participate in any program, 19 (30.6%) responded that they would participate later, 10 (16.1%) indicated they would participate a little later, 17 (27.4%) stated they would participate depending on circumstances, 10 (16.1%) indicated they cannot participate, and 6 (9.7%) expressed little intention of participating (Fig. 4D).

In response to the question regarding when they took a leave of absence after retirement, most respondents indicated it was after they turned 65. Two of the 12 respondents each (16.7%) reported taking a leave of absence at age 80 and 65, respectively. Additionally, when asked when they would retire in the future, 16 (32.7%), 14 (28.6%), 11 (22.4%), and 2 (4.1%) respondents indicated they would retire after ages 80, 75, 70, and 85, respectively. Two (4.1%) indicated they would continue to work if their health permitted.

When asked what the appropriate legal retirement age for physicians should be, 14 (26.9%) of 52 respondents indicated it should be 80 years; 6 (11.4%) and 3 (5.8%) respondents stated it should not be mandated by law and should be determined by physicians themselves, respectively. Regarding the retirement age for anesthesiologists, the majority believes that anesthesiologists should retire at age 70, followed by 75 and 80 years. The responses to the questionnaire on the advantages and disadvantages of anesthesiology and pain medicine are summarized in supplementary file 2.

DISCUSSION

An aging general population also implies an aging population of healthcare providers. As many aging physicians continue to deliver medical care for patients, the aging process may impact the medical practice. If physicians experience health issues related to aging, this may affect their working environment as well as the quality of patient care. Therefore, systemic changes to manage the healthcare workforce and their health are required [15]. Certain countries have established a mandatory retirement age for physicians. For example, in Canada, Ireland, and India (only in public sectors), the minimum retirement age is 65 years. In Russia and China, the retirement age are 55 for females and 60 for males. However, the United States, the United Kingdom, Germany, Italy, and Australia have not stipulated a retirement age for physicians [13]. The airline pilot profession has stringent age-related requirements. After age 40, pilots must obtain a first-class medical certificate every six months and undergo a flight review test every 24 months. Once they reach 65 years of age, they can no longer serve as commercial air-flight pilots, except under significant limitations [16]. In 33 states and Washington, D.C., in the United States, there is a mandatory retirement age for judges. Additionally, the United States. federal laws specify a “retirement” age in various professions, ranging from 57 to 65 years. The retirement age for air traffic controllers, Federal Bureau of Investigation agents, law enforcement officers, firefighters, individuals transporting nuclear materials, and those involved in parcel service is regulated by the law. Moreover, driver’s license is regulated by state law; in many states, individuals aged 70 years or older must visit a site to renew age-related driver’s requirements rather than using postal services. They are also required to undergo vision test and renew their drivers’ licenses more frequently. Certain states require a physician’s certificate to verify that they are qualified to drive [16]. In South Korea, there is no legal age limitation for physicians; rather, age limitation are recommended for certain professions or for obtaining driver’s license. The recommended retirement age for public officers and educators is

The aging of physicians is also a growing concern in many countries. According to the data from the United States statistics, 23% of physicians were older than 65 years in 2015 [13]. Approximately 24% of Australia’s medical workforce is older than 55 years. In Canada, the proportion of physicians older than 65 years is expected to reach at least 20% in 2026 [17]. Similar changes in the overall number of physicians are anticipated in South Korea. According to the data from the KSA in 2018, there were 5,764 specialists, of whom 299 (5.2%) were 60 years of age or older. Although this number is small, it is not negligible due to the shortage of anesthesiologists. In the future, approximately 200 new anesthesiology specialists are expected to be added annually, while the number of aging specialists will also increase. Many physicians will consider retirement as they age. However, age is not the only factor influencing retirement decisions. Physicians may retire due to illness, reducing their clinical practice while maintaining their current jobs, or even changing specialties. Women are four times more likely to stop working after retirement compared to men [18]. The retirement of highly skilled and experienced anesthesiologists will impact on the supply and demand for healthcare providers who can manage operating rooms, ICUs, and pain clinics [19,20]. A shortage of healthcare providers is expected to be effectively managed through appropriate retraining, evaluation, and health and workforce management for those who have already retired or are nearing retirement age. It is necessary for both governments and medical associations, as well as respective professional societies, to consider these issues. Survey results indicated that respondents expected the KAMS, KMA, and respective professional societies to provide training. Additionally, seven respondents (11.7%) expressed interest in participating in education and training of young physicians by sharing their clinical experience and knowledge.

