Screen Aging Physicians for Competency, Report Asks

Marcia Frellick

June 15, 2015

CHICAGO — The nation's largest organization of doctors says it will work to develop processes to screen and assess competency for senior physicians.

Delegates here at the American Medical Association (AMA) 2015 Annual Meeting voted to approve a report that says it's time to have a system in place to test the competence of older physicians, although it didn't specify who would do the testing or how it would be done. It did say testing should include an evaluation of physical and mental health and a review of doctors treatment of patients.

The report points out that the number of physicians 65 years and older has quadrupled since 1975, and is now 240,000.

The sensitive issue drew impassioned testimony at a prevote hearing from those who say more assessment is necessary and those who call it discriminatory.

Michael O'Dell, MD, an alternate delegate from Kansas City, Missouri, speaking on behalf of the Heart of America Caucus, explained that "our caucus feels strongly that this is inappropriate and smacks of ageism."

If we can't get current maintenance of certification guidelines "right with the broad majority of physicians," he asked, "how can we possibly get it right with a small minority of physicians?"

The committee report has singled out seniors because "a large body of research demonstrates that cognitive dysfunction is more prevalent among older adults, although aging per se does not necessarily result in cognitive impairment."

Physicians can't rely on their own instincts when deciding when it's time to quit, said Claire Wolfe, MD, from Dublin, Ohio, during the prevote hearing. She was representing the Senior Physicians Section, which sponsored the resolution that led to the report.

 
Self-recognition of cognitive loss, even significant cognitive loss, doesn't happen.
 

"Self-recognition of cognitive loss, even significant cognitive loss, doesn't happen," she explained.

Unlike airline pilots — the profession often used for comparison because of the risk to human life involved in that job — doctors have no mandatory retirement age and there are no national mandates on making sure older physicians can give safe and effective care. However, all doctors must meet state licensing requirements, and some hospitals require age-based screening.

Nancy Church, MD, on the governing council of the Organized Medical Staff Section, said that the procedures already in place are enough.

 
They are scapegoating the senior physician.
 

"We all should have criteria and surveillance, no matter who we are. That's how we practice medicine," she told Medscape Medical News. But with this proposal, "we feel they are scapegoating the senior physician."

The extra assessments will give senior doctors one more reason to retire, just when the profession faces a rising shortage of physicians, she pointed out.

The report concludes by stating that "it is the opinion of the Council on Medical Education that physicians should be allowed to remain in practice as long as patient safety is not endangered and that, if needed, remediation should be a supportive, ongoing and proactive process."

Dr O'Dell, Dr Church, and Dr Wolfe have disclosed no relevant financial relationships.

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