Competency is the foundation of sound clinical practice and is essential to preserving the lives of patients. However, unlike many other critical professions like airline pilots, air traffic controllers and law enforcement officials, the medical profession does not mandate that physicians of a certain age retire. There is considerable evidence that physician fitness does degrade following age 65; a 2005 report by Khaliq, et al, found that physicians who have served for forty years or more had a 6.6% likelihood of receiving some form of disciplinary action as opposed to the 1.3% rate among those with only ten years of service. With the wellbeing of patients at stake, many within the healthcare community have argued that there should be a mandatory retirement age for physicians.
There is a significant legal hurdle in the United States to introducing a mandatory retirement age: the Age Discrimination in Employment Act of 1967 (ADEA). The ADEA protects employees aged 40 or older from discrimination in hiring, firing, promotion, compensation and other employment issues. While it may be possible to successfully pass legislation that would classify physicians as a profession which merits such limits, it would require strong support from the health care community, which is unlikely to materialize.
While the vast majority of physicians over 65 who are still active possess the mental and physical skills necessary to provide adequate care, there is a significant population whose skills have declined to the point of impairment. Currently there are no national or industry standards in place to ensure that aging physicians are competent to practice. While there are continuing education requirements, these are often fulfilled as long as the physician is present, with no regard for skill level. Issues of competency do not typically arise until a disciplinary action by a state medical board is enacted.
Some hospitals and managed care organizations have taken steps to identify physicians with deteriorating performance, but this is still a limited group. According to some estimates only five to ten percent of hospitals have introduced evaluations for aging doctors. There are institutional issues which inhibit the implementation of these testing programs. Many hospital administrators and fellow physicians are reluctant to disqualify an elderly physician who has performed admirably in the past and may have a strong desire to continue practicing.
The growing number of senior physicians has also compelled the premier medical organization to examine the issue. The American Medical Association is currently in the process of formalizing guidelines to ensure physician fitness. There are currently AMA committees developing mental and physical evaluations that practicing physicians must pass on a periodic basis following a certain age threshold. It is unknown when the AMA plans to publish its suggested guidelines although it does plan to reveal committee findings at an upcoming conference.
The heated opposition to ageist policies, however, point to other studies that suggest that older physicians are often the most skilled and careful. Martin Makary of Johns Hopkins performed a study that showed physicians aged 60 or older were the least likely of any age group to commit catastrophic errors like operating on the wrong patient or organ.
Many critics argue that there are other issues than mere age-related decrepitude at play. Some older physicians find it difficult to adopt new treatment modalities, and this undermines their patient outcomes. The solution may not lie in barring older doctors from practicing, but rather in mandatory skill training.
Another compelling factor is that older physicians may lack patient management experience. A study in the Harvard Business Review examined the patient mortality rates among older physicians. While those older doctors that cared for less than 200 hospitalized patients annually did have a higher mortality rate than younger physicians, older physicians with more than 200 patients had a comparable mortality rate to other age groups.
Both sides of the debate have convincing arguments to support their contentions, but there may be a factor that outweighs all others. The rapidly growing shortage of physicians practicing in the U.S. is placing enormous strain on an already overburdened health care system. With the American senior population becoming the fastest growing segment, and one which utilizes an enormous share of our medical services, we may not be in a position to deny a physician the right to practice no matter how old they may be.
Article written by:
Dr. Robert Moghim - CEO Onyx M.D.
Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.