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June 10, 2015

AMA to develop competency tests for older doctors

Daily Briefing

The American Medical Association (AMA) on Monday voted to develop competency guidelines to ensure elderly physicians are able to safely treat patients, Lindsey Tanner reports for the Associated Press.

According to AMA, about 25% of all doctors nationwide are over age 64, with the number of such physicians quadrupling since 1975. But unlike other fields where mistakes can result in loss of life—such as aviation and the military—there has been no mandatory retirement age for physicians. And although some hospitals have voluntarily implemented age-based screenings, there is no universal, mandatory screening to ensure continued competency as doctors age.

Details of AMA plan

The AMA-approved plan, authored by the association's Council on Medical Education, states that "physicians should be allowed to remain in practice as long as patient safety is not endangered."

The plan notes that changes in hearing, sight, memory, and motor skills could be affected by a physician's age, but says there is no evidence directly linking such changes to worse patient outcomes. Nonetheless, it acknowledges that while "unfortunate outcomes may trigger an evaluation at any age ... perhaps periodic reevaluation after a certain age such as 70, when incidence of declines is known to increase, may be appropriate."

How do you hold difficult conversations with doctors?

To address the issue, AMA will convene groups to create preliminary assessment guidelines for aging doctors. According to an AMA report, the plan should include a test of physical and mental health, as well as a review of a physician's cases. The report did not specify who should conduct the assessments or how regular they should be.

AMA says that creating its own standards "may head off a call for mandatory retirement ages or imposition of guidelines by others."

Doctors respond

Some physicians say that competency guidelines are not needed and that they are capable of knowing when it's time "to hang up the stethoscope," the Associated Press reports.

William Nyhan, an 89-year-old pediatrician at the University of California-San Diego, says, "I don't myself have any doubts about my competency and I don't need the AMA or anybody else to test me." He adds, "There are a lot of people overlooking my activities. This is a litigious society—if we were making mistakes, we'd be sued."

Similarly, physician Jack Lewis, who turns 81 this week, recognizes that his "hands aren't as good as they used to be," but says, "If I made a mistake, I'd be the first one to quit here."

Louis Borgenicht, 72, says a hospital required him to take a mental assessment, but it was based on one given to airplane pilots and had little to do with medical practice. But generally, Borgenicht says he would support competency guidelines, as long as they are "based on something that makes sense" and adequately tests physicians' skills (Tanner, AP/Philadelphia Inquirer, 6/8).

The takeaway: The American Medical Association will begin developing guidelines to ensure elderly physicians are competent to safely treat patients. The group notes that doing so now "may head off a call for mandatory retirement ages or imposition of guidelines by others."

How to meet ED call commitments as physicians grow older

Hospitals have long struggled to provide adequate specialist coverage in the ED. In a 2012 survey by Sullivan Cotter and Associates, 58% of hospital survey respondents reported difficulty finding enough physicians to provide call coverage.

One force behind the continuing challenge is the aging physician workforce. According to the AMA, about 42% of the one million doctors in the U.S. are older than 55, up from 35% in 2006. Over a quarter of hospitals allow older physicians (those over age 60) to opt out of participating in ED call rosters, placing a greater burden on younger physicians and leading to medical staff tensions.

To address the issue, some medical groups are linking new call coverage policies for older physicians to retirement planning.

Interested in learning more? See our post on physician leadership succession planning.


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