Personal views: When should a specialist retire?
Authors: Jeremy Hugh Baron
Journal: BMJ (1998)

In 1844 an editorial in the Lancet (1844;i:486-90), presumably by Thomas Wakley, excoriated the eminent William Prout as a man who had outlived his reputation and exerted a stultifying influence on progress in his field: 

“[H]is main researches have been superseded by others .... [He] has retained in the text of his last edition his own account of the process of digestion without taking proper cognisance of the digestive principle pepsin .... [His] pathological notions ... have the appearance of closet speculations, and are diametrically opposed to the opinions of the soundest and most experienced men of the day .... [He has] total disregard of numerical and statistical details ... [and offers] hypotheses which are unsubstantiated either by facts or arguments .... Dr Prout’s name and authority exercise an influence that is detrimental to the cause of science in this country .... Time was when our schools stood foremost in the ranks for originality and discovery, but that time seems to have passed away .... The fault lies [in] the authority of those who, having earned a reputation for themselves, cast unfounded doubts upon the labour of others, neglect and repudiate, without sufficient cause, the methods followed by their competitors, and deny them that honour to which they are justly entitled by their discoveries. We regret to find Dr Prout in this category.” 

Charles Mayo, after visiting Britain in 1907 also found superannuated specialists. 

“Men who occupy the chief positions in the London hospitals, have gained them ... through long years of patient waiting and working in subordinate positions. By the time they became leaders, their work is more or less crystallized; and unfortunately, in many hospitals there is no machinery ... whereby these men may be retired .... [In] Edinburgh ... [it] is unfortunate that there is no age limit for the retirement of division heads, since the present system leads to their retention after their usefulness has departed, and the consequent delay in the advancement of the younger men.” 

Both Osler and Sir Ian Fraser had insight. Osler had two “fixed ideas: The first is the comparative uselessness of men above forty years.... The ... vitalizing work of the world is done between the ages of twenty-five and forty ... the anabolic or constructive period .... My second is the uselessness of men above sixty ... and the incalculable benefit it would be in commercial, political and professional life if, as a matter of course, men stopped work at this age.” 

Fraser “told one senior colleague that I was going to retire; he said very kindly, ‘We will miss your mature judgment.’ I hope he meant it. On the same day I ran into a much younger man and I told him the same. His reply was, ‘High time,’ and I know he meant it.” 

I sent a questionnaire to gastroenterologists around the world asking the usual age of retirement. In 34 countries 19 required retirement at 65. Retirement age ranged from 58 in India, 60 in seven countries and 63 in Finland up to 67 in Norway and 70 in Brazil, Denmark, and Spain. Australia and the United States had no fixed age limit. Four countries allowed academics, department heads, or professors to retire later, while in 10 employment could be prolonged for a few years. 


I have suffered from gerontocracy, and was pleased to be forced to retire at 65 from both my health service and university sessions in Britain. I retired from editorial boards and committees, and told journals, funding bodies, and universities that I would not write editorials, referee scientific papers, or grant applications, nor examine. I no longer see patients or direct research, and limit my competence to the history of medicine, science, and healthcare arts, where I do not lock out younger people. Most British private hospitals and NHS private wings stop consultants working after 70 except by annual extension by their medical committees. Some private health insurers will not pay specialists after their 70th birthday. 


“We will miss your mature judgment”



The Wellcome Trust told me their choice of “most of the referees used are still active in research. However, there are circumstances—for example, when we need advice on academic or strategic scientific issues, when we seek advice from more senior individuals who can contribute some of the wisdom which accrues from a lifetime of research.” 

I work half the year in New York, which, as in my stay in 1961-2, has no mandatory retirement age for hospital or academic specialist staff, because it has no national health service and because by law no one can be forced to retire at any age except for incompetence. Instead each institution adopts its own policy. Few impose mandatory retirement ages on individual doctors, but many require retirement at specified ages for department or division heads. It will be interesting to see whether the changes in the delivery of specialist health care in the United States lead to a compulsory retirement age. 

I thank those who answered my questions and improved my text.