E Patchen Dellinger, MD
How did you become involved with researching and writing about the issue of aging physicians?
The discussion about aging physicians is part of a larger societal context that includes rising life expectancies, delayed retirement, and changing societal attitudes toward potential contribution of older individuals to their profession or community. One might say that “80 has become the new 60,” necessitating a new paradigm in the medical profession.
However, we are all aware that there are a variety of complex skills in any field like medicine or surgery, and we have all observed over the years some physician or surgeon performing below the standard we would like. I promised myself early in my career that I would stop operating before someone calls me over and says, “We have to have a conversation about what’s going on [with your capacity to practice medicine].”
I was in practice for a very long time – 41 years on faculty of the University of Washington – and as I got older, I still felt that I was competent. I read about competency testing for older physicians and took a partial test when I was in my low 70s.
I decided to give grand rounds to the Department of Surgery about aging physicians and, in the course of learning more about the subject, I was struck by the research conducted by Powell et al12 regarding cognitive decline and aging. In particular, I was interested in the study comparing physicians to non-physicians and showing that at each age, on average, physicians had more cognitive ability than average non-physicians. Although the average declined significantly with age, variability dramatically increased, so that some older physicians remained sharp as a tack although the overall average cognitive level dropped down.
After offering grand rounds, I decided to summarize my findings and perspectives in a review I coauthored that was published in JAMA Surgery.4
What was the viewpoint you put forth in your review?
We encourage physicians to voluntarily have regular, thorough physical exams and discuss aging-related issues with their physicians. On the other hand, purely voluntary policies for assessing the ability of physicians to practice safely as they age do not go far enough because they rely either on the physicians themselves to notice and self-report concerns or on other clinicians to report their colleagues.
So we recommended moving from voluntary to mandatory programs to assess the wellness and competence of physicians at a given age, with every critical stakeholder group – including individual physicians, healthcare organizations, local medical societies, national professional membership organizations, such as the AMA, liability insurers, and specialty certifying boards – playing a role in this transition.
The best case scenario would be if the standards for these programs and perhaps even administration of testing could occur at the national levels, involving membership in specialty societies as well as specialty certifying boards. However, it is unlikely that this will happen, given the negative response on the part of readers to the ACS’ recommendation of voluntary testing.
We also recommend that healthcare organizations develop local policies regarding mandatory of physicians for wellness and competence, starting at a certain age, to potentially identify physicians whose competence is declining before patients are harmed and connect them with programs that can restore their ability to practice safely.
What was the response to your review?
Although this is a controversial area and many physicians are opposed to any kind of testing, I have gotten relatively little pushback. I think people recognize that this is a genuine problem and that our suggestion might be a reasonable approach.
Are any steps being taken to forward this concept?
Within the last few months, the Society of Surgical Chairs published a paper in JAMA Surgery containing recommendations regarding transition planning for senior surgeons.14 (Table) Right now, informal discussions are taking place among several of us in ACS regarding ways to promote the idea of regular cognitive and physical testing for surgeons.
One idea that has come up in these discussions is an alternative to saying that a surgeon or other physician should start being tested at a particular age, which can lead to an outcry of age discrimination. Instead, we have discussed developing a program where physicians are tested beginning early in their career and then tested sequentially to see over time how their cognitive and physical performance compared with their own cognitive and physical performance in previous years.
Clearly, more work needs to be done to develop and fine-tune these concepts, and to implement them. We also don’t want these tests to be burdensome to physicians who are already completing regular tests for MOC [maintenance of certification], although these tests of cognitive and physical abilities are quite different. Some interesting work is being done in this area—for example, there is a group at Stanford developing ways to use artificial intelligence to test the physical agility and consistency of surgeons in simulated settings.15 So this is a work in progress.
This article originally appeared on MPR