Should Doctors Be Tested for Competence at Age 65?

Leigh Page

Disclosures

October 28, 2015

In This Article

How Big Is the Problem?

There's no well-informed estimate on how many impaired older physicians might still be practicing, but there are many scientific studies on various aspects of this topic. The AMA report cites 72 such studies, many of which point to issues with older physicians, although they may not necessarily be age-related. For example:

  • A 2005 study[8] showed a much higher rate of disciplinary actions against doctors out of medical school for 40 years compared with those out of school 10 years.

  • Another study, also from 2005,[9] indicated that performance on a range of outcomes declined as physicians' years in practice increased.

  • A 2008 study[10] found "no notable relationship" between older physicians' own assessment of their cognitive skills and objective cognitive measures, indicating that the physicians may be unaware of their impairments.

  • Older surgeons, although competent in routine operations, performed more poorly in complicated procedures, such as coronary artery bypass graft surgery, according to a 2006 study.[11]

But even the most convincing studies show that a significant percentage of older physicians have no serious competency problems, even when they're at an advanced age. For example, a 2010 study[12] found that one third of surgeons in their 70s still matched younger surgeons in competence on a variety of tasks.

However, Dr Stockdale disputes that loss of cognitive ability is the main reason why physicians make mistakes. "The major reason for errors," he says, "is not cognitive problems but behavioral ones," such as alcoholism, substance abuse, and failure to document, which occur more frequently in younger physicians. "The mid-career is a more risky time for physicians," he asserts. "These doctors are 15 years or more beyond training, and what they learned has started to wane."

Rather than focus on end-of-career physicians, Dr Stockdale believes hospitals should beef up evaluations of all doctors, regardless of age. He noted that the Joint Commission already requires hospitals to regularly evaluate physicians' competence[13] in six areas, including patient care, clinical knowledge, and interpersonal skills.

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