Friday, June 12, 2015

Aging physicians

Confession:  I am 64.

Stepping back incrementally from medical practice in this way is one solution for a generation of aging physicians. A Virginia Healthcare Workforce Data Center survey found that by age 65 more than one-third of physicians still on the job were working part-time; by 70, fewer than half still had full-time schedules. Presumably, most of those doctors have cut back because they wanted to, and that’s how Carmel thinks it should work—that physicians can be trusted to do the right thing, curtailing or ending their medical careers when aging begins to impinge on their ability to practice safely...

Blasier cites a study in Neurology that found a direct correlation between the length of time a surgeon has been licensed and the likelihood that a patient will die during carotid endarterectomy. He also points to a Clinical Orthopaedics and Related Research study of knee replacement in which patients of younger surgeons had fewer complications.

Still, there’s little hard-and-fast evidence that older doctors are generally worse for their patients...

Medicine is a hierarchical field that has always revered its seniors and storied experts. Now the profession faces a time when some of those men and women must be asked to come down from their pedestals and be assessed for their basic abilities to continue to help their patients...

In efforts to find physicians whose competence and effectiveness might be faltering, some hospitals have initiated age-based assessments. At Driscoll Children’s Hospital in Texas, for example, physicians over 70 who are up for reappointment now have to undergo physical and cognitive evaluations assessing skills in their specialties. At Stanford Hospital and Clinics and at Lucile Packard Children’s Hospital in California, physicians get physical exams, cognitive screening and peer assessment at age 75...

Airline pilots and federal agents must retire at 65 and 57, respectively, and state and local governments set the ages at which police and firefighters must leave the job. And while having the same sort of automatic cutoffs for physicians may not be likely or even desirable, the life-or-death nature of their work does suggest a need for some kind of evaluation to ensure that doctors continue to practice safely as they age. “We just have to make it more acceptable” to assess older doctors’ abilities, says UCSD’s Norcross. “Pilots are intensively assessed, and if any problem is found it has to get fixed, or they don’t fly.”

For now, at least, it’s largely up to physicians themselves to know when to stop. When Carmel was chair of his department, he gave his power of attorney to a colleague and asked that surgeon to make sure Carmel’s medical privileges were revoked if he saw that Carmel was no longer competent.
Various types of checks and balances are common within surgical groups, Carmel says. But those amount to a voluntary and piecemeal approach to a problem that will only become more pronounced as the general population ages. Hospitals and medical boards need to get involved, perhaps by requiring a deeper level of ongoing assessment, with teeth. The painful reality is that everyone gets older, and there can’t be any special dispensation for doctors when the time comes to call it quits. 


  1. But there are no national mandates or guidelines on how to make sure older physicians can still do their jobs safely.

    It's time to change that, the report suggests, noting that the number of U.S. physicians aged 65 and older has quadrupled since 1975 and now numbers 240,000 - one-fourth of all U.S. doctors - although not all still see patients...

    It's a touchy topic for older doctors, and not all welcome the prospect of extra scrutiny.

    "I don't myself have any doubts about my competency and I don't need the AMA or anybody else to test me," said Dr. William Nyhan, an 89-year-old pediatrician, genetics researcher, runner and tennis player who works with the University of California, San Diego and a children's hospital there.

    "There are a lot of people overlooking my activities" already, he said. "This is a litigious society - if we were making mistakes, we'd be sued."

    Dr. Jack Lewis of Omaha, Nebraska, turns 81 this week and has worked as an internal medicine specialist for half a century - first with his dad, who worked until age 83, and now with his 41-year-old physician son.

    "My dad always told me to watch to see if he was making mistakes or losing it, and my son is watching me the same way," Lewis said.

    Lewis sees 25-30 patients daily. While his "hands aren't as good as they used to be" and he sometimes forgets patients' names, he doesn't think anyone should make him leave the work he loves.

    He agrees that some sort of age-based assessment for physicians is probably a good idea, but said, "If I made a mistake, I'd be the first one to quit here."


  2. "We all know 80-year-olds who can play an intense game of tennis and others who can't even walk to the mailbox," says Katlic. "Surgeons are the same; many still do great work in their 70s, but others should not be practicing anymore."

    Katlic points to several worrying anecdotes he has heard of excellent surgeons who ran into trouble as they got older. One needed to be led back to his office after an operation. Another began showing up to work sloppy and unclean. Still another surgeon fell asleep while performing a procedure.

    "I think the general public would be very interested to know that [surgeons] don't police [themselves] well as a profession," Katlic says. "It often takes a bad complication that hurts a patient before something serious is done."...

    The key is creating a series of tests and guidelines that check capabilities, instead of chronological age. The Aging Surgeon Program at Sinai Hospital is one example of this....

    Surgeons who are concerned about their health can opt to take the test, but hospitals can also request evaluations of their surgeons. The results and recommendations — good or bad — are entirely confidential and supplied solely to the individual who requested the evaluation.

    While it may sound like a good option for senior surgeons, the program has had its difficulties. For one, not a single doctor has stepped forward to take the test.

    "However, we've learned that a number of physicians have opted to retire when threatened to be put through our program," Katlic says.

    Some critics of these sorts of tests and guidelines say they are needlessly discriminatory, and should focus on competency, not age. Others point out that physicians, of all people, have the training and experience to evaluate their own health, and shouldn't need outside oversight. But that's not good enough, Katlic and Perry say. Doctors are human, too.

    Courtesy of: