Aging physicians: Liability or source of wisdom?

A 2011 New York Times article (“As Doctors Age, Worries about their Ability Grow,” Jan. 24, 2011) discussed a 78-year-old vascular surgeon in California who operated on a woman who developed a post-op pulmonary embolism and died after the surgeon failed to respond to urgent calls from nurses.

A neuropsychological exam of the surgeon was “very abnormal,” William Norcross, MD, director of the physician assessment program that evaluated the surgeon, told the Times. Among the findings were that the surgeon could not perform fine motor movements or retain information. The surgeon was asked to surrender his medical license.

High percentage of older docs

One in five U.S. physicians are over 65 years of age as of 2010, the American Medical Association reports. With the present trend continuing, more aging physicians will continue to practice, and the figures may reach more than 30% by 2015.

At the same time, the American population is also aging, with the first baby boomers becoming eligible for Medicare in 2011. Adding fuel to the fire is the Affordable Care Act’s requirement that all citizens carry health insurance, which will add another 35 million patients to the health care roller coaster. We will need more physicians who can work full time and take care of these patients.

The Times article points out that airline pilots have a mandatory retirement age of 65 years. However, many physicians over 60 to 65 years of age continue to practice. The reasons are many: increasing financial pressures, lack of retirement hobbies or activities, and passion to continue their lifelong profession, to name a few. According to a 2011 Jackson & Coker survey, 52% of physicians’ retirement plans have changed since the recession hit, and they are resorting to locum tenens and part-time ambulatory assignments, which are more appealing with manageable workloads.

Although many physicians retain their skills and sharpness of mind into advanced age, they are not immune to the perils of aging, including cognitive failure, dementia, Parkinson’s disease, stroke, and other age-related illnesses.

A call for screenings, but what kind?

Some experts say that regular cognitive and physical screenings are needed once physicians reach 65 or 70 years of age, but no standardized screening is available and less than 5% of hospitals in the country are even considering implementing this practice, the Times reports.

“More research is needed to define what combination of cognitive and motor skills are important,” Stuart Green, MD, a member of Ethics Committee of the American Academy of Orthopedic Surgeons, told the Times. Most of the continuing medical education programs that are required by the state medical licensures are not proactive and require only passive attendance.

Complaining or “whistle blowing” against colleagues is not a common practice in medical circles, and is especially rare in the case of elderly physicians who are respected as mentors. Physicians often cover for elderly physicians who are losing their cognitive and professional abilities by having another surgeon in the operating room or by regularly reviewing their cases, Dr. Green said.

Many positives with age

Age, to say the least, is not always a negative factor. Physicians who have been practicing for a long time have more experience and wisdom, having seen more patients and faced more clinical encounters. This wisdom and experience are hard to obtain by reading books or attending classes. Hobus et al reported strong positive correlation between experience and diagnostic accuracy (Med Educ 1987; 21:471-6). Even with minimal clinical and laboratory information available, elderly physicians’ diagnostic skills are superior. They also try to be more conservative with laboratory and procedural techniques, a welcome trend considering the rising cost of health care.

On the other hand, elderly physicians, who grew up before the advent of today’s technology, are not very comfortable with the high-tech additions to medicine such as electronic health records, laptops, tablets, smartphones, social media, etc. Unfortunately, for them, these tools are becoming everyday norms in the practice of medicine.

In summary, one cannot draw a Biblical line against elderly physicians and declare they cannot practice after 65 or 70 years of age. Most senior citizen physicians are recognizing their limitations and are trying to restrict their practice and workload depending upon their ability and performance capability. One has to realize age is an independent variable.