Key stakeholders explore assessment of aging physicians

Amy Farouk
Past Editor
AMA Wire
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Representatives from key physician, hospital and patient safety organizations met last week to discuss the growing trend of assessing the competence of aging physicians and explore the question of whether national guidelines need to be developed.

Why now

The number of physicians 65 years and older has more than quadrupled since 1975, reaching more than 241,000 in 2013, according to a recent report of the AMA Council on Medical Education. Senior physicians make up 23 percent of the nation’s physician population, and roughly 40 percent of them are actively engaged in patient care.

“It is the opinion of the Council on Medical Education that physicians should be allowed to remain in practice as long as patient safety is not endangered and that, if needed, remediation should be a supportive, ongoing and proactive process,” the report states.

 
  Darlyne Menscer, MD, chair of the AMA Council on Medical Education

“Self-regulation is an important aspect of medical professionalism, and helping colleagues recognize their declining skills is an important part of self-regulation,” the report states. “Therefore, physicians must develop guidelines/standards for monitoring and assessing both their own and their colleagues’ competency.”

One of the primary recommendations of the report was to convene national stakeholders to further explore this issue.

Bringing together the key players

As the group prepared to meet Wednesday, Darlyne Menscer, MD, chair of the AMA Council on Medical Education, said the initial goal was to look at the available evidence around physician assessment and competence.

“Many people have presupposed that the AMA has taken a position on whether physicians should be assessed and how that should be done,” she said. “The truth is that we have not.”

The meeting brought together nearly three dozen representatives from such organizations as the Joint Commission, the American Hospital Association, the Coalition for Physician Enhancement, the Council of Medical Specialty Societies, the National Board of Medical Examiners, the National Board of Osteopathic Medical Examiners and the National Patient Safety Foundation.

Experts who research physician competence, run assessment programs and deal with related legal issues also participated, sharing their insights.

 
  Barbara Hummel, MD, chair of the AMA Senior Physicians Section

The group began deliberation around key issues and challenges for determining whether guidelines should be developed, including:

  • Legal implications of screening physicians based on age
  • Variability of how age impacts individual physicians’ competence
  • Uncertainty of how to interpret tests of cognitive or motor function in physicians
  • Confounding effects of other variables on physician competence and performance

“How do we keep our patients safe and yet be fair to both the physicians and the patients?” said Barbara Hummel, MD, chair of the AMA Senior Physicians Section. This is an essential question that stakeholders will continue to explore.

Dr. Menscer said it’s particularly appropriate that the AMA Council on Medical Education is spearheading this effort alongside the AMA Senior Physicians Section.

“The AMA Council on Medical Education has historically been involved in many issues concerning continuing professional competency and is well-positioned to convene this conversation,” she said. “Who better than us?”

The AMA Senior Physicians Section, meanwhile, was the driving force behind the AMA policy that led to the council report and Wednesday’s stakeholder meeting.

Watch AMA Wire® for additional information as the group continues to explore the issues surrounding physician assessment and potential solutions.