A survey on retirement among all physicians in Canada found that the mean retirement age was 65.1 ± 7.8 years, with women retiring 4.1 years earlier than men. Physicians working in rural areas retire 2.3 years earlier than their metropolitan counterparts, while those trained abroad retire 2.3 years later than domestically trained physicians. The retirement age was reported to be unrelated to specialization, age, or place of work or training center [18]. Studies on pre-retirement activity revealed that practice activity levels and workload in the group without a retirement plan either did not change or changed gradually [15,18]. In 1977, physicians aged 50 years were expected to practice medicine for an additional 13 years; this expectation increased to 16 years by 2009. It was noted that physicians reaching the age of 60 would contemplate retirement. Additionally, the mean retirement age for otolaryngologists was reported to be 67 years [15]. We suspect that the maximum retirement age for anesthesiologists may be longer than that of other medical specialists, given the nature of their specialization such as surgical specialist due to the rapid advancement of techniques. In South Korea, retirement age is determined by date of birth. In teaching hospitals (e.g., university hospital), physicians retire in either February or August after reaching the age of 65, while government-employed physicians at national or city public hospitals resign in the month they turn 60. Consequently, there are difference in the timing of retirement or change in work based on the characteristics of the hospitals where individual work.

The perspective on retirement may differ between physicians who own their own hospitals and those working at teaching hospitals, such as university hospitals. Physicians with their own practices are more likely to cease working entirely, whereas those in teaching hospitals may have other options, such as opening a hospital or joining another institution. In this context, physicians in academic medicine may view their institution as “greedy” and impact medical research, education, and institutional succession planning within a hospital. Thus, retirement may be postponed or occur abruptly [21].

If physicians resign from their current job due to age, most physicians can resolve their economic challenges through pensions (public employee pension, private school pension, teachers’ association pension, or national pension) or by managing personal wealth (fund or stock). However, a minority may experience financial difficulties [10,11]. In this study, no complaints of economic problems were reported. Although these issues are primarily personal, we believe that the government, KAMS, KMA, and respective professional societies should play a role in analyzing and resolving the situation.

Physicians often choose not to retire despite advanced age due to factors such as flexible work hours, workload intensity, job satisfaction, career opportunities or lack thereof, resource adequacy, intrinsic self-worth, convenience, financial incentives, coworker relationship, length of training, late entry of into the workforce, attachment to work, strong work identity, and the 4% rule [15]. Conversely, reasons for early retirement, include dissatisfaction, inflexibility, bureaucracy, electronic medical records, burnout, and the desire for personal time. No gender difference was associated with those reasons [15]. In this survey, no difference was observed between men and women, although accurate judgment was hampered by a small numerical distribution. Respondents reported on issues related to working conditions, including working hours and night and weekend duties.

According to the American Medical Association (AMA), individual differences in the aging process and deterioration exist; however, physical dexterity, neurocognitive function, and overall health begin to gradually decline once individuals reach 65 years of age. Thus, the AMA recommends that individuals aged between 65 and 70 years receive periodic medical examinations (basic physical examination and visual testing) performed by primary care physicians to assess their health status [22]. Canadian surveys anticipate that by 2026, 20% of physicians aged at least 65 years will experience cognitive issues, with 13% potentially suffering from dementia and 10–20% having mild cognitive dysfunction [15,17]. Based on these findings, anesthesiologists should undergo regular health examinations to maintain their ability to provide medical care as they age. In South Korea, since national health insurance offers a regular health check-up program, there should not be significant issues; however, because problems related to physical dexterity and neurocognitive functions are often subjectively determined rather than objectively assessed, challenges may arise. Accurate criteria and applications for these issues should be considered by the government or KMA and KAMS. Most respondents were practicing medicine and reported few unusual health problems; however, many noted changes in vision and hearing function due to aging, while a few provided vague responses or chose not to answer. Their concerns appeared to focus more on cosmetic effects rather than health, as some respondents colored their hair or underwent cosmetics procedures, such as double eyelid surgery and skin lifting, to migrate aging effects and appear younger.

