This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine in New York City, where I run the Division of Medical Ethics.
An interesting opinion piece appeared in The New York Times. A doctor asked, "How would you feel if your doctor was 100 years old?" That may seem a little extreme, but I think the point was that we're seeing more aging going on in the doctor workforce. I don't know how many people are practicing to 100 years of age — I suspect it's not many — but there are more and more older physicians.
Retirement is not mandatory for your doctor at age 65. By the way, it is for an airline pilot. They can't fly commercial after that age. Many other professions have mandatory retirement, partly linked up to the idea that there may be cognitive or health decline, and partly linked up to the idea that they want, if you will, new people to come in and be able to rejuvenate businesses or organizations.
This issue about what to do with an aging workforce of doctors is serious because the workforce is aging and there's a shortage of doctors. It may seem a little crazy to start to talk about whether we should force retirement for physicians when we don't have enough physicians, and every manpower prediction shows that there are going to be fewer and fewer physicians to meet demand in the years ahead. Don't we want to keep those people active? Don't we want to keep as large a workforce as we can? Well, sure, but it's obvious that we want a competent workforce.
The good news is that science is beginning to understand that there are people among us who are so-called superagers. They do very well. Memory is maintained. They stay relatively healthy. They are able to function at a very high level into their seventies and eighties.
Indeed, studies are ongoing to try to figure out why some of us do well in old age. Most of the studies are focused on why some of us don't do so well — say, Alzheimer's or Lewy body syndrome — but there is a subset of people who do very well.
Obviously, there are some doctors who can practice and do what they need to do in their specialty well into their seventies and eighties. I don't know about 100, but certainly they're getting on in age and are still able to do a good job.
I think the time has come for something that makes people nervous, but I don't think it has to be extraordinarily burdensome, and that's checking for competency. Now, before everybody gets angry about that idea — because, obviously, there are doctors out there who are young and their competency isn't very good for a variety of reasons, such as impairment or they don't keep up with the literature — the fact is that we know that aging can impair and aging impairs a subset of people at a stronger clip.
There must be a simple way to just recheck basic competency using a memory test, some sort of dexterity test, or a simple 20- or 30-minute examination annually or every other year, just to make sure that once you are older than 65, your skills have not slipped in a way that would harm patients or cause the risk of malpractice to increase. I know nobody likes to get tested, and I know I don't like to get tested.
Professors are another group that can stay on, and I would advocate the same for them — that they have to pass a mandatory recertification in order to be a professor past age 65. I think we all understand that the testing doesn't have to be on the understanding of the latest literature, because experience and wisdom count strongly in medicine and you can refer to others when you're really looking for someone who has the latest, most up-to-date knowledge in a subfield. We probably do that anyway. The testing should be focused on basic mental capacity and skill.
Look, I've called for testing in this forum before, for presidential and vice presidential candidates. I think we ought to be testing them routinely when there are elections via independent assessment for basic skills.
Although I'm not calling for any type of mandatory retirement age for healthcare workers or doctors, I do think the same basic testing makes sense. There are those superagers out there who are going to do great and there's a subset of folks who are going to start to slip.
Although there are protections — certainly, peers, keep an eye on one another — to make sure that their practice is what it should be, I don't think it would hurt to have a basic, simple recertification test so that we don't damage the workforce when we need it the most, but we don't allow people to slip through who probably shouldn't be practicing any longer.
I'm Art Caplan at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thank you very much for watching.
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Cite this: Arthur L. Caplan. Would You Go to a 100-Year-Old Doctor? - Medscape - Dec 22, 2022.