Retirements and organizational performance: Mixed methods evidence from Portuguese public hospitals.

BACKGROUND: Healthcare systems across Europe are facing increasing workforce shortages. This supply-side constraint is particularly relevant in Portuguese National Health Service (NHS) hospitals, considering the impending volume of health professionals' retirements. OBJECTIVE: This paper aims to estimate the impact of physicians' and nurses' retirements on hospital operations and inpatient outcomes. METHODS: The analysis draws on 2006-2018 NHS records (covering all discharges from Portugal's public hospitals) merged with Social Security records (covering all public servant retirements) at the hospital-month level and panel fixed-effects models with case-mix controls. Semi-structured interviews with health professionals and hospital executives contextualize findings. RESULTS: Our study shows that retirements, especially of physicians, are associated with short-term shifts in hospital activity, particularly a reduction in the share of inpatient-care admissions and changes in specific admission categories, rather than a broad reduction in total admissions. However, short-term patient outcomes remain stable, as resources are reallocated to critical cases. CONCLUSION: This study highlights the need for strategic retirement planning and timely staff replacements to minimize disruptions in hospital operations, which may include streamlining administrative processes and introducing more flexible job arrangements.