Aging docs need regular evaluation to ensure competence

One-third of physicians practicing in the United States today are over age 65, a statistic expected only to rise as financial pressures make it more difficult for doctors to retire. And with the expected flood into the healthcare marketplace as more Americans will carry health insurance thanks to the reform law, a recent article in the New York Times highlights concerns that there aren't enough precautions in place to ensure the competency of our aging doctors.

As physicians know, the signs of mild cognitive impairment may be subtle at first. They may not themselves notice difficulty being able to recall words, learn new material, apply knowledge to solving problems, or multitask. For this and other reasons, it often is the responsibility of fellow physicians and medical societies to report doctors who aren't able to proficiently perform. However, a 2005 study found that the rate of disciplinary action for physicians out of school 40 years was only 6.6 percent, while a separate 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 or elders who may be struggling. According to the Times, they're 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 to not having to take the test, notes physician blogger Kevin Pho, MD. Thus, some experts are calling for regular cognitive and physical screening once doctors reach 65 or 70. According to Dr. Jonathan Burroughs, a consultant with the Massachusetts-based Greeley Company, between 5 and 10 percent 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 newspaper.

But at the end of the day, systematically assessing older physicians' competence may be the most effective and compassionate option. "By identifying the issue early enough, it enhances their chance of being able to practice longer," Burroughs said. Pho agreed, writing, "If a physician is found to have deficits, adjustments to his schedule can be made to better conform to his abilities. It beats the alternative, where medical licenses are revoked when patients are hurt by doctors no longer able to properly function."

To learn more:
- read the article in the New York Times
- here's the post from the NYT Well blog
- check out these comments from physician blogger Kevin Pho