Should Doctors Be Tested for Competence at Age 65?

Leigh Page


October 28, 2015

In This Article

Is Cognitive Testing Right for Physicians?

Owing to concerns about cognitive impairment in older physicians, many age-based testing programs use cognitive tests, such as MicroCog™ and the Montreal Cognitive Assessment, as assessment tools. Such tests have been used for years by physician health programs, which evaluate doctors who may be impaired.

In many age-based testing programs, physicians start with a fairly short cognitive screening, such as the Mini-Mental State Examination. If the findings show any concerns, doctors then get the full-blown exam, which is given by a neuropsychologist and lasts about 10 hours, spread over 2 days.

But as Stanford Medical Center concluded, cognitive tests haven't been validated for use on physicians. When scoring the test, the baseline for the general population is known, but experts say physicians should have to meet a higher baseline, which hasn't yet been identified.

To establish the physician baseline, researchers would have to a conduct a very expensive round of testing in each metric, according to Peter Donovick, PhD, a neuropsychologist at Binghamton University in Binghamton, New York, who has tested physicians. "You would need to evaluate a large group of several hundred fully functioning physicians and put each of them through a thorough cognitive evaluation," he says.

Doris Gundersen, MD, a psychiatrist who is president of the Federation of State Physician Health Programs and medical director of the Colorado physician health program, agrees that "no cognitive screening tests that I'm aware of have been validated specifically for the physician population," but she thinks age-based testing programs should use cognitive testing anyway. "We don't have the luxury of waiting for the 'gold standard' screening instrument," she says.

However, some age-based testing programs in addition to Stanford's program don't use cognitive tests. The College of Physicians and Surgeons of Ontario requires active physicians who reach age 70 to be evaluated, but rather than use cognitive tests, they're assessed by their peers, who review the doctors' medical records and how they treat patients.[14]

Some physicians would rather have peer review than a cognitive test. William Wilkoff, MD, a 70-year-old pediatrician in Brunswick, Maine, who retired 2 years ago, says he would feel uncomfortable with a cognitive test. "I wouldn't want to know that I have incipient Alzheimer disease and have only a few more years of clear thinking ahead of me," he says.

This glimpse into the future is made possible with cognitive testing. In fact, Dr Gundersen and a colleague reported[15] that 80% of the physicians identified with mild cognitive impairment would develop dementia within 6 years.


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