1 Identify important factors to consider when determining an optimal - - PDF document

12/4/2018 1

Hanging up your stethoscope: preparing and planning for retirement

Filmed Oct 2014 Slides updated Oct 2018

Kim Bowers Solicitor, Avant Law Dr Peter Walker Risk Adviser, Avant Nicky Coskinas Solicitor, Avant Law Professor Tony Eyers Professor of Ethics Macquarie University Dr Chanaka Wijeratne Old Age Psychiatry, Prince of Wales Hospital.

Housekeeping

> Poll questions and the opportunity to ask other questions is not available for this on demand version of the webinar. If you require medico-legal assistance please call Avant’s Medico-legal Advisory Service on 1800 128 268.

2

Learning objectives

3

1 2 3

Identify important factors to consider when determining an optimal time to retire. Identify the factors related to ageing that increase your level of risk. Outline the medico-legal requirements leaving practice.

12/4/2018 2

Factors leading up to the decision to retire

> You may establish a predetermined age > Or consider the following: – demands of on-call – decline of fine motor skills – change in family circumstances.

4

> Doctors have lower rate of overall mortality than community. > Extent of chronic physical disease & associated disability unclear. > Low overall rate of smoking (2%) protective. > Age related decline in vision & hearing expected. > Similarly, decline in fine motor skills expected.

5

Physical health

> National Mental Health Survey of Doctors & Medical Students (2013). > Psychological distress scores declined progressively with age, lowest in doctors aged over 60. > Similar pattern for rate of hazardous, but not harmful, drinking. > Burnout (emotional exhaustion, cynicism, low personal efficacy) lower with age.

6

Psychological health

12/4/2018 3

Psychological distress & age

National Mental Health Survey of Doctors & Medical Students (2013)

Burnout & age

> Theoretical reduction in risk of dementia in doctors. > Overall reduction in cognitive scores with age (especially attention, memory, reasoning). > ‘Crystallised intelligence’ stable with age. > ‘Fluid intelligence’ declines progressively with age. > Older doctors who are subject of notification to Medical Council tend to have mild cognitive impairment.

9

Cognitive changes

12/4/2018 4

Fluid & crystallised intelligence & age

https://hankhng.com/2018/05/13/declining-memory-function/

How older adults fare better than young adults

11

Occupational knowledge Avocational knowledge Intelligence (IQ test) Intelligence as process

The locus of adult intelligence: Knowledge, abilities, and nonability traits. (1999) Akerman, P. Rolfes, E. Georgia Institute of T echnology

12

Risks to performance associated with age

Burnout Illness (physical or mental) Bereavement (family or identity) Cognitive decline Cognitive impairment

12/4/2018 5

13

At risk groups

Multiple physical co-morbidities (esp. vascular risk factors, heart disease or neurological disease) The ‘old’ doctor >75 Subject of a complaint about competence or conduct Protective factors International medical graduates (IMG) Isolated practitioners

14

The doctor at risk for complaints

Individual factors

Male Age (pass peers around 55) Individual complaints history Communication skills Dogmatic/assertive personality

Practice factors

Plastic surgery Dermatology Skin cancer clinics Obstetrics Isolation Report writing (insurance, psychiatric and court)

15

Retirement Planning

12/4/2018 6

> Full retirement > Semi-retirement > Assisting > Locum > Installing a successor to take over your practice > Leaving the premises

16

Decision Leaving a practice

17

> How much notice should I give? > Returning medical records, script pads and practice property. > Notifying Medicare and AHPRA. > Organising run-off cover.

Run-off cover

18

> This provides indemnity for claims arising from incidents yet to be reported that occur between the commencement of your period of insurance with Avant and your retirement date. > You may be eligible for cover under the Australian Government’s Run-off Cover Scheme (ROCS). > Contact Avant’s Member Service team to discuss run-off cover on 1800 128 268

12/4/2018 7

Your practice as a business that is closing

19

> Obtain advice from your accountant and solicitor as part of your retirement planning. > Finalise any business leases, loans, payment of staff entitlements, superannuation, workers compensation and public liability insurance. > Outstanding Medicare payments owed to other practitioners will need to be paid. > Consider where correspondence will be sent after your practice closes (e.g. post office box)

Notifying patients

20

> Write to patients inviting them to transfer or collect their records. > Provide recorded message on answer machine

• r website.

