Volume 76 Number 4

Reimagining the Retirement Model to Mitigate Workforce Shortages

The surgical care needs of New York state’s residents are expected to increase continuously over the next decade. Even with efforts to expand training of certified registered nurse anesthetists (CRNAs), potential utilization of certified anesthesiologist assistants (CAAs), and an increase in the number of anesthesiology residency programs and residents, a significant gap will remain between available anesthesia providers and the anesthetic demands of future patients.¹ All of these efforts are limited by the time it takes to recruit faculty and to train residents, CRNAs and CAAs.

One immediate strategy to address this deficit lies in leveraging the retirement-age anesthesiologists and nurse anesthetists who are willing to delay their retirement. To facilitate the retention of retirement-age anesthesia providers, it is crucial to provide them with compelling reasons to remain in the workforce. More importantly, they need to understand how they can remain active and still be welcome members of the team. A successful initiative must delineate a clear pathway that allows these providers access to the lifestyle they desire in the last quarter of their careers, while recognizing their value and continued contributions as they transition into retirement.

Every anesthesia provider over the age of 55 should be offered the opportunity to continue working under modified terms.² This should be a statewide initiative, not one that depends on individual health systems or facilities. A simple set of options should be presented, accompanied by a counseling process. The options should include a staged reduction of obligations along with incentives for continued service.

One could think of this as a “retirement retention” system not unlike recruitment tools used to offset education costs for providers in the first quarter of their clinical careers. The National Health Service has such supports. Federally qualified health centers offer tuition abatement for those willing to serve in an underserved community.^3,4 Those in the military can take advantage of GI Bill benefits. Retirement-age anesthesia providers should have a similar program that encourages continued service, even if at a reduced capacity or intensity.

When thinking about incentives to retain older providers, it will be important to recognize that those 65 and older are more likely to qualify for Medicare. Many may no longer need employer-sponsored health insurance, and some may not need additional retirement contributions. Quite often what they will need is assistance with planning for the required minimum distributions (RMDs) they must take from their retirement accounts (currently beginning at age 73). Withdrawals are included in your taxable income, with the exception of any part that was taxed previously or that can be withdrawn tax-free.⁵ Because this tax is likely to be a disincentive to continue working for many, a powerful incentive could be the elimination of state income taxes on retirement withdrawals for providers who remain in the workforce.

Most who will want to continue working simply need to be provided the “how”: How can I keep earning and not be penalized (on my income taxes) for that unplanned income? How can I continue to work and not carry the same call burden as others? How can I have a reduced call burden and still receive a fair market wage? How do I control the time away from work that travel and relaxation require?

An incremental increase in the per diem stipend for services provided, tied to a gradual reduction in hours, could incentivize providers to continue working. An annual bonus for remaining in the workforce would be immediately impactful. This would be akin to the sign-on bonuses that are present in many providers’ first contracts, which are usually tied to a minimum number of years of service. Payback or hold-back clauses, which are simple to implement, could be tied to specific commitments, such as a minimum number of service days per year or completion of a specific contractual period.

In an academic practice, an alternative to the professor emeritus position that does not require clinical service could be created to encourage retirement-age anesthesia providers to continue to teach, thereby easing the burden on younger clinical faculty members. A retirement retention system could also serve as a valuable recruitment tool, enticing younger faculty by offering opportunities not typically available in private practice.

While training new anesthesia providers is essential, it is not a timely solution to the current staffing shortage. The only way to address staffing issues immediately is to retain those who are already working.

William A. Roberts, M.D., Ph.D., is an associate professor of anesthesiology and perioperative medicine and the director of anesthesia strategy for the region at the University of Rochester. He is also the associate director of the Rural Anesthesia Residency Electives Pathway. Suzanne Karan, M.D., FASA, is the vice chair for education, residency program director and chief clinical coordinator at the University of Rochester Medical Center.