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Assessing the Competency of Older Physicians

Assessing the Competency of Older Physicians

The number of older physicians is on the rise, presenting a potential conflict practice managers could have to face in the coming years — how to fairly and legally assess aging physicians.

In a recent meeting, the AMA stated that the number of physicians older than 65 has quadrupled since 1975 and now accounts for one out of every four physicians. Armed with this information, in June 2015, the AMA decided they needed to develop guidelines and methods to screen and assess older physicians, to ensure they are competent in providing care to patients. The organization is currently in the planning stages of implementing this policy, saying it will gather perspectives from different stakeholder representatives before moving forward.

AMA backed this decision with research from its Council on Medical Education, which claims that past the age of 60, there are "differences in performance" that "may become apparent." The largest physician organization in the country also says that older physicians are less likely to acquire knowledge over time. While the AMA says age is not the only factor that determines whether or not a physician is capable of practicing medicine to the fullest extent, the report summarized recommendations from various sources that cognitive and physical screening should begin between ages 65-70.

"Physicians are professionally obligated to ensure that they are providing high-quality care to their patients and to continually assess their own physical and mental health, even though there is no national standard for screening physicians who have reached a certain age. A number of regulators and policymakers are considering some form of age-based competency screening, and some hospitals and health systems already require such screenings," Rich Hawkins, the physician vice president of medical education outcomes at AMA, said in an e-mail to Physicians Practice.

Yet, not everyone is onboard with the AMA's edict. Jane Orient, a general internal medicine physician and head of the Association of American Physicians and Surgeons, says that the actions of the AMA are an example of "blatant discrimination" and a money grab.

"Someone has a vested interest in making a lot of money from the [screening and assessment] tests that they'll sell to you," says Orient. "I think it's unfair because while capacities do change with age, to assume the older physicians are not as capable as younger ones is dangerous … when I'm looking for a physician, I want an older physician. His years of experience and early basic training count for a lot more than any slowing down he may have experienced."

Some physicians, like David Norris, an anesthesiologist with Wichita Anesthesiology Chartered, based in Wichita, Kan., and the owner of a physician-based training organization, the Center for Professional Business Development, wrestle with the idea of judging of older physicians, especially when it comes to people who may have mentored or hired him. "Who am I to say you are not a good doctor? Telling someone, 'You've been practicing for so long and now I don't know if you have the skills,' that's the hard thing," he says.

STICKY SITUATION

Norris faced a difficult situation in his medical group a few years back, which speaks to just how hard this kind of scenario can be. In his case, the doctor's age wasn't the reason for his retirement, but rather an injury.

"We had a [doctor] who suffered a closed head injury and was in the [intensive care unit] for quite some time. When he came back to practice, things weren't quite right," says Norris. "He was having issues with clinical judgment and it was clear he wasn't the same person from before."

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