AMA Steps Into Aging Doc Competency Quagmire

When is it time to step away from the operating table and lay down that scalpel? And who should decide?

The American Medical Association (AMA) adopted a plan on June 8, 2015 to create competency guidelines to help decide when it’s time for an aging physician to retire. This is new territory for any medical society.

25% of Docs Over 65

There is some urgency to the issue with 240, 000 U.S. physicians, or one out of four, older than 65. Physicians have to meet state licensing requirements, but there are no mandates or guidelines to assure competency hasn’t been impacted by age. It begs the question: What does age have to do with it if surgical skills are good?

Evidence?

As all things medical, what’s the evidence that physicians stay too long and harm patients?

The AMA report says that it’s typical age-related changes in hearing, vision, memory and motor skills that could potentially affect physicians’ competence. But notes the report, there is no evidence that directly links these changes to worse outcomes for patients.

The AMA voted to convene groups to collaborate in developing preliminary assessment guidelines, as recommended in the report. According to an AP article, the report says testing should include an evaluation of physical and mental health and a review of doctors’ treatment of patients. It doesn’t specify who would do the assessing nor how often it would take place.

“Unfortunate outcomes may trigger an evaluation at any age, but perhaps periodic reevaluation after a certain age such as 70, when incidence of declines is known to increase, may be appropriate, ” the report from the Council on Medical Education says. “Physicians should be allowed to remain in practice as long as patient safety is not endangered.” By developing guidelines and standards for monitoring and assessing themselves and their colleagues’ competency, physicians “may head off a call for mandatory retirement ages or imposition of guidelines by others, ” noted the report.

Angry Old Docs

It’s a touchy subject for older physicians who bristle at efforts to evaluate their work based on their age.

“I don’t myself have any doubts about my competency and I don’t need the AMA or anybody else to test me, ” said William Nyhan, M.D., an 89-year-old pediatrician, genetics researcher, runner and tennis player who works with the University of California, San Diego and a children’s hospital, according to the AP story.

“There are a lot of people overlooking my activities” already, he said. “This is a litigious society—if we were making mistakes, we’d be sued.”

Current Screening

The Joint Commission requires U.S. hospitals to evaluate physicians’ performance on a periodic basis. Most hospitals do these evaluations every nine months for physicians of all ages, said Ana McKee, M.D., the commission’s chief medical officer told the AP.

The University of Virginia Health System, and Stanford Health Care at Stanford University, require additional scrutiny of older physicians.

Stanford requires a special assessment every two years for physicians over 75. The assessment includes a performance evaluation and a comprehensive medical history and physical exam, said Ann Weinacker, M.D., a Stanford quality improvement specialist.

“It is not a pass-fail type of screening. However, if concerns are raised, we require the person to have further evaluation, ” she said.

The University of Virginia’s screens physicians starting at age 70 and involves physical and cognitive exams every two years. The university’s credentialing committee chair, Scott Syverud, M.D., told the AP that the vast majority of the physicians score “very well.” Those who don’t “can choose to cut down their practice or even to retire, ” Syverud said, although he declined to say if any have been deemed incompetent.

Physician Shortage-Patient Glut

We have seen many warnings that there will not be enough physicians to handle all the new patients covered under Obamacare. With more patients and a looming physician shortage, the AMA and other provider organizations will have to come up with new ways to serve patients.

Stay tuned.