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Original Research |
1 Institute for Health Care Studies, Michigan State University, A134 East Fee
Hall, East Lansing, MI 48824-1316.
2 Research Department, American College of Radiology, Reston, VA 20191.
Received October 21, 2005;
accepted after revision November 3, 2005.
Address correspondence to C. Meghea
(cristian.meghea{at}hc.msu.edu).
Abstract
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MATERIALS AND METHODS. We present detailed information from 2003 about the planned retirement age of radiologists, their labor force participation late in their careers, and their actual retirement pattern based on data from the American College of Radiology's (ACR) 2003 Survey of Radiologists. To analyze changes over time, we compare these data with information from the ACR's 1995 and 2000 Surveys of Radiologists. Multivariate regression analysis was also used to identify the effects of radiologist and practice characteristics on radiologists' retirement plans.
RESULTS. The percentage of radiologists fully retired and the average retirement age were the same in 1995 and 2003. Overall, labor force participation rates were decreasing over the period 1995-2003 for both women and men. Standardized labor force participation rates for radiologists age 55-74 years appeared to decrease from 1995 to 2000 and remained at a lower level in 2003, but the changes were not statistically significant. As of 2003, radiologists retired at 64, approximately 2 years older than the average U.S. worker.
CONCLUSION. Radiologists remain active in their profession longer than the typical U.S. worker. There was no change in radiologists' pattern of gradually moving into retirement. If anything, radiologists were retiring earlier in 2003 than in the past. A delay in retirement is not an explanation of the recent easing of the radiologist shortage.
Keywords: career planning • radiologists • retirement • workload • work trends
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There are several possible explanations that might reconcile increasing utilization with the easing of the shortage [10]. One is that radiologists now retire later or work more late in their career—that is, they switch to part-time work later or not at all. The belief that retirement and switching to part-time work have been delayed has been supported by the major decrease in the value of personal assets, including retirement savings, triggered by the decline in the stock market since its 2000 peak.
Radiologists want to know their peers' path to retirement and trends in the recent years. This article provides a service to the radiology profession, especially because the most recent article about retirement patterns and plans was published approximately 3 years ago [16].
In this study, we present detailed information from 2003 about the planned retirement age of radiologists, their labor force participation (amount of work) late in their careers, their actual retirement pattern, and the extent to which they work part-time before retirement. To analyze changes over time that might partly explain the easing of the shortage, we compare these data with information from the American College of Radiology's (ACR) 1995 and 2000 Surveys of Radiologists.
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In brief, the 2003 Survey was conducted by mail between March and July 2003 and covered a broad range of topics. With up to four remailings to non-respondents and other reminders, it achieved an overall 63% response rate, including 1,676 responses from posttraining radiologists.
Of main interest for this study were the work status of the survey participants (full-time, part-time, or not working in radiology) and, if professionally active, the radiologist's retirement plans. The professionally inactive radiologists were asked for the main reason they were temporarily or permanently not working in radiology. Their most frequent responses were that they were retired, disabled, or raising children. When active radiologists were asked about their future retirement plans, the response options were keep working full-time in radiology, never retire; change careers; go part-time before retiring; and fully retire. These responses were not mutually exclusive, and there were often more than one response per radiologist.
The radiologists were classified in seven age groups. Two groups span 10 years: 35-44 and 45-54 years old. In most cases, retirement occurs between the ages of 55 and 74 years. To better capture radiologist retirement behavior, we classified these physicians in 5-year age groups: 55-59, 60-64, 65-69, and 70-74 years. Radiologists 75 years old or older constitute the last group.
The 2003 Survey also asked radiologists whether they subspecialize; their weekly work hours; whether they feel overworked; whether they are an owner of their main practice; and other information about their main practice, such as practice type and practice location.
We also used data from two other nationally representative surveys, the ACR's 1995 Survey of Radiologists and the ACR's 2000 Survey of Diagnostic Radiologists and Radiation Oncologists, both of which are described in detail elsewhere [16, 18].
Analysis Methods
Our study excludes radiologists in training (fellows and residents). Survey
responses were weighted for different sampling rates and response rates to
make the data representative of what answers would have been if all
radiologists in the United States had been surveyed and had responded.
