Aging physicians should be required to undergo competency and health screening, study says

Beginning at the age of 70, physicians' physical health, mental health, and cognition skills should be evaluated to determine whether they should continue practicing medicine, according to a paper recently published in the Journal of Medical Regulation.

That's likely a controversial recommendation as many doctors already believe that the practice of medicine is over-regulated and that physicians are losing some of their autonomy.

Regardless, what's beyond debate is that the U.S. physician populating is aging, according to data from the study, called "Approaching the Issue of the Aging Physician Population." For example, in 1985, the number of active physicians in practice was 476,683, with 9.4% aged 65 or more years. In 2011, physicians in active practice numbered 697,340, with 15.1% aged 65 or more years.

"The public thinks that physicians’ health and competence is being vigorously monitored and assessed. It isn’t,” William Norcross, MD, one of the study's authors, told KaiserHealth News last year.

Other professions are subject to age-related regulations. For example, airline pilots must undergo regular health screenings staring at age 40 and must retire at age 65. FBI agents must retire at age 57, Kaiser reported.

But is older age associated with increased risk of patient harm? It appears likely, according to a review of 62 published studies that the authors cite. More than half of those studies found declining clinical performance outcomes with increased age, whereas only one study showed improvements in all outcomes with greater age.

"Aging results in a wide spectrum of physiological changes which may affect clinical competence," the authors write. "Amongst the most important are the reductions in dexterity and visual-spatial acuity, short-term memory, problem-solving, and ability to adopt new ideas and to re-examine old ideas."

Still, the authors are quick to point out that positive psychological aspects of aging exist. Attributes such as optimism, resilience, compassion, and wisdom do not decline but stay stable or even increase with age, they say.

Nonetheless, patients with highly complex conditions, certain major operations, and multitasking confer higher patient risk with older physicians, the authors write.

The researchers explicitly state that they do not favor a mandatory retirement age for physicians for a variety of reasons, including that age in and of itself hasn't been shown to be a risk factor for incompetence. But they do favor age-based screening.

"The evidence, however, does point to a need for evaluation of mental and physical health at appropriate junctures throughout a physician’s lifecycle," they write. "A call for a process beyond self-regulation is warranted."

Although age-based screening may be a thorny issue that many doctors would prefer to avoid confronting, the authors warn that if physicians don't address the issue themselves, it's likely that someone else will.

"Physicians must take the lead in addressing this important issue. …The medical profession should act now, lest others dictate the direction of this important issue," they write.

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