Should aging doctors be tested for competency?
In a poignant scene from a 2003 episode of the medical show Scrubs, the usually lighthearted comedy takes a turn for the somber. Dr. Townshend — played by the then 78-year-old guest star Dick Van Dyke — has come under scrutiny for recommending a physician to perform an IJ cut down procedure instead of a much-safer modified Seldinger with disastrous results. His explanation? “Guys like us, we’re set in our ways.”
Chief of Medicine Dr. Bob Kelso levels with him: “This is not an age thing, Doug. Hell, these days if you’ve been out of med school five years, half of what you learned is obsolete. Why do you think I spend every other weekend at a seminar in some two-star hotel ballroom that still stinks of last night’s prom vomit? I do it because I have to keep up.”
When Townshend balks that he does not “have the energy for all that stuff,” Kelso tells him, “well… then we got a problem.”
This scene may be fictional, but it illustrates the challenges older doctors must face in a rapidly-evolving field like medicine. Age related impairments coupled with the increasingly-demanding medical standards can leave a lot of older doctors out of their depth.
While this qualification does not affect everyone, it has become enough of a concern for the AMA to file a report questioning whether physicians over the age of 65 should be required to submit to mandatory evaluations in order to maintain their licensure. Subsequently, the topic regarding what standards a physician must comply with just because of their age has prompted opinions from all corners of the medical field.
Naturally, the most vocal opinions are coming from the physicians aged 65 and over themselves. They have a vested interest in preserving their privacy and protecting themselves against what could be construed as age-related discrimination.
There are a lot of people in this camp, too. Four times more than in 1975, in fact. An estimated 241,000 doctors are aged 65 or older, and 95,000 of them are still in patient care. Between 10,000 and 15,000 of these doctors are considered “actively practicing” surgeons. In professions like ophthalmology, the average physician’s age is around 54 years old. No matter what side of the camp you are on, you can see how that many interested parties leaves a lot at stake.
Individuals who fall under this umbrella are skeptical of the value additional testing might bring. “There’s already so much peer review, continuing education, maintenance of certification and self-assessment” and testing, said 72-year-old oncology surgeon Paul Goldfarb. “Regardless of your age, if your practice changes — you become more difficult to deal with, you forget to show up in the OR, or you have complications, you misspeak when writing your orders — that’s what should trigger intervention and review.” He even highlighted the danger of conducting periodic tests that may “fail to capture the actual change in behavior and practice that’s occurring.”
Others similarly point to the processes most physicians must undergo as a result of aging. Many hospitals and health institutions are already enacting mandatory evaluation policies. Stanford began performing special assessments for physicians aged 75 and older last year. The assessments are supposed to occur every two years. The University of Virginia began a similar policy in 2011 for physicians aged 70 or older.
Preventing mistakes before they occur
The issue with relying on processes and policies like those at Stanford and UVA is that not every provider uses them. Other times, the physician will be practicing outside such auspices. A mass migration of healthcare professionals from a hospital setting to a clinical, ambulatory care or office setting has diminished the oversight capabilities of these programs. “The new paradigm is that most physicians don’t go to the hospital anymore” says Dr. Claire Wolfe, a 71-year-old AMA member on its governing council of Senior Physicians. “Most physicians are off in their office silos. Our concern was, should we be looking at physicians as they age?”
Those like Wolfe are fearful that damning incidents outlined by Goldfarb that should trigger reviews may cost more than just the aging doctor’s dignity. “We’ve seen a number of tragic career endings,” says Dr. David Bazzo, director of the University of California San Diego’s Fitness for Duty Program.
Simply put, waiting until a problem does occur may make it too late to pull a doctor from duty before damage is done. This philosophy is what prompts mandatory retirement ages for U.S. Pilots and military personnel. Otherwise, an innocent mistake could cost lives.
Evidence scant for aging doctor competency trends
The only missing component in the AMA’s argument is perhaps a direct link between a doctor’s age and their ability to perform patient care. Grounds for anti-discrimination lawsuits could result unless research somehow proves that age 65 or any other number can mean a downward decline in professional abilities, not just the ability to see clearly or remember names.
As the issue heats up, expect more pressure to be placed on finding and interpreting evidence that could irrefutably justify competency assessments. Until then, older physicians have enough to keep up with while new developments like electronic health records and ICD-10 roll in.