Competency and retirement: Evaluating the senior physician

AMA Wire
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For older physicians, deciding when to leave practice is about more than just clinical competency—it also comes with emotional internal struggles. Physicians examined this issue from both angles at the 2015 AMA Annual Meeting and agreed to convene a special group of professional organizations to develop guidelines that will help older physicians continue to provide high quality care throughout their practice careers.

About one in four U.S. physicians is older than 65, and the number of physicians in this age bracket more than quadrupled between 1975 and 2013. While research shows cognitive dysfunction is more prevalent among older adults, aging doesn’t necessarily result in cognitive impairment. An AMA Council on Medical Education report took a deeper look at assessing senior physicians’ ability to provide safe and effective patient care.

Safety and patient care

Several factors associated with aging may impact physicians’ analytical processes, such as decreasing working memory, declining visual acuity and slowing speed of mental operations.

Published physician assessment data show important differences in performance may become apparent after age 60. Research also shows that older physicians are less likely to acquire new knowledge over time. For example, older primary care physicians are less likely to incorporate new treatment strategies into their practices, according to the report.

Still, the effect of age on any individual physician’s competence can be highly variable. While age is one factor in predicting potential competence, other factors such as practice setting, clinical volume, specialty and stress also can contribute.

What this means for older physicians

Physicians are professionally obligated 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. But a number of other professions that can impact public safety do have age-related cutoffs in place. Commercial airline pilots, for instance, must be regularly screened beginning at age 40 and must retire at 65.

But the report pointed out that moving into retirement can be a difficult change for many physicians.

“Some physicians are glad to move into a different phase of their lives when they reach age 70,” the report said. “For others, however, this transition is not easy, and it may require the guidance and support of peers. … Physicians with decades of experience and contribution deserve the same sensitivity and respect afforded their patients as they experience health changes that may or may not allow continued clinical practice.”

This shift from practice to retirement was the focus of a special education session at the meeting, led by Glen Gabbard, MD, a clinical professor of psychiatry at Baylor College of Medicine and an expert in physician health and professionalism.

“For most of us, the practice isn’t a job: It’s more of a calling,” Dr. Gabbard said. “One of the things that’s unique about physicians is that who we are—our identity—is so wrapped up in being a physician. … There are certain psychological characteristics that make for a good physician, but [they] also [make] for someone who is going to struggle with slowing down or not practicing.”

For physicians who do want to slow down, the report suggests that the following steps may be beneficial:

  • Simplified documentation forms
  • Decreased case load or time demands
  • Narrowing or limiting the scope of practice

“Whatever you do, you have to make time for living, and we [physicians] are not necessarily good at that,” he said. “Retirement should not be about leaving something—it should be about going to something.”

Taking the lead in professionalism

Regulators and policymakers are considering some form of age-based competency screening, according to the report. Some hospitals and health systems already require such screenings.

To ensure physicians can continue to practice as long as patient safety is not at risk, physicians approved policy at the 2015 AMA Annual Meeting to develop preliminary assessment guidelines.

“Formal guidelines on the timing and content of testing of competence may be appropriate and may head off a call for mandatory retirement ages or imposition of guidelines by others,” the report said.

Testing could include an evaluation of physicians’ mental health and a review of their treatments of patients. But figuring out such guidelines will be difficult, “especially in view of the limited and conflicting data available on this topic,” the report said.

For physicians who want help moving into the next phase of their careers, the AMA Senior Physicians Section offers resources and support. The section is for physicians age 65 or older and offers ways for senior physicians to remain active after retirement through volunteer opportunities.

For more on opportunities and challenges for aging physicians, watch a webinar that focuses on understanding impairment in older physicians and developing prevention strategies. Also visit the AMA Store for titles of interest for seniors who are easing into retirement, starting a new career or who are curious about their retirement choices. 

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This topic, as outlined in this piece, is quite timely and its importance cannot be overstated. However, the report deals primarily with the "cognitive" specialties such as Primary Care. Perhaps an even stickier problem is in methods of competency screening for the surgical specialties. As a full-time, academic/university cardiac surgeon approaching retirement age, this problem is somewhat less terrifying since I will have many clinical and non clinical options. But the majority of surgeons in the United States do not. What we do to assess their technical competence will be an enormous challenge in the future that cannot be avoided - no matter how difficult. This will require careful, compassionate thought while keeping the patient's well being as the sine qua non of any discussion.
Spare us new regulations, restrictions unless there is clear evidence that the elder physician is impaired in his/her practice. At this point, this is conjecture and just another attempt, akin to MOC, to push around physicians.
As a well aged physician now approaching 60 years since graduation all this is important. But <br/> there is a terrible mistake in all this screening - it is phrased as essentially negative and more work . It produces fear and anxiety and stress that makes errors and even death potentially move in to the picture. There are so many opportunities available to the aging physicians that allow self esteem, respect by others and enjoyment of a new found freedom to be available, but often unfamiliar to physicians that both ideas and personal stories and anecdotes would help deal with the negativity that Gabbard points out . Harry Prosen MD
Clinicians who practice in groups already have regular evaluations of their competency in the form of review of their work by their peers.<br/> <br/> In addition, most states require continuing medical education as a condition of maintaining licensure.<br/> <br/> Given that the competency of clinicians is already undergoing evaluation both locally and at the level of the state, which approves their licenses, national standards are superfluous.<br/> <br/> Here is another problem with national standards: they could not possibly take into account the infinite number of variations that exist among practices. Only local peer review committees are able to do so.<br/> <br/> With regard to the declining number of clinicians who practice solo, it would be far more sensible to have their work reviewed locally than by a national body.<br/> <br/> Finally, it's worth remembering that every state has some sort of organization to which patients may file complaints regarding competency. Here in California, the medical board regularly disciplines clinicians -- suspends and revokes their licenses -- as a result of patient complaints.<br/> <br/> Given that it is the states rather than the federal government that are charged with regulating the practice of medicine within their borders, the concept of national regulation is a non-starter.<br/> <br/> State-licensed clinicians should object, loudly, to the concept of interference with their practices by some distant national body.
Can we have same Evaluation for Presidential Candidates, Senators, Mayors ,Governors, Politicians , CEO of Companies.....and Many More !!!!!??????
Age-related cognitive/emotional screening for judges? Recent SCOTUS decrees suggest the time has arrived.
It is true age plays a role in functioning & memory. But that process starts as early as 20s & 30s and Physicians start their careers then. What offsets aging in Physicians is experience & wisdom which makes them more efficient overall. Where dexterity is mandatory there is a case for vigilance, but to generalize this to all Physicians is counter-productive. It is a well known fact that when Dementia sets in the last faculty to go is their clinical acumen for the simple reason that they have been practicing it exclusively & intensively all their lives. Lastly there is such a variability that setting at what age ? 40, 50, 60, 70 there is no definitive answer.
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