Aging Physicians: Are Enough Precautions in Place?

This article was originally published on HCPLive.

A third of physicians practicing in the U.S. today are over age 65, a statistic that is expected to continue to rise as financial pressures make it more difficult for doctors to retire. 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, especially as more Americans are expected to seek out medical care thanks to new health-insurance coverage under Obamacare.

As physicians know, signs of mild cognitive impairment can be subtle at first. Doctors may not notice difficulty being able to recall words, learn new material, apply knowledge to solving problems, or multitask. For this and other reasons, the responsibility to report doctors who aren't able to proficiently perform often falls to fellow physicians and medical societies. But 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 who may be struggling. According to the Times, physicians are 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' and so don’t have to take the test, according to 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, Mass.-based Greeley Co., 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 Times.

When Karl Serrao, MD, the credentials chairman at Driscoll Children’s Hospital in Corpus Christi, Tex., tried to enlist the staff’s help in drafting a policy for aging physicians, the workers 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