> Notice in local newspaper. > Signage in waiting room and/or window. > Advise patients in writing of the time, type and nature of follow up that they will require. > Complete a list of high risk patients to pass on to your successor.

21

Identifying patients who require follow up

12/4/2018 8

Medical records

22

> Keep a register – name, DOB, period the records cover, what has happened to records. > Transfer, store, or destroy. > Store for seven years or to age 25 from the date of the last appointment and in a secure environment. > Our vocation forms part of our identity. > Loss of self-worth. > Daily routine and activities add purpose to life. > Spending time on hobbies and interests, may not be as rewarding and meaningful as anticipated. > Grandparents may find they are expected to baby sit all the time. > Partner issues can include differing (and conflicting) ideas on retirement lifestyle.

23

Common fears and conflicts

Source: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Reti rement_issues_to_consider

Spouse, partner and family issues

24

> One partner has retired or plans to retire, while the other wants to continue working. > Ideas on retirement lifestyle may clash. > It can be difficult at first to work out how much time to spend together. > Some people may try to do everything as a couple. > Bereavement and isolation.

12/4/2018 9

Hanging up the stethoscope

25

We all have to retire eventually There is more to life than work Retirement can be a time of growth and discovery Because it’s time

Source: Should older family physicians retire? YES http://www.cfp.ca/content/58/1/22.full?ijkey=7c9078cce5e229f48 97c6db9779f99908e92c38b&keytype2=tf_ipsecsha

> You need a decade to prepare for your retirement. It’s not too early to start thinking of a date. > Don’t think of locums as a retirement job – it requires retraining. > Having a GP of your own means seeing that doctor for check-ups, regularly. > Listen to friends and family if they share concerns. > Factors predicting happy retirement.

26

Take away messaging

> Avant Member Support Program > Accountant > Financial planner > Psychologist > Career counsellor > Centrelink T

• el. 132 490

> Doctors’ Health Advisory Service > Beyondblue

27

Advice and support

12/4/2018 10

28

Avant’s Retirement Reward Plan

Avant resources > Factsheet: Preparing for retirement: https://www.avant.org.au/Resources/Public/20141047- preparing-for-retirement/ > Factsheet: FAQ for doctors leaving a practicehttps://www.avant.org.au/resources/public/20140326-faq-doctors-leaving-a-practice/ > Health and wellbeing – Preparing for retirement http://www.avant.org.au/Health-and-Wellbeing/Your-Health/Physical-and-mental-health-and- wellbeing/Preparing-for-retirement/ Avant member benefit > Retirement Reward Plan http://www.avant.org.au/ARRP/ Articles > Wijeratne C; Peisah C, 2013, Accepting the challenges of ageing and retirement in

• urselves: the need for psychiatrists to adopt a consensus approach., Australian and New

Zealand Journal of Psychiatry, vol. 47, no. 5, pp. 425 – 430 > Draper B. 2017, Older doctors and retirement. Med J Aust. 20 March 2017 https://www.mja.com.au/journal/2017/206/5/older-doctors-and-retirement

29

Resources

General disclaimer The information in this presentation is general information relating to legal and/or clinical issues within Australia (unless otherwise stated). It is not intended to be legal advice and should not be considered as a substitute for obtaining personal legal or other professional advice or proper clinical decision-making having regard to the particular circumstances of the situation. While we endeavour to ensure that documents are as current as possible at the time of preparation, we take no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently. Avant Mutual Group Limited and its subsidiaries will not be liable for any loss or damage, however caused (including through negligence), that may be directly or indirectly suffered by you or anyone else in connection with the use of information provided in this document.

Important notices

30