Should Doctors Be Tested for Competence at Age 65?

Leigh Page

Disclosures

October 28, 2015

In This Article

Senior Doctors Are Divided

Doctors in their 70s are taking leading roles on both sides of the debate.

Claire Wolfe, MD, a 71-year-old physiatrist in Dublin, Ohio, was a key player in the AMA's decision to draft preliminary guidelines. She's a member of the governing council of the AMA Senior Physicians Section, which spearheaded the AMA's decision to take up the issue.

Last year, the section introduced a resolution to the AMA House of Delegates calling for mandatory testing of older physicians. After spirited debate, the House referred the matter for study. The resulting study,[1] presented at this year's annual meeting, proposed what the AMA should do, and the House approved it in May with reportedly little debate.

Dr Wolfe says there are several reasons why age-based testing is needed. "Unfortunately, older physicians don't always know when to quit practicing," she says, and "it's very difficult to get physicians to identify impaired colleagues" and convince them to quit.

She says older physicians who aren't impaired should be allowed to practice no matter how old they are. Even when impairments are identified, every effort should be made to help physicians alter their practice without ending their careers, she says. But if they have serious impairments, such as dementia, they'll need to resign.

Dr Wolfe fully expects that many physicians will resist age-based testing. "This isn't going to be an easy sell to the medical community," she says.

Insurgents against the policy are already at the barricades—for example, Frank E. Stockdale, MD, also a septuagenarian. The 79-year-old breast cancer physician leads a group of 13 older physicians who have forced Stanford Medical Center to rewrite its age-based testing policy and have rallied Stanford faculty to come out against it.

"Older physicians aren't the problem," says Dr Stockdale. "Mid-career physicians are responsible for a disproportionately higher number of bad outcomes."

Although he's slowing down physically, Dr Stockdale says he has learned to adjust. "My memory isn't as good as it used to be and I don't play basketball anymore, but that doesn't mean I'm not competent to practice medicine," he says. "You learn to compensate." Older physicians tend to see fewer patients; focus on patients with less acuity; and spend more time with them, which patients like, he says.

Dr Wolfe has a markedly similar view about her own ability to continue practicing. Although she now works just 2 days a week, she doesn't think she's lost her mental acuity. "If I started to lose it, my colleagues would tell me." But she thinks many other end-of-career physicians are less willing to quit when impairment strikes. "Doctors say they'll know when they need to quit, but in many cases they won't do it," she says.

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