Concerns exist regarding whether coworkers can practice medicine, and whether medical staff can perform hospital leadership roles without fear of retribution. In South Korea, physicians aged 90 years and older have been reported to continue providing patient care [23].

In this survey, 50% of respondents indicated that they felt changes in their functional abilities due to age and acknowledged problems in medical processes or reported that others identified such issues. This finding suggests a consistent concern. As these issues can impact patients’ safety, it is imperative for physicians to undergo regular health check-ups, and for families or coworkers to explicitly recognize any concerns.

Senior physicians should have a pivotal role in hospitals and communities regardless of their specialization, as their knowledge and experience are valuable for teaching, assisting, research, and administration. Thus, they can play crucial roles in areas of their choice [19]. A few studies have emphasized the significance of clinical experience and knowledge accumulated over years [17,24]. In this study, some respondents agreed—albeit unenthusiastically—to share their knowledge and experience if opportunities arose. Additionally, most respondents worked at university or general hospitals instead of their own hospital. This may be due to the nature of anesthesiology and pain medicine—anesthesiologists are more likely to work at general hospitals rather than at personal clinics or hospitals.

Problematic aspects of retirement planning can differ among individuals, societies, and countries. One aspect pertains to economic problems: another, to the psychosocial dynamics of retiring from medical practice. The third relates to satisfaction with their work and colleagues. The fourth relates to the institution and physician employment organization where they work—such as the flexibility of work hours, the number of patients seen, and the complexity of cases. The fifth concerns whether the organization and society provide post-retirement opportunities including peer support, teaching, mentoring, administration, and other non-clinical activities, and if so, how much they support these activities. Additionally, organizations should avoid mandatory retirement age and recognize the limits of cognitive testing administered for the first time to older physicians. The factors affecting retirement planning include the maintenance of physician identity, interaction with a spouse, activities to perform throughout the days, and long-term financial security. As most physicians who retired early say that retirement was a mistake, individuals must, therefore, deeply contemplate retirement [25,26]. However, if one retires too late, the number of malpractices may increase. Conversely, early retirement can lead to a significant loss for society by decreasing the number of physicians. Therefore, “everyone in medicine regardless of age, should give considerable thought to this complex issue—it affects everyone” [15,26].

In this study, a respondent stated that he or she would continue working until their 80s. Meanwhile, the result of another survey reported that in an aging society, an aging physician would be one who is at least 70 years old [27]. In Korea, physicians—not anesthesiologists—aged 90 years or older have been reported to provide patient care and published an article. However, a few hospitals and clinics employ aging physicians who cannot provide patient care as surrogate physicians to open a hospital. Additionally, some oppose physicians aged 80 years or older practicing medicine and suggest that periodically undergo refresher training, have their health status checked, and renew their medical licenses. Therefore, individuals, societies, and professional associations should seriously consider making medical policies about how they can help and resolve these problems.

This study has a few limitations. First, the response rate was 26.5% (n = 63), which represents a small sample size. This relatively low response rate may create another potential bias. Second, there were different numbers or rates of respondents in each question, which may create another misconception or bias. Third, those who do not perform clinical practice and health official activity or have health problems did not participate. Thus, we were unable to obtain a more accurate actual status. Furthermore, owing to personal privacy (e.g., types of diseases, their severity, and income level), specific parts were not investigated. Fourth, it was suspected that most of the respondents work in university hospitals and general hospitals where residents are receiving training, rather than in private practice. Therefore, it is assumed that there will be differences in the concept of retirement.

It is important to increase the number of medical students and physicians in the healthcare plan of the government, but it is also more important to retrain and redeploy the aged general practitioners and specialists to utilize their experience and knowledge. This is easier than previous method and saves the time and money. Therefore, the governors and society of medicine have a responsibility to carefully consider these problems.

In conclusion, in addition to the aging of the general population, the aging of healthcare providers can cause significant challenges, and preliminary measures to address these challenges are necessary. Additionally, government agencies, academic societies, medical associations, KSA, and other professional societies should cooperate with each other to plan and implement long-term measures related to these issues. This includes determining suitability for patient care through retraining and providing regular health check-ups with the active participation of aged anesthesiologists. Adequate retraining of older healthcare providers will significantly improve public health and medical quality, despite the challenges discussed above. Every professional society and government agency should identify the issues related to aging not only in medical professions but also in other professions that do not have a retirement age and must develop appropriate solutions.

