Older Physicians: Balancing Experience With Competence

Paolo Spriano

January 30, 2023

Traditionally, physician experience is narrowly regarded as related to years in practice or to one's age. The ability to practice one's profession may decrease over time for various reasons. There is some evidence that physicians with greater experience may provide poorer-quality care than their less-experienced counterparts, as captured by various quality assurance measures.

Age-related cognitive decline and even full-blown dementia may become an increasingly common feature with the aging of the medical population in Italy and around the world. This fact has driven a discussion about whether assessment criteria can be used to ensure that physicians work competently for as long as possible and, if so, what these criteria are.

Physician Aging

It is estimated that in the United States over the next 10 years, more than 40% of practicing physicians will be older than 65 years, an age range in which 11.7% of people report cognitive decline. Although cognitive decline is less common among more highly educated individuals (like physicians), the data show that around 1 in 5 physicians older than 70 years may experience mild cognitive decline, and 1 in 15 may have cognitive impairment.

Various age-related factors may affect a physician's process of analysis, such as a reduced working memory and visual acuity and slowing of mental operations. The differences, in terms of care provision, may become evident in physicians older than 60 years. Practitioners may be less likely to acquire new knowledge over time, such as new treatment strategies, for example.

Faced with an aging medical population in the US, the American Medical Association advocates a process involving not only the checking of professional competency but also the review of cognitive and motor capacity in late-career physicians to ensure that they can provide medical care competently and safely. The rate of variation in executive function, wisdom, memory, and other cognitive components is not linear. It may change unpredictably over time and be influenced by various factors independent of age.

Age and Experience

Older physicians have valuable skills and clinical and professional experience that can only be earned through years of practice, yet younger physicians may bring vitality and innovation to the role. Instead of isolating aging physicians, healthcare systems should consider developing acceptable standards of assessment that are applicable to all physicians, regardless of age.

For many physicians, the decline in professional competency may simply be a matter of not managing to stay up to date with the most recent guidelines and with rapid advances in medical science.

If this were how physicians were to be judged, then the longer they had been practicing as a physician, the more likely it would be for them to have decreasing knowledge of the current standards of care. This concept was verified by a review study of how a physician's clinical experience can affect healthcare quality and of which dimensions of quality might be affected. Overall, 27 (43%) evaluations yielded a positive or partially positive association between physicians' clinical experience and healthcare quality; 22 (35%) found no association; and 14 (22%) evaluations reported a negative or partially negative association.

The review found a proportional association between physicians' clinical experience and quality regarding outcome measures that reflect safety, particularly in the surgical fields. For other dimensions of quality, no firm evidence was found. Nearly two thirds of physicians across multiple specialties in the United States report spending insufficient time keeping current in their area of practice. This problem is reflected in data showing that 4% to 13% of physicians in varying specialties fail their recertification examinations and that nearly 6% of family physicians do not even attempt recertification.

In Italy, the idea of professional requalification is currently not under consideration, despite the aging of a professional class that has had to seek an extension until 2023 to fulfill its CME requirements. With many physicians who are older than 60, are tired of their job, and are willing to leave the profession as soon as the opportunity arises, there are two ways of addressing the problem, one temporary and the other permanent. But these approaches do not resolve the question of how to check the competency of physicians toward the end of their careers.

This article was translated from Univadis Italy.


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