There are some occupations where employees are mandated to receive age-based skills and cognitive testing. For example, the National Business Aviation Association has a mandatory retirement age of 65 for airline pilots. Additionally, firefighters, employees of the Federal Bureau of Investigation, air traffic controllers, and nuclear material couriers are all subject to age-based regulations. These agencies impose age-based regulations to ensure the safety of others. What about physicians? The physician population in the U.S. is aging and with 42% of physicians being 55 years of age or older, are there rules or regulations around when physicians should receive age-based testing and if/ when they should stop treating patients?
Why the need for regulations?
A recent article in JAMA Surgery discusses the AMA Council on Medical Education’s review of the evidence linking age with sensory and cognitive capabilities. The council concluded that advancing age was associated with a decrease in visuospatial ability, manual dexterity, processing speed, ability to complete complex tasks, hearing, and visual acuity as well as increased influence of the order information is received and increased difficulty inhibiting irrelevant information.
Another recently published observational study in The BMJ investigated and compared the outcomes of hospitalized patients when treated by older and younger physicians. Using a national sample of elderly Medicare beneficiaries with similar patient characteristics the authors found a higher 30-day mortality rate for those patients treated by older physicians than those treated by younger physicians. However, it is worth noting the authors’ acknowledgement that the study is exploratory and may only reflect a specific cohort. The association between age and 30-day mortality was only found among those physicians with low and medium patient volumes but not for those with high patient volumes.
Without guidelines, the onus is placed on fellow-physicians, nurses and other healthcare staff to identify potentially unsafe practices. In a 2011 article from The New York Times, the director of the physician’s assessment program at the University of California, San Diego, expressed the difficulty with confronting fellow physicians who may no longer be able to practice safely. In the same article, a member of the ethics committee of the American Academy of Orthopaedic Surgeons, Dr. Green, explained that “doctors often cover for physicians who are becoming less sharp.”
What are the current regulations?
In 2015, the AMA Council of Medical Education released a report titled “Competency and the Aging Physician” [PDF]. This report stated, “physicians must develop guidelines/standards for monitoring and assessing both their own and their colleagues’ competency.” While the AMA Council of Medical Education acknowledged that creating age-specific guides and testing would require significant resources, they noted that such activities would lessen the need for a mandatory retirement age.
Furthermore, the American College of Surgeons (ACS) released the “Statement on the Aging Surgeon.” The ACS statement recognized the vital role that senior surgeons play in hospitals; however, it stressed that surgeons are not immune to age-related diseases or decline. The ACS recommended that “starting at age 65 to 70, surgeons undergo voluntary and confidential baseline physical examination and visual testing by their personal physician for overall health assessment.”
Presently, there are no nationally accepted age-related guidelines, regulations, or required testing to ensure physician competency. Consequently, some healthcare organizations have decided to tackle the matter individually. The JAMA Surgery article mentioned three previously recognized US hospitals that mandate health assessments and/or competence examinations for physicians: Driscoll Children’s Hospital, University of Virginia Health System, and Stanford Hospitals and Clinics.
What are future options?
This is a complicated issue and is not going away. Additionally, it is unlikely that there will be a single regulation that can be easily applied across the healthcare field. The credentials chairman of Driscoll Children’s Hospital acknowledged that when drafting the aging physician policy there were concerns about age discrimination, the loss of physicians with valuable experience, and invasion of privacy. However, another interviewee pointed out that by identifying deficits, physicians may be able to practice longer with schedule adjustments and a reductions in patient loads. Age-based guidelines don’t have to the end of a physician’s career but a step toward improving patient safety and preventing harm. All physicians aim to provide the best care possible for their patients and at a minimum, we all can agree that providing safe and effective patient care should take priority.