Physician, retire thyself. Not an easy task

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It was a lucrative offer: a prebuilt family medicine practice, with nearly 2,000 patients and all the necessary equipment, free to any new doctor when Arthur Parsons retired.

But no one bit. While Dr. Parsons had realized earlier that he couldn't sell his Halifax practice, to his dismay he later discovered he couldn't even give it away. Entrepreneurship, the 71-year-old says, is no longer attractive or appealing to the latest generation of doctors.

"Ethically, I was supposed to find somebody to take over my practice," says Dr. Parsons, who retired in January and had to pass on many of his patients to a young doctor who didn't want an ownership or management stake in the clinic.

The rest of his patients were divided among the 14 other doctors who worked in the north-end clinic, while others migrated to doctors in the suburbs. "There are a lot of people who don't want to take on that patient load," he says. "Medicine is changing. Society is changing."

Finding steady, full-time work is a well-documented struggle for many young adults today, but there is an ironic flipside to the trend: younger professionals, such as doctors, are seeking greater work-life balance than their forebears, including carrying the burden of running a business. That leaves retiring professionals such as Dr. Parsons with a burden of their own, as they struggle to pass on their practices before retiring, especially in regions such as Atlantic Canada where populations are shrinking or stagnant.

While Nova Scotia has detailed plans to recruit and keep doctors in the province, the generational shift in workload is clear, says Kevin Chapman, the director of health policy and promotion for Doctors Nova Scotia, the province's professional association. As part of recruiting forecasts, he says the province now needs to hire at least five doctors to cover the patient load of four who retire.

"There isn't as much interest in coming into a practice with 2,000 charts and being a solo practitioner and having that kind of a work-life balance," Mr. Chapman says.

Doctors Nova Scotia has taken this into account in its physician resource plan. Of the 425 family physicians Nova Scotia hopes to recruit in the next 10 years, 277 of them will be to cover retirements outright, with an additional 65 needed to cover the generational difference for the same amount of patients, according to association documents.

Mr. Chapman admits the rush to replace doctors isn't particularly smooth. "As much as we'd like the system to be seamless, it's not," he says. To ease the transition, the province is shifting toward "interdisciplinary" health teams that allow non-doctor medical professionals to treat patients, such as pharmacists doing immunizations.

The province is also offering a new tuition incentive to convince young doctors to work in Nova Scotia's under-serviced areas.

Dr. Parsons, who has written medical ethics books with his wife and is a former ethics committee chair with the Canadian Medical Association, practised family medicine in Halifax for 45 years before retiring. After stints at a Quinpool Road clinic and at the Halifax Infirmary, he and several colleagues struck out on their own to build their own practice in the city's North End. At one point, he saw 3,600 patients in a single year.

In 1997, Dr. Parsons began to slow down, no longer delivering babies, and a decade later, he stopped offering on-call services. Three years ago, he began to let the world know he was ready to hand over his practice. He put notices in medical journals and anywhere else where younger doctors would see them. He was willing to be flexible – to split his practice for a year to introduce a new doctor to his patients and clinic, or even retire earlier than expected if someone took it over full time.

After no response, Dr. Parsons kicked into high gear, reaching out to medical school deans and professors, and advertising in more Canadian journals. "You name it, I did it," he says.

He attributes much of this to a shift in thinking in the latest generation of doctors. "I think that their idea of work, how long they want to work, and how hard they want to work, is different," he says. That affects the number of doctors who want to handle the business end of their practice, too. "You need to have people who have somewhat of a business orientation to look after that part of the practice."

"Each generation has a different view of work," says David Simpson, director of the Ivey Business School's Business Families Centre at the University of Western Ontario in London, Ont.

The latest generation of workers, he says, "are more likely to be tilting the work-life balance toward life on their journey, so it is difficult to sell a business that has an owner-operator dedicated for six or seven days a week and long hours. Sure, the buyer could make a lot of money, but that is not their only motivation."

Passing off a clinical practice is a different beast than a traditional business, but Mr. Simpson suggests that physicians such as Dr. Parsons who hope to sell or give away their practices think of the buyer, not themselves.

"You may be looking for more than one buyer, as it is difficult to envision a buyer that wants to work in the same manner as you do," he says. "Take a look at your portfolio of patients and consider a method to categorize your clients in a manner that might make sense to a buyer. ... Remember to think about what the buyer needs, as that is the best way to sell something. I would also assume that doctor-client portfolios are attractive to clinic operators who are more businesslike in their approach."

Since retiring last January, Dr. Parsons and his wife have moved to Toronto, where they live in a downtown condo, walk everywhere, and take in all the cultural offerings the city has to offer.

He doesn't mind the lifestyle change, especially after struggling with the medical system to find a successor.

"At one point in time, I loved to spit in the wind and do a Don Quixote type of thing," he says. "But I'm giving up tilting at windmills."