Notes

FUNDING

None.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

DATA AVAILABILITY STATEMENT

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

AUTHOR CONTRIBUTIONS

Writing - original draft: Hong Seuk Yang. Writing - review & editing: Hong Seuk Yang, Won Uk Koh. Sung Mi Hwang. Formal analysis: Won Uk Koh, Hong Seuk Yang, Jong Ho Kim, Youngsuk Kwon. Methodology: Hong Seuk Yang, Won Uk Koh. Project administration: Won Uk Koh, Hong Seuk Yang. Visualization: Hong seuk Yang, Won Uk Koh. Jonh Ho Kim, So Young Lim. Youngsuk Kwon, Sung Mi Hwang. Sangwoo Kim. Investigation: Hong Seuk Yang, Won Uk Koh, Jae Jun Lee. Software: Sangwoo Kim, Jong Ho Kim, Youngsuk Kwon, Sung Mi Hwang. Supervision: Hong Seuk Yang, Won Uk Koh. Jae Jun Lee.

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Article information Continued

Fig. 1.

Working type and environment of the respondents. (A) Working experience. (B) Working at current workplace. (C) Working type. (D) Working time.

Fig. 2.

Satisfaction and patient care environment of the respondents. (A) Life satisfaction. (B) Income satisfaction. (C) Number of patients care. (D) Specialty preferences. ICU: intensive care units.

Fig. 3.

Health condition and effects. (A) Effects of aging. (B) Aging-related symptoms. (C) Aging-related abnormalities. (D) Symptom onset.

Fig. 4.

Retraining and its necessity. (A) Necessity and authorities of retraining. (B) Retraining period. (C) Knowledge compared to young anesthesiologist. (D) Participation in knowledge exchange programs.

Table 1.

Demographics and Gender Distribution of Survey Respondents

Age (yr) Total (n = 63) Male (n = 52) Female (n = 11)
60–65 4 (6.3) 3 (5.8) 1 (9.1)
66–70 38 (60.3) 30 (57.7) 8 (72.7)
71–75 12 (19.0) 10 (19.2) 2 (18.2)
76–80 6 (9.5) 6 (11.5) 0 (0.0)
81–90 2 (3.2) 2 (3.8) 0 (0.0)
Over 90 1 (1.6) 1 (1.9) 0 (0.0)

Values are presented as number (%).

Table 2.

Current Employment Types of Physician Respondents

Employment types Respondents (n=63)
Professor
 Tenured professor 2 (3.2)
 Clinical professor 7 (11.1)
 Advisory professor 2 (3.2)
 Emeritus professor 8 (12.7)
Employed hospitalist
 working at non-university hospital in anesthesiology department 15 (23.8)
 working at non-university hospital in pain medicine department 1 (1.6)
 working at non-university hospital in both anesthesiology and pain medicine department 3 (4.8)
 Cancer Immunology Clinic 1 (1.6)
Private physician
 Local clinic owner (pain clinic) 3 (4.8)
 Freelancer (providing anesthesia) 5 (7.9)
 Providing anesthesia only upon direct demand from local clinic 1 (1.6)
Nursing hospital (head director, administrator) 4 (6.3)
Public health administration
 Head of public (or branch office of) health center 1 (1.6)
 Health administrative positions (Health Insurance Corporation, Health insurance review agency) 3 (4.8)
Not working as a physician
 Director of university(academic) foundation 1 (1.6)
 Currently on leave of absence 6 (9.5)

Values are presented as number (%).

Table 3.

Discomfort with Age-Related Physical Abnormalities

Discomfort due to aging Respondents (n=24)
Difficulties in performing on-call duty 4 (16.7)
Difficulties in performing weekend duty 2 (8.3)
Difficulties in examining ultrasound images due to reduced eyesight 3 (12.5)
Difficulties in securing venous access due to reduced eyesight 3 (12.5)
Difficulties in maneuver such as spinal punctures 3 (12.5)
Difficulties in maneuver such as endotracheal intubation 2 (8.3)
Difficulties in reading X-ray findings for pain treatment 3 (12.5)
Feeling easily tired when providing care for many patients 1 (4.2)
Presbycusis (poor hearing) 2 (8.3)
Presbyopia (poor vision) 1 (4.2)

Values are presented as number (%).