The Aging Physician Conundrum

A third of physicians practicing in the United States today are over age 65, a statistic expected only to rise as financial pressures make it more difficult for doctors to retire. And with the expected flood into the healthcare marketplace as more Americans will carry health insurance thanks to the reform law, an article published in the New York Times highlights concerns that there aren't enough precautions in place to ensure the competency of our aging doctors.

As physicians know, the signs of mild cognitive impairment may be subtle at first. They may not notice difficulty being able to recall words, learn new material, apply knowledge to solving problems, or multitask. For this and other reasons, it often is the responsibility of fellow physicians and medical societies to report doctors who aren't able to proficiently perform. However, a 2005 study published in the American Journal of Medicine found that the rate of disciplinary action for physicians out of school 40 years was only 6.6%, while an Annals of Surgery study in 2006 confirmed that patient mortality for complicated procedures was higher when the surgeon was over age 60.

Without a systemized way to regularly review physicians’ cognitive abilities and competence, physicians understandably are reluctant to confront or report peers or elders who may be struggling. According to the Times, they're more likely to help cover up a colleague's deficiencies by having another surgeon in the operating room, for example.

While some specialty boards already require physicians to renew their certification every seven to 10 years, the vast majority of affected physicians have been 'grandfathered' in to not having to take the test, noted physician blogger Kevin Pho, MD. Thus, some experts are calling for regular cognitive and physical screening once doctors reach 65 or 70.

According to Jonathan Burroughs, MD, a consultant with the Marblehead, MA-based Greeley Company, between 5% and 10% of hospitals around the country have started to put such screening mechanisms in place. "The other 90 to 95 percent are not willing to take this on," he told the newspaper.

When Karl Serrao, MD, the credentials chairman at Driscoll Children’s Hospital in Corpus Christi, TX, tried to enlist the staff’s help in drafting a policy for aging physicians, the staff expressed concerns about age discrimination, losing the valuable experience of older physicians, and invasion of privacy. Now the hospital’s policy states that when doctors 70 and older are up for reappointment, they must undergo cognitive and physical exams that assess skills specific to their specialty.

Burroughs believes that screening physicians may be a more compassionate route than doctors think. “By identifying the issue early enough, it enhances their chance of being able to practice longer,” he said. When a cognitive deficit is discussed openly, the physician’s practice can be simplified, he can reduce his patient load, and his partners can regularly monitor and assess his work.

“But once something bad happens,” he added, “he’ll get his license taken away.”

Source: FiercePracticeManagement

For more:

• As Doctors Age, Worries About Their Ability Grow (New York Times)
• When Older Doctors Put Patients at Risk (NYT Blog)
• Old doctors who continue to treat patients (KevinMD.com)