How to handle aging physicians

With a national physician shortage and growing numbers of insured patients coming down the pike, hospitals are facing the conflict of hanging onto their physicians who are growing older while offering care for their expanding patient population. But are older physicians fit for practice?

A study published in the British Medical Journal this week indicated that surgeons who are not too old and not too young are the safest, that is, had the fewest patient complications. This Goldilocks data found that the sweet spot for optimal performance is a surgeon between the ages of 35 and 50, who provide safer care than their older and younger colleagues. The thought-provoking study indicated that surgeons with five to 20 years of experience since graduation had better patient outcomes. The surprising part wasn't that middle-aged physicians fared better than green surgeons; the surprising part was that they did better than physicians who had more years of experience on them. What was the reason for this sweet spot? Study authors concluded that more research is needed but noted it could have to do with mental fatigue from taking on more surgeries, suggesting burnout or reduced competency.

While most can respect the expertise and experience that older physicians have to offer, what are hospitals to do when their providers get on in their golden years?

Kenneth Cohn, a practicing general surgeon and CEO of HealthcareCollobration, described a situation with an 83-year-old general practitioner, seen as a "ticking time bomb." Does the physician's senior citizenship status negate his hospital experience during the past five decades? Even though there may not be any complaints (yet) about the physician's performance, the medical executive committee is charged with tackling this delicate issue and preventing patient harm, Cohn wrote in a Hospital Impact blog post. But what could be a fair solution, as physicians and other practitioners inevitably age?

As many hospital executives have noticed during the past decade, physicians are delaying retirement. In fact, more than half (52 percent) of surveyed physicians said their retirement plans have changed since the recession hit, according to a Jackson & Coker survey last year. Out of these physicians whose plans have changed, a quarter (25 percent) of physician respondents said they find locum tenens or part-time assignments appealing. Offering part-time work could be one way to usher providers into more manageable workloads.

Another solution is to offer an advisor role, in which the physician can coach other providers. That respects their years of experience and allows the older physician to mentor the next generation of doctors.

What about physicians who have no interest in slowing down? For example, Fred Goldman, the oldest licensed physician practicing medicine in Ohio, turned 100 last month. The century-old internist started his private practice in 1946 and said he has no intention of retiring anytime soon, as FiercePracticeManagement previously reported.

For physicians who are committed to continuing to practice like Goldman, some hospitals are implementing mandatory assessments. The strategy requires all physicians over a particular age to undergo a physical exam, as the Credentialing Resource Center Blog recommended. Consider including in the medical staff bylaws a policy, which balances the rights of the provider with the safety of patients. The institution should decide what is an appropriate age, the post noted.

As some Hospital Impact commenters pointed out, there are age discrimination implications of mandatory assessments. Although organizations theoretically could use a blanket policy to assess all providers (regardless of age), there are associated costs with these kinds of tests--who can afford to pay for that?

Is it fair (not to mention, legal) to include a medical staff policy for practitioners over a certain age? How has your institution cared for your patients and aging physicians? - Karen (@FierceHealth)