BACKGROUND: The decrease in the number of healthcare workers and the resulting deterioration in healthcare quality and availability have been subjected to intensive discussion in Czechia in recent years. Estimating future healthcare worker capacities requires a detailed analysis of their "movement" within the healthcare system. This study focuses on exits of the primary care physicians from the healthcare system in Czechia. METHODS: Using anonymised data obtained from the largest Czech health insurance company (2012-2022), we constructed working life tables and calculated working life expectancy, which indicates the expected average number of remaining years of work at the exact age of the physician. The study focuses on primary care physicians, who are crucial for the effective functioning of the healthcare system. RESULTS: At age 50, working life expectancy was 20 years for female physicians and approximately 21 years for male physicians. Over the monitored period, working life expectancy decreased by 1 year for both genders. Gynaecologists had the longest working life expectancy, while dentists had the shortest. CONCLUSIONS: The decrease in the working life expectancy and the length of tenure indicates the need to create favourable conditions for the extension of the working lives of physicians to avoid early exits from the system.

Department of Demography and Geodemography Faculty of Science Charles University Albertov 6 128 00 Prague Czechia

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Prince M, Wu F, Guo Y, et al. The burden of disease in older people and implications for health policy and practice. Lancet. 2014;385(9967):549–62. 10.1016/S0140-6736(14)61347-7. PubMed

Kurashvili M, Reinhold K, Järvis M. Managing an ageing healthcare workforce: a systematic literature review. J Health Organ Manag. 2023;37(1):116–32. 10.1108/JHOM-11-2021-0411. PubMed

Šídlo L. Ageing of primary care physicians in the Czech Republic [Stárnutí lékařů primární zdravotní péče v České republice]. Demografie. 2011;53(3):203–13 (Czech).

Šídlo L, Kahoun L, Čábela F, Havelková T. Estimating the required general practitioner capacity due to generational change in Czech regions up to 2035. Moravian Geogr Rep. 2024;32(2):112–22. 10.2478/mgr-2024-0010.

Kroezen M, Hoegaerden VM, Batenburg R. The Joint Action on Health Workforce Planning and Forecasting: results of a European programme to improve health workforce policies. Health Policy. 2018;122(2):87–93. 10.1016/j.healthpol.2017.12.002. PubMed

Duckett SJ. Health workforce design for the 21st century. Aust Health Rev. 2005;29:201–10. 10.1071/ah050201. PubMed

Ono T, Lafortune G, Schoenstein M. Health workforce planning in OECD countries a review of 26 projection models from 18 countries. OECD Health Working Papers. 2013;62. 10.1787/5k44t787zcwb-en.

Szabo S, Nove A, Matthews Z, et al. Health workforce demography: a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals. Human Resour Health. 2020. 10.1186/s12960-020-0445-6. PubMed PMC

Zhang X, Lin D, Pforsich H, et al. Physician workforce in the United States of America: forecasting nationwide shortages. Human Resour Health. 2020. 10.1186/s12960-020-0448-3. PubMed PMC

Domagała A, Klich J. Planning of Polish physician workforce—systemic inconsistencies, challenges and possible ways forward. Health Policy. 2018;122(2):102–8. 10.1016/j.healthpol.2017.11.013. PubMed

Batenburg R. Health workforce planning in Europe: creating learning country clusters. Health Policy. 2015;119(12):1537–44. 10.1016/j.healthpol.2015.10.001. PubMed

MoH CR. Joint action HEROES [Společná akce HEROES]. Ministry of Health of the Czech Republic; 2023. https://mzd.gov.cz/spolecna-akce-heroes/. Accessed 28 Oct 2024. (Czech).

Kuhlmann E, Batenburg R, Wismar M, et al. A call for action to establish a research agenda for building a future health workforce in Europe. Health Res Policy Sys. 2018. 10.1186/s12961-018-0333-x. PubMed PMC

Russo G, Perelman J, Zapata T, et al. The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions? Human Resour Health. 2023. 10.1186/s12960-023-00842-4. PubMed PMC

Kringos DS, Boerma W, Bourgueil Y, et al. The strength of primary care in Europe: an international comparative study. Br J Gen Pract. 2013;63(616):742–50. 10.3399/bjgp13X674422. PubMed PMC

Schäfer WLA, Boerma WGW, van den Berg MJ, et al. Are people’s health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Primary Health Care Res Dev. 2019;20: e104. 10.1017/S1463423619000434. PubMed PMC

OECD. OECD Health at a Glance 2021: OECD indicators. Paris: OECD Publishing; 2021. 10.1787/ae3016b9-en.

GHIC CR. GHIC Yearbook 2022 [Ročenka VZP za rok 2022]. General health insurance company of the Czech Republic. https://www.vzp.cz/o-nas/dokumenty/rocenky. Accessed 15 June 2024. (Czech)

MoH CR. Health 2030. Strategic framework for the development of health care in the Czech Republic by 2030. [Zdraví 2030. Strategický rámec rozvoje péče o zdraví v České republice do roku 2030.]. Ministry of Health of the Czech Republic: 2020. https://zdravi2030.mzcr.cz/. Accessed 28 Oct 2024. (Czech)

Leong SL, Teoh SL, Fun WH, Lee SWH. Task shifting in primary care to tackle healthcare workershortages: an umbrella review. Eur J Gen Pract. 2021;27(1):198–210. 10.1080/13814788.2021.1954616. PubMed PMC

Kringos DS, Boerma WGW, Hutchinson A, Saltman RB. Building primary care in a changing Europe. Copenhagen: European Observatory on Health Systems and Policies; 2015. PubMed

OECD. OECD Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023. 10.1787/7a7afb35-en.

Papp M, Kőrösi L, Sándor J, Nagy C, Juhász A, Ádány R. Workforce crisis in primary healthcare worldwide: Hungarian example in a longitudinal follow-up study. BMJ Open. 2019;9(7): e024957. 10.1136/bmjopen-2018-024957. PubMed PMC

Wangler J, Jansky M. How can primary care be secured in the long term?—a qualitative study from the perspective of general practitioners in Germany. Eur J Gen Pract. 2023;29:1. 10.1080/13814788.2023.2223928. PubMed PMC

ACMMP—Dutch advisory committee on medical manpower planning. The 2013 recommendations for medical specialist training; 2014. Capaciteitsogaan, Utrecht.

Attal‐Toubert K, Vanderschelden M. La démographie médicale à l’horizon 2030: de nouvelles projections nationales et régionales détaillées. 2009. French Ministry of Health, DRESS. Dossiers solidarité et santé no 12 2009.

Zapata T, Azzopardi-Muscat N, McKee M, Kluge H. Fixing the health workforce crisis in Europe: retention must be the priority. BMJ. 2023;381: p947. 10.1136/bmj.p947. PubMed

Czech Republic. Act No. 155/1995 Coll. Pension Insurance Act [Zákon č. 155/1995 Sb. Zákon o důchodovém pojištění]. https://www.zakonyprolidi.cz/cs/1995-155. (Czech)

OECD. Ready for the next crisis? Investing in health system resilience. Paris: OECD Health Policy Studies, OECD Publishing; 2023. 10.1787/1e53cf80-en.

Walsh R, Telner D, Butt DA, et al. Factors associated with plans for early retirement among Ontario family physicians during the COVID-19 pandemic: a cross-sectional study. BMC Prim Care. 2024. 10.1186/s12875-024-02374-9. PubMed PMC

Schram JL, Solovieva S, Leinonen T, et al. The influence of occupational class and physical workload on working life expectancy among older employees. Scand J Work Environ Health. 2021;47(1):5–14. 10.5271/sjweh.3919. PubMed PMC

Cr GHIC. Individual anonymized data provided for scientific purposes under an agreement between General Health Insurance Company of the Czech Republic and Charles University, Faculty of Science. General Health Insurance Company of the Czech Republic; 2023.

Preston S, Heuveline P, Guillot M. Demography: measuring and modeling population processes. Oxford: Blackwell; 2001.

Pavlík Z, Rychtaříková J, Šubrtová A. Principles of Demography [Základy demografie]. Praha: Academia; 1986. p. 736 (Czech).

Ledent J, Zeng Y. Multistate demography. In: Zeng Y, editor. Encyclopedia of life support systems, vol. 2. Oxford: EOLSS Publishers/Unesco; 2010. p. 139–63.

Pedersen J, Schultz BB, Madsen IEH, Solovieva S, Andersen LL. High physical work demands and working life expectancy in Denmark. Occup Environ Med. 2020;77:576–82. 10.1136/oemed-2019-106359. PubMed PMC

Chungkham HS, Högnäs RS, Head J, Zaninotto P, Westerlund H. Estimating working life expectancy: a comparison of multistate models. SAGE Open. 2023. 10.1177/21582440231177270.

Cipra T. Financial econometrics [Finanční ekonometrie]. Praha: Ekopress; 2008. (Czech).

Burcin B, Tesárková K, Šídlo L. The most frequent methods of smoothing and extrapolating mortality curves and applying them to the Czech population [Nejpoužívanější metody vyrovnávání a extrapolace křivky úmrtnosti a jejich aplikace na českou populaci]. Demografie. 2010;53(2):77–89 (Czech).