Reported means, SEs, tests of statistical significance, and regression
coefficients are calculated taking into account not only the weighted nature
of the data but also the complex survey design—that is, the fact that
there are three distinct physician strata in our data set (osteopathic
radiologists, radiologists self-designated as vascular or interventional
radiologists in the American Medical Association's [AMA] Physician Masterfile,
and all other allopathic radiologists).
The work status of radiologists in 2003 (full-time, part-time, or not working in radiology) is presented by sex and age groups in Table 1. We excluded the radiologists younger than 35 from this analysis because there are few posttraining radiologists at this age. Having considerably fewer women than men in our data, we aggregated women in the age group 55-64 to obtain a usable sample size for that age category. We did not report results for women over 65 because the sample size was too small to obtain reliable results. The 2003 statistics on work status are compared with similarly derived statistics based on the ACR's 1995 Survey reported in this article and with 2000 data already published elsewhere [16].
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To investigate the labor force participation of both men and women, we measured the full-time equivalency of radiologists in 1995, 2000, and 2003, as reported in Table 2 and Figure 1. We recognized from analyzing the 2003 Survey data that there were problems with the previous surveys' questions to part-timers about the hours they worked. On the basis of the more reliable information from the 2003 Survey, we realized part-timers' hours average about 50% of full-timers. We therefore computed the 2003 labor force participation and adjusted the previously published 1995 and 2000 numbers counting a full-time radiologist as 1, a part-time radiologist as 0.5, and a radiologist not working in radiology as zero.
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To study whether radiologists were retiring earlier than in the past, we present overall labor force participation rates in 1995, 2000, and 2003 in Figure 2. The rates are for radiologists 55-74 years old because that age range is the one in which the overwhelming majority of radiologists reduce their workload or retire. Changes over time in labor force participation could be caused not only by genuine changes in work behavior, but also by changes in the age-and-sex mix of radiologists. To account for the latter potential changes, we standardized the 1995 and 2000 labor force participation rates to the 2003 population characteristics using the method called by epidemiologists "direct standardization" [19, 20]. We created eight cells consisting of four 5-year age categories for each sex, measured the full-time equivalency for each cell, and applied the full-time equivalencies from 1995 and 2000 to the 2003 population distribution by age and sex. As a result, we obtained a measure of what labor force participation would have been if the 2003 population had been at work with the work characteristics of the 2000 and 1995 populations.
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To measure the effects of radiologist and practice characteristics on radiologists' retirement plans, we perform logistic and ordinary least-squares (OLS) regressions. Logistic regression is used when the variable analyzed is dichotomous, such as "plan to never retire: yes/no," and OLS is used when the analyzed variable is continuous, such as "planned retirement age." Regression analysis identifies the independent effect of each factor considered, such as the radiologist's age or the practice type, statistically controlling for the effects of all other variables included. The explanatory variables we considered were the sex and the age of the radiologist; whether the radiologist subspecialized or not, worked full-time, or felt overworked; the extent the radiologist liked the profession; and the location and the type of practice where the radiologist works. Logistic regression results are reported in terms of odds ratios (the ratio between the probability that an event does and the probability that the event does not take place). We use odds ratios to compare whether the probability of a certain event is different between pairs of radiologist subgroups.
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Most (83%) of those not working in radiology were retired. However, another 7% of the inactive posttraining radiologists, approximately 1.2% of all posttraining radiologists, said they were disabled, being on average 63 years old, and 3%, approximately 0.5% of all posttraining radiologists, were not working in radiology because they were raising children. All six respondents not working in radiology because they were raising children were women. As in the previous 2000 Survey, because each nonretirement category is small, the uncertainty regarding its size is relatively large because of sampling variability.
Overall, 11.5% of women and 19.4% of men were retired from radiology in
2003 or otherwise not working in the field. These percentages are
significantly different (p 
0.05). At younger ages ( 54
years), women were more likely than men not to be working in radiology: For
example, 10.1% of women age 45-54 were not working in radiology versus 2.1% of
men in that same age range. The percentages were not significantly different
between men and women age 55-64. The small number of female radiologists age
65 years or older makes any comparison between men's and women's retirement
patterns uncertain.
