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From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

Objective. Australia has a critical shortage of general practitioners (GPs). A third of the profession are expected to leave within the next 5 years, and recruitment initiatives have been insufficient to address the gap. Female GPs practice differently to their male colleagues and seem to be reducing their clinical work at higher rates. The aim of this study was to explore the reasons why they are leaving, so that Australian communities are better able to attract and retain their expertise and capacity. Methods. The study used a narrative methodology with an online survey method. We recruited female GPs who were retiring or reducing their clinical workload by at least 50% and used descriptive, comparative and open-ended questions. The survey explored the way physical, emotional, social, financial and occupational wellbeing influenced their decisions to: become GPs, remain in general practice, choose to leave and consider returning. Results. There was rapid uptake with 770 eligible participants completing the survey within a month. The cohort was broadly representative of the female GP population, in age, experience and geographical distribution. Female GPs expressed a deep commitment to their patients and communities, but described financial, social and occupational barriers to care that were physically, mentally and morally harmful. GPs felt 'targeted' by politicians and policy makers who treated them with 'malignant disregard'. Conclusions. Female GPs describe unsustainable working conditions that prevent them from working in a profession they love. Rebuilding trust will be a core task if this critical workforce is to be retained.

The healthcare systems throughout the world are facing numerous problems, including aging and shortages of medical staff. Although senior medical practitioners are important to the healthcare, their competency may decline with age. A major problem experienced nowadays by some elderly practitioners is digital exclusion caused by difficulties with adopting new technologies. Some attempts are being made to determine the optimum moment to retire, considering its possible impact on the safety and wellbeing of patients, as well as on the health system and human resource allocation. Until legal regulations are adopted, the age-related screening programs can be used to determine the optimal retirement age.

The provision of pensions for Civil Servants and other employees in public office, such as the police, as well as in large private businesses, became more widespread in the second half of the nineteenth century. Such pensions, and other non-pay benefits, including sick pay, not only helped with recruitment but also provided a means of managing the retirement of workers who were deemed to be incapable of performing their roles. The rules governing eligibility to receive a pension in the Metropolitan Police in London were closely linked to the certification of poor health. Police doctors restricted the certification of sickness as a reason for retirement because it impacted the size of the force, resulted in the loss of more experienced men, and added to the cost of the pension fund. This strategy generated conflict with the workforce, resulting in industrial unrest. Piecemeal reforms failed to address workers’ concerns until 1890, when the rights to receive a pension were improved. These reforms, rather than stricter vigilance by police doctors, were an effective way of retaining experienced officers in the police force.

Background During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care. Method We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample ( N  = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits. Results About 30% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care. Conclusions Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future.

Purpose Social adaptability is essential for healthy aging. This study examines how Contracted Family Doctor Services (CFDS) affect social adaptability in rural Chinese middle-aged and older adults, assessing the mediating role of regular health management (RHM). Methods and materials Using national cross-sectional data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we analyzed 13,895 community-dwelling adults. We employed generalized linear models (GLM), mediation analysis, and an instrumental variable-based control function approach (IV-CFA) to evaluate causality and control for confounding. Results Research demonstrated that CFDS participation was significantly associated with enhanced social adaptability ( β = 0.204, p < 0.01). RHM partially mediated this relationship, explaining 29.5% of the total effect. Heterogeneity analyses indicated significant associations between CFDS and social adaptability for adults aged 45-60 years ( β = 0.250, p < 0.01) and males ( β = 0.308, p < 0.01), whereas no significant effects were observed among adults ≥60 years or females. Conclusions CFDS significantly enhances social adaptability among rural middle-aged and older adults, broadening primary care's impact beyond biomedical domains. RHM mediates 29.5% of this effect. The benefits were particularly pronounced among younger individuals and male subgroups. To sustain CFDS effectiveness, China should maintain 1-3% annual coverage growth while implementing targeted measures: combating social isolation in older adults, screening for perimenopausal comorbidities among women, and strengthening intergenerational care support programs.

Background Occupational stress and burnout are highly prevalent among medical doctors and can have adverse effects on patient, doctor, and organisational outcomes. The purpose of the current study was to review and evaluate evidence on psychosocial interventions aimed at reducing occupational stress and burnout among medical doctors. Method A systematic review was conducted for original research articles reporting on psychosocial interventions targeting occupational stress or burnout among medical doctors, published in the English language, and with data collected at a minimum of two time points. Searches were conducted across five electronic databases, as well as by manual search of Google Scholar. Data was extracted relating to study characteristics and outcomes, quality and rigour, as well as modes of delivery and engagement. Studies were appraised using the Strength of Recommendation Taxonomy (SORT) and Critical Appraisal Skills Programme (CASP). Results Twenty-three articles were reviewed, which reported on interventions utilising cognitive-behavioural, relaxation, and supportive discussion strategies. Only 12 studies allowed estimation of pre- to post-intervention effects. Cognitive behavioural interventions demonstrated the strongest evidence, particularly for reducing stress. Some evidence was identified to support the efficacy of relaxation-based approaches, but no such evidence was found for the efficacy of discussion-based interventions, such as Balint groups. There was a lack of quality among reviewed studies, with no studies receiving a quality rating of 1, and the overall body of evidence being rated as level B, according to the SORT. Effect sizes were not pooled due to a lack of quality among the study sample. Conclusion This review found that despite increased scientific attention, the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low. Despite this, interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout. Limitations of the current review include a lack of risk of bias assessment or pooling of analyses. Recommendations for improving the quality of research in this area, as well as implications of the current body of evidence are discussed. Systematic review registration PROSPERO CRD42016032595

Co-residential care is associated with poor caregiver health and a high burden. Although Portugal relies heavily on co-residential care by individuals aged 50 and over, studies on the impact of co-residential care provision on Portuguese caregivers’ healthcare use are lacking. This study aims to analyze the impact of co-residential care (spousal and non-spousal care) on healthcare use of the Portuguese population aged 50 plus. Data from waves 4 (n = 1697) and 6 (n = 1460) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Negative Binomial Generalized Linear Mixed Models with random (individual level) and fixed (covariates) effects were performed. The results show that the number of visits to the doctor decrease significantly over time for the co-residential spousal caregivers as compared to the non-co-residential caregivers. This result highlights the fact that the Portuguese co-residential spousal caregiver group is at a higher risk of not using healthcare, thus jeopardizing their own health and continuity of care. Promoting more accessible healthcare services and implementing public policies adjusted to the needs of informal caregivers are important to improve the health and healthcare use of Portuguese spousal co-residential caregivers.