Should aging doctors be tested for competency?

There has been growing concern within the medical industry that senior physicians can negatively impact patient care.

The American Medical Association (AMA) recently voted to acknowledge this possibility by unanimously adopting a plan to evaluate senior healthcare providers’ on-the-job effectiveness.

The plan is of particular interest to ophthalmologists, since the mean age of ophthalmic physicians is 54 years old, according to a 2013 American Academy of Ophthalmology membership survey.

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The AMA plan-proposed by the association’s Council on Medical Education-will give guidance to state medical boards about the maintenance of licensure process, and preliminary assessment recommendations will be developed.

Additionally, the plan emphasized that testing should include a review of the physician’s physical and mental health, as well as treatment of patients.

While some hospitals in the United States already require age-based screenings, there is no national policy to ensure older physicians are still practicing safely.

“Physicians should be allowed to remain in practice as long as patient safety is not endangered,” the AMA plan said. “Unfortunate outcomes may trigger an evaluation at any age, but perhaps periodic reevaluation after a certain age . . . when incidence of declines is known to increase, may be appropriate.”

Nevertheless, the AMA plan did note that no direct link between age and patient safety has been established. Further, the plan added that the move to create better guidelines could “head off a call for mandatory retirement ages or imposition of guidelines by others.”

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According to the AMA, the number of U.S. physicians who are 65 years or older has quadrupled since 1975 and currently stands at about 240,000-which is about one out of every four physicians.

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“A similar policy was proposed by the Federation of State Medical Boards with input from AMA . . . but the framework is relatively new and no state has implemented it,” Associations Now reported. “With the newly passed AMA policy, the group said it can continue to work with state medical societies and medical boards as they begin to work age-related MOL policies in.”

Not surprisingly, the AMA plan has already been met with resistance from the medical community. Associations Now reported that several Stanford University physicians claim the policy is “constituted age discrimination.”

Dr. Medow

Norman Medow, MD, FACS-an Ophthalmology Times editorial advisory board member-echoed a similar opinion.

“I am not in favor of competency based testing,” said Dr. Medow, director of pediatric ophthalmology and strabismus, Montefiore Hospital Medical Center, New York. “I think it is hard to evaluate, either by technical observation unless done over a broad range of skills and for a defined period of time, or by question and answer testing.

“Doctors of all ages working in a hospital full-time have mandatory annual physical exams and are constantly working under the eyes of their peers,” Dr. Medow continued. “Many subspecialties have mandatory 10 year re-credentialing renewal exams. What I do think that is important about this initiative is to make all physicians aware of the changes that can occur as we age.

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“Heightening the awareness of these changes is a very good idea, and should hopefully lead to physicians changing their practice life sooner than later,” he added. “The heightened awareness should be discussed, not infrequently, but periodically. I applaud the idea, not necessarily the initiative.”

That awareness is the silver lining in the plan, according to Roy Chuck, MD, PhD.

Next: 'Ophthalmology . . . would certainly be affected'

“The AMA report acknowledged that no direct link between age and patient safety has been established,” said Dr. Chuck, chair of ophthalmology and visual sciences at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, New York. “However, the move to develop the guidelines could ‘head off a call for mandatory retirement ages or imposition of guidelines by others,’ it said. So, as written, there is apparently no data available to support a direct link between physician age and patient safety.  

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“The AMA's call here in actuality is (or at least should be) to explore the issue of whether or not such guidelines are necessary,” Dr. Chuck continued. “Furthermore, the AMA may be raising the issue itself now, rather than have an outside entity raise it for them later on. This type of proactive, self-awareness makes sense.

Dr. Chuck

“Our field of ophthalmology, a combination medical and surgical field, would certainly be affected if such concerns were eventually borne out in data,” he added. “As we care for our patients, recall of critical knowledge base, intact faculties, and senses to the extent needed for our specialty, reaction time, and manual dexterity may all come into play.  I look forward to what the discovery process brings the AMA and other medical professional organizations.

“There are many, many factors that go into the making of a caring, competent doctor,” Dr. Chuck continued. “To have as much relevant data as possible is usually a good thing.”