Hulíková Tesárková K. Selected methods of mortality analysis focused on adults and the oldest age-groups. Praha, 2012. 261. Ph.D. Thesis. Charles University, Faculty of Science. https://is.cuni.cz/webapps/zzp/detail/84804. Accessed 15 June 2024.

Andreev EM, Shkolnikov VM. Spreadsheet for calculation of confidence limits for any life table or healthy-life table quantity. Rostock: Max Planck Institute for Demographic Research; 2010.

Wilmoth JR, Horiuchi S. Rectangularization revisited: variability of age at death within human populations. Demography. 1999;36(4):475–95. 10.2307/2648085. PubMed

Šídlo L, Hülleová I, Sykáčková P. The planned closure of GP practices for children and adolescents in the Czech Republic from the point of view of the doctors themselves: isn’t it the “12th time”? [Plánované ukončení praxí praktických lékařů pro děti a dorost v Česku pohledem lékařů samotných: Není už „po dvanácté“?]. Časopis lékařů českých. 2018;157:367–72 (Czech). PubMed

Eurostat. Duration of working life—statistics; 2023. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Duration_of_working_life_-_statistics#Steady_increase_in_the_expected_duration_of_working_life_in_the_EU. Accessed 15 June 2024.

Silver MP, Hamilton AD, Biswas A, Warrick NI. A systematic review of physician retirement planning. Hum Resour Health. 2016;14:67. 10.1186/s12960-016-0166-z. PubMed PMC

Hedden L, Lavergne MR, McGrail KM, et al. Patterns of physician retirement and pre-retirement activity: a population-based cohort study. CMAJ. 2017;189(49):E1517–23. 10.1503/cmaj.170231. PubMed PMC

Owen K, Hopkins T, Shortland T, Dale J. GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey. BMJ Open. 2019;9(2): e026048. 10.1136/bmjopen-2018-026048. PubMed PMC

Dudel Ch, Myrskylä M. Working life expectancy at age 50 in the United States and the impact of the great recession. Demography. 2017;54(6):2101–23. 10.1007/s13524-017-0619-6. PubMed

Rohrbacher M, Hasselhorn HM. Social inequalities in early exit from employment in Germany: a causal mediation analysis on the role of work, health, and work ability. Scand J Work Environ Healthy. 2022;48:569–78. PubMed PMC

Solovieva S, de Wind A, Undem K, et al. Socioeconomic differences in working life expectancy: a scoping review. BMC Public Health. 2024;24:735. 10.1186/s12889-024-18229-y. PubMed PMC

Shiri R, Hiilamo A, Lallukka T. Indicators and determinants of the years of working life lost: a narrative review. Scand J Public Health. 2021;49:666–74. 10.1177/1403494821993669. PubMed PMC

Šťava J. Working after retirement age: Institutional incentives in the Czech Republic [Pracovní aktivita po dosažení důchodového věku: Institucionální pobídky v České republice]. IDEA. Praha. Národohospodářský ústav AV ČR. 2015.

Kadefors R, Nilsson K, Rylander L, Östergren P-O, Albin M. Occupation, gender and work-life exits: a Swedish population study. Ageing Soc. 2018;38(7):1332–49. 10.1017/S0144686X17000083.

Kalwij A, Pasini G, Wu M. Home care for the elderly: the role of relatives, friends and neighbors. Rev Econ Household. 2014;12:379–404. 10.1007/s11150-012-9159-4.

Jeřábek H. Mezigenerační solidarita v péči o seniory. Praha: Sociologické nakladatelství (SLON); 2013.

Smith F, Goldacre MJ, Lambert TW. Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977. BMJ Open. 2018;8: e022475. 10.1136/bmjopen-2018-022475. PubMed PMC

Halliday L, Walker A, Vig S, et al. Grit and burnout in UK doctors: a cross-sectional study across specialties and stages of training. Postgrad Med J. 2017;93:389–94. 10.1136/postgradmedj-2015-133919. PubMed

Kimak A, Woźniacka A. How old is too old to work for physicians? Postepy Dermatol Alergol. 2023;40(3):368–71. 10.5114/ada.2023.128977. PubMed PMC

Sataloff RT. Physicians and retirement. Ear Nose Throat J. 2019;98(7):394–5. 10.1177/0145561319858882. PubMed

Crowson MG, Vail C, Eapen RJ. Influence of electronic medical record implementation on provider retirement at a major academic medical centre. J Eval Clin Pract. 2016;22(2):222–6. 10.1111/jep.12458. PubMed

Lillis S, Milligan E. Ageing doctors. Aust J Ageing. 2017;36(1):14–8. 10.1111/ajag.12371. PubMed

OECD. Health workforce policies in oecd countries: right jobs, right skills, right places. OECD Health Policy Studies, OECD Publishing; 2016.