Thirty-four percent of all women radiologists versus 12.5% of all men
worked part-time; this difference is significant (p 0.05). More
than one third of women younger than 55 years worked part-time, whereas the
fraction for men was only approximately 2-5% at similar ages
(Table 1). However, working
part-time was quite common for older men: for example, 32.3% of men age 65-69
years worked part-time.
Statistics on the work status of posttraining radiologists in 2000 by age group and sex have been published before [16]. As an additional basis of comparison, in 1995, 93.5% of radiologists age 35-44 were working full-time and 6.5% were working part-time. In 1995, the full-time versus part-time distribution at other ages was 92.8% full-time versus 5.8% part-time at age 45-54 years; 87.2% full-time versus 8.8% part-time at age 55-59; 65.2% full-time versus 13.3% part-time at age 60-64; and 46.7% full-time versus 18.7% part-time radiologists age 65-69.
Overall labor force participation rates in 2003 were lower than in the past both for men—81% in 1995, 78% in 2000, and 75% in 2003—and for women—84% in 1995, 79% in 2000, and 71% in 2003 (Table 2). Labor force participation rates decreased slightly between 1995 and 2003 for men younger than age 65 years (Fig. 1): For example, the labor force participation rate decreased from 91% in 1995 for men age 55-59 to 87% in 2003. Conversely, at ages 70-74 the labor force participation rates of men were substantively higher in 2003 than in 1995: 31% in 2003 versus 19% in 1995. Also, there were relatively large decreases in labor force participation rates between 1995 and 2003 for women younger than 55.
To study the trends in early retirement, we performed an analysis of changes in the work patterns of radiologists age 55-74 in the 1995, 2000, and 2003 Surveys. This age range covers almost the entire process of retirement: few radiologists younger than 55 do anything other than work full-time, and few radiologists age 75 or older work at all (Table 1). The full-time equivalency of radiologists (labor force participation rate) 55-74 years old in 2003 was 61.5% (Fig. 2). If radiologists in each age-sex category (such as men 55-59 or women 70-74) had had the work pattern that the same category had in 2000, the standardized full-time equivalency of radiologists age 55-74 years would have been 61.6%. Derived in a similar fashion, the standardized labor force participation rate in 1995 would have been 65% (Fig. 2). The decreases in labor force participation from 1995 to 2000, from 2000 to 2003, and from 1995 to 2003 were not statistically significant.
Retirement Patterns and Plans
Thirteen percent of posttraining radiologists were completely retired at
the time of the 2003 Survey (Table
3). Only 2% of radiologists age 55-59 were retired. Fifty-one
percent of those age 65 or older remained professionally active, including 71%
of radiologists age 65-69, 53% of those age 70-74, and 30% of radiologists age
70 or older.
The average retirement age of those who had already retired was 64 years in our 2003 Survey. Forty-two percent of retired radiologists had worked part-time before full retirement, on average for the last 4 years of their professional career. Twenty-eight percent of retired radiologists age 60-64 said they would consider returning to radiology part-time, whereas the corresponding statistic for those age 65 years or older was only 17%. The economy reportedly influenced the full retirement of 15% of retired radiologists, including 25% of those who retired between 1999 and 2003 and only 9% of those who retired in 1994-1998.
As for future plans, only 4% of those working (full-time or part-time) reported a plan to change careers in the future; 13% of all professionally active posttraining radiologists indicated they hoped to keep working full-time, never retiring from radiology; 57% of full-timers said they planned to go part-time before fully retiring; and 39% had plans to fully retire at some date in the future (more than one response could be given).
Present age influenced the responses to the questions about future retirement plans. Twenty-three percent of all professionally active posttraining radiologists age 65 or older planned never to retire from radiology, whereas only 10% in the age range 45-54 had similar plans. Among those planning to retire, the percentage of full-timers who intended to work part-time before retiring increased with age up to age 65, from 51% for those age 35-44 years to 69% for radiologists age 60-64 years. However, it dropped to 45% for full-time radiologists age 65 years or older.
