Should Doctors Be Tested for Competence at Age 65?

Leigh Page

Disclosures

October 28, 2015

In This Article

A Call for Preliminary Guidelines

The AMA Senior Physicians Section is just a couple of years old, and age-based testing was a topic for the section to make its mark, Dr Wolfe says. "We thought this issue was where we could be of value to the AMA." For the past few AMA meetings, the section has been inviting experts on physician performance and quality to speak on the aging doctor. She says the sessions drew so many attendees that there were no chairs left.

She's somewhat disappointed with the AMA report, however. The 21-page document "presented a lot of powerful reasons why testing is needed, but the recommendations didn't come out forcefully for testing," Dr Wolfe says. "A lot of people felt they were a little tepid."

Rather than fully embrace this approach, the report states that "formal guidelines on the timing and content of testing of competence may be appropriate," and called for the creation of "preliminary guidelines."

Dr Stockdale has a very different view of the AMA report. Having read many of the same studies cited in the report while on a Stanford committee probing the issue, he thinks it accepted favorable findings on age-based testing "with an uncritical eye." A lot of the studies, he maintains, "depend on samples that are too small, or make conclusions based on very slight differences in performance that have no clinical importance."

The Stanford professor says his own informal review of the data shows that older doctors aren't responsible for more mistakes than those of other age groups. For example, when he looked at "never" events—serious events that could have been prevented—"the percentage involving older physicians was not disproportionate for this age group," he says.

Some Hospitals Have Created Policies

A small but growing number of hospitals have age-based testing policies, according to Jonathan Burroughs, MD, a healthcare consultant in New Hampshire.

Altogether, he says, about 50 hospitals he advises have some kind of policy to screen older providers. He cites age-based testing programs at Driscoll Children's Hospital in Corpus Christi, Texas; Jewish Hospital and Sts. Mary and Elizabeth Hospital in Louisville, Kentucky; and Portsmouth (New Hampshire) Regional Hospital.

In many cases, hospitals that initiated policies "had an issue with an older doctor who was incapacitated but had not yet gotten into trouble," Dr Burroughs says. "This was a ticking time bomb."

He added that some hospitals considered age-related policies but then backed off, after pushback from doctors on staff. "They (hospitals) know this is the right thing to do, but they're worried about upsetting their doctors," Dr Burroughs says. "Ultimately, most hospitals are going to put patient safety ahead of physician autonomy."

A formal policy on age-based testing is necessary, he says, because hospitals that choose to sanction on older physician will need to have an airtight case that he or she is too impaired to practice, and then provide solutions that treat the doctor fairly without violating the law.

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