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Comments

It is so important to start evaluation of senior Doctors specially Surgeons.I remember as a resident senior MDs usually gave us the case to operate on & learn<br/> Some times it was hard on them to supervise.I retired at age 62,Junior Docs could provide better care,Though at times clinical sense helps but doing surgery after 65 is not a good idea.I prefer Surgeons for myself in 50s they have experience & steady hand. It will be nice to have some guide lines for Physisians & Surgeons.
Question?<br/> Is this another solution looking for a problem?<br/> What it the extent of the problem to be rectified?<br/> How will the government eventually be involved?<br/> Will if really impact patient care.<br/> Is it not possible to make everything safe and right for everyone, every time...Remember, NONE OF US IS GETTING OUT ALIVE!
Since when is the patient not able to make this assessment?<br/> If there is a good doctor-patient relationship and the patient trusts their doctor, isn't that enough?<br/> I have never been aware of a case where outside help was needed to sort this out. But then I am Old School and remember the days when patient care was not all chopped up by insurance, big business, and social mobility.<br/> I wish the young physicians all the luck in the world. What is to keep the young from scrutiny for mental illness and odd behavior?<br/> This is one more encroachment on what used to be the sacred doctor-patient relationship.
This is a very complex issue that requires sensitivity to multiple groups. While it could lead to heavy-handed intrusion, considering these issues also might offer insight into making all physician-patient relationships safer. <br/> Senior physicians are now a very substantial sub-set of providers, but deserve the same dignity as others. Likely there are some who have become less reliable, but others may well be better than SOME of the younger physicians. Thus it seems to me that we should try to find ways to allow selective review of EHRs of ALL physicians, with stringent safeguards of patient and physician confidentiality, plus non-adversarial discussions of "problem cases." <br/> The bias should be toward making the process educational for all sides. Sometimes the original choices may be better than the reviewer's alternative! IF there are confirmed concerns about the physician's competence, then remedial efforts or retirement should be considered, regardless of age. <br/> I envision this as similar to what has been done for years when complaints have been lodged, but instead to be applied to EVERYONE at an earlier stage -- hoping to find more subtle evidence of substandard care before major harm to patients.<br/> As you can see, I think we are beyond either assuming that patients can predict how well their physicians will perform OR assuming that all physicians are supremely competent until a magic milestone (age, or other circumstance of practice) when some, or even most, become incompetent.<br/> Better we should guide these assessments, with great sensitivity for all people, rather than leaving it to the "rough and tumble" of litigation.
As a pathologist in a large acute care hospital and director of continuing education I never over the years knew a physician who needed to retire or made mistakes because of his age. Mistakes are more common in specialists who know more and more about less and less. They hone in on a single problem and too often ignore important problems that are out of their speciality training.
I was surprised to find out there is an SPS in the AMA and that in a few months it will give me automatic membership. I was dismayed that my SPS leadership is mentioned as the driving force behind the AMA policy that led to a meeting of "stakeholders" to discuss the issue of senior physician competency. I believe the biggest stakeholder present for meetings on senior physicians should be senior physicians. It was stated in the AMA Wire that the Council on Medical Education believes physicians should be allowed to remain in practice as long as patient safety is not endangered. I believe this would apply to all physicians and not just to seniors.<br/> I am currently an ACLS and PALS instructor and an ATLS provider in good standing. I take and pass my recertification boards for the AAFP every six years. I maintain my continuing education requirements and have a license in good standing with my state. Many of the younger physicians in our county have asked for assistance on management of patients with DKA, severely depressed sodium, rhabdomyolysis or difficult ventilator management while in the hospital. I do not however see a need to convene a stakeholder meeting to discuss the competency of younger physicians.<br/> I do however find myself offended that I should be singled out to have my competency evaluated by others since I am now turning 65. I have practiced with a group of senior physicians in our area in their late eighties and even ninety. I saw those older MDs cut back on areas they felt less comfortable to practice in while still teaching me secrets of patient management they had learned over decades. I do not see a need for this evaluation or anyone with the jurisdiction to cary it out.
I will legally challenge any attempt to regulate my practice of medicine on the basis of age unless there is evidence that older physicians practice less safely. I have yet to see any such evidence.
I agree with the article. Unless we assume that physicians are not subject to dementia, diminished eyesight, decreased stamina and other consequences of old age, there has to be some process in place. It has to be reasonable and not follow the ABIM recertification boondoggle. I am an Interventional Cardiologist ,60 and keenly aware that at some point I would not be the person you want to treat your heart attack at 3 am.
Elderly physicians often have placed themselves in positions of strength at the facilities they work. Many are former hospital board members or chiefs of sections or departments. The mer suggestion of incompetence by any other practitioner is meet with stiff retribution. Perhaps this is due to ego, economic or psychological issues? <br/> The issue of competency has been solved with several boards by establishing Maintenance of Certification (MOC). Even this concern has been meet with great resistance. The matter of medical conditions interfering with the ability of a practitioner to function is a separate concern. When an issue of health affecting performance or judgement occurs often a suggestion of a proctor or monitor is made. Suggesting that a subordinate monitor & supervise an elderly physician is inappropriate. Independent reviewers or proctors can be expensive.<br/> The liabilities can be immense for all involved. Some large health care systems have set up mandatory retirement age(s) based upon a practitioners profession in medicine or surgery. Perhaps a more flexible & reasonable approach to monitor the healthy physician would be to require hospitals & medical boards to have mandatory physicals for all practitioners past the age of 70. If there are no issues then, the physicals could be repeated every 2 years until retirement?? <br/> No one really likes to be told what to do. History in health care has shown that it is much better to give than receive. Establishing recommendations now for monitoring aging practitioners could prevent regulating agencies from instigating policies & procedures that could be less than favorable?? Though not likely to be approved by all MOC & periodic physicals may be the best tools to protect our elderly physicians. Best,<br/> <br/> Gary R Culbertson, MD, FACS
Some senior doctors are very enthusiastic, knowledgeable and have vast experience, especially Physicians. Others slip a little. In the UK, we have yearly appraisals. telling the 2 different groups is hard sometimes
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