Forty-two percent of professionally active posttraining radiologists said the economy had influenced their future work plans. The percentage of radiologists influenced by the economy was lower at younger ages—29% among those age 35-44 years—increased to 56% among radiologists age 55-59 years and dropped to 44% for those age 65 years or older.
Overall, 7% of all professionally active radiologists have been retired and have returned to work. There were very few (2%) among those age 45-54 years, and the percentage increased with age to 47% among those age 75 years or older.
Effects of Radiologist and Practice Characteristics on Retirement Plans: Regression Findings
Logistic regression showed that, other factors being equal, younger
radiologists, those who enjoyed their profession very much, and those who
wanted their workload increased had higher odds of reporting they plan never
to retire. Conversely, the odds of planning eventually to retire for
radiologists who feel overworked were more than twice as high as the odds for
those who reported that their workload was appropriate.
As for planned retirement age, OLS regression showed that, other factors equal, radiologists age 35-44 planned to completely retire 1 year younger than radiologists age 45-54 years (the reference group). Those planning to go part-time before retirement intended to completely retire from radiology approximately 2 years older than radiologists who do not plan to go part-time. Radiologists who enjoy their profession very much planned to retire 2 years older than others; those working in a government practice planned to retire 5 years older than radiologists working in a multispecialty practice (the reference category). Radiologists who wanted a lower workload planned to retire almost 2 years younger than those feeling their workload was about right.
Regarding plans to change careers, others things equal, radiologists who were owners of their practice had half the odds of planning to change careers as did nonowners. In addition, radiologists who sought a decreased workload had odds of planning to change careers that were twice as large as for radiologists who reported their workload was about right.
In terms of going part-time before retirement, logistic regression findings were that, other factors equal, the odds that radiologists who subspecialized at least to some extent planned to work part-time before retirement were 0.7 of the odds of nonsubspecialists. The odds that radiologists practicing in the Northeast census region planned to work part-time before retiring were 1.5 the odds of those practicing in the Midwest. Finally, the odds of planning to go part-time before retirement of radiologists who sought a decrease in their workload were more than twice the odds for radiologists who reported their workload was about right.
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To investigate trends in retirement in a more sophisticated fashion, we analyzed standardized labor force participation rates for radiologists age 55-74. The standardized rates appeared to decrease from 1995 to 2000 and remain at that lower level in 2003, although the change was not statistically significant. If anything, radiologists are retiring earlier. Therefore, a delay in retirement is not an explanation of the recent easing of the radiologist shortage.
Women were more likely than men to work part-time, more so in 2003 than in 1995, and the difference is more dramatic at younger ages. This is a sign of women taking more advantage than men of the flexible hours possible in the radiology profession. The large difference at younger ages is most likely indicative of social role distinctions, with women taking a more active role than men in raising children. The finding that radiologists not working at all due to child-rearing responsibilities were predominantly women supports this conclusion.
Approximately half of radiologists age 65 years or older still remained active in the profession in 2003. In the general U.S. population, in comparison, fewer than 15% of the individuals 65 years and older were still actively working [21]. The mean retirement age across the entire U.S. population remained constant at approximately 62 over the period 1995-2002 [22, 23]. Radiologists retire, on average, 2 years later than the average U.S. worker, and we found no change over the past decade in the retirement age of radiologists either. The much higher percentage of elderly radiologists still active in the workforce and the later retirement age probably occur because radiology is both more remunerative than the average job and more interesting than many other occupations in the United States.
We cannot make reliable comparisons between the retirement age of women and that of men because we have too few retired women in our data set. As more women from the increased number who joined the radiology profession a decade or two ago retire, we will know whether women and men tend to retire at different ages and whether the average retirement age will change from what it is now. If the working behavior at ages approaching retirement is an indication of retirement behavior, it is useful to note that there was a decreasing trend in labor force participation rates for women in the 55-64 age range over the period 1995-2003, a similar trend as for men in that same age group.
Four in 10 radiologists who were fully retired as of 2003 had worked part-time before retiring, a fraction similar to that in 1995, indicating no change in radiologists' pattern of gradually moving into retirement. In contrast, almost six in 10 of the active radiologists in 2003 said they planned to go part-time before fully retiring. This may be an indication of a future increase in the percentage of radiologists who will work part-time before retiring. However, the 1995 Survey also showed plans for about six in 10 full-time radiologists to work part-time before retiring, and those plans did not, in fact, materialize by 2003. As a result, the future change apparently implied by 2003 plans may simply reflect that radiologists do not predict very well their behavior around retirement years, more so at younger ages further from retirement. Overall, the full pattern of findings from the 1995 and 2003 Surveys makes this latter explanation of the data seem likely.
One third of active radiologists age 65 years or older in 2003 had been retired and had returned to work, most of them to part-time. A possible reason for the quite large percentage having returned to work is the major stock market decline after 2000 and the resulting likely decline in the value of radiolo gists' retirement assets. Support for the hypothesis that the stock market was important is that one in four radiologists who retired in the years 1999-2003 said the economy had affected their retirement decision compared with one in 10 who retired in 1994-1998. This higher percentage saying the economy affected their retirement in 1999-2003 could have been due to both the rising stock prices up to 2000 encouraging retirement and the subsequent sharp decline generating a return to work or a delay in retirement. In other words, findings can be explained by the following two points: First, the apparent (but not statistically significant) decline in labor force participation rate for those age 55-74 years shows that the stock market slump did not outweigh other forces enough to, overall, delay retirement. Second, the large percentage of recent retirees who say the economy influenced their retirement and the large portion of active radiologists 65 and older who were fully retired for a period suggest the economy had substantial effects on some radiologists.
However, alternative explanations should be considered. The working radiologists age 65 years and older who had been retired for a time could be individuals who found that in retirement they missed the mental stimulation of radiology or whose retirement income was what they had anticipated, but who found they wanted the extra income that working part-time brings. Similarly, the fact that radiologists who retired before 1999 relatively infrequently reported that the economy influenced their decision to retire may merely reflect that radiologists decreasingly remember all the factors that influenced retirement as the retirement event becomes further and further in the past.
Limitations
The 2003 Survey, the source of our data, has strengths—most notably,
its high response rate, careful weighting to adjust for differences among
categories of radiologists in response rate, relatively large number of
responses, and careful data cleaning and editing to improve data quality.
Nonetheless, like surveys generally, it has important limitations. These
include imprecision due to sampling (measured by the SEs presented in Tables
1,
2,
3 for most statistics);
possible response bias with respect to characteristics not considered in the
weighting; and some residual implausible and probably erroneous data, despite
the careful data cleaning. Also, because few women surveyed in 2003 were over
the age of 55, we have little information about older female radiologists.
There is a possibility of selection bias in our regression analysis of decisions regarding the future work-related plans of radiologists. For example, elderly radiologists still in the workforce are more likely to be the ones planning to never retire from radiology, and their odds of ever retiring are then artificially low. Elderly, not retired radiologists are the ones who tend to work longer, and their planned retirement age is artificially high. To limit the extent of this bias, we restricted the regression analyses of retirement plans to radiologists age 55 or younger.
The survey responses presumably were accurate as to whether radiologists were retired or not. Responses as to when they retired and the reasons that influenced retirement are probably less accurate, especially for radiologists who left the profession far in the past.
Finally, as our data suggest, plans seem not to be a reliable guide to what will happen in the future, especially for younger radiologists who are not close to retirement and have not thought much about it.
Conclusions
Radiologists remain active in their profession longer than do U.S. workers
overall, retiring approximately 2 years older than the average U.S. worker.
The fraction of retired radiologists who had worked part-time before full
retirement was similar in 2003 to that in 1995, indicating no change in
radiologists' pattern of gradually moving into retirement. Similar percentages
of radiologists were retiring, and at similar ages, in 1995 and in 2003. Labor
force participation rates appeared to decrease from 1995 to 2000 and remain at
that lower level in 2003, although the change was not statistically
significant. A delay in retirement is thus not an explanation of the recent
easing of the radiologist shortage; if anything, radiologists are retiring
earlier.
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