David Weiss, MD

What is your background?

I am 69 years old, and will be 70 in January. I graduated from medical school in 1975, did a residency and eventually a pulmonary fellowship, which was completed in 1982. I have been in practice since then as an internist, pulmonary specialist, and in the ICU. I am presently practicing in an outpatient clinic in the Bronx.

What are your perspectives on administering skills and cognitive tests to aging physicians?

It seems inappropriate to me. I think it’s ageism. I don’t see anyone testing lawyers or accountants at age 70. Our president and a number of candidates for the next election are over 70 years old. They function in a respected manner in our society. I understand the rationale – meaning, that physicians have a high level of responsibility for people’s lives. But so do lawyers and accountants. A lawyer can make a mistake and have someone inappropriately jailed for life. An accountant’s mistake can lead to a client’s financial ruin. So I don’t see why any special testing is needed for physicians. I think that CME and MOC provide more than enough testing and, in fact, that MOC involves an excessive amount of testing.

I do think that for surgeons who use their hands, additional assessment might be necessary – but that could be accomplished through developing CME using simulations and focusing on manual dexterity and competence. These tests, like other aspects of CME, could be delivered throughout the surgeon’s career.

What role do you think stakeholders can play in assuring patient safety?

Hospitals should – and do – monitor all physicians of any age and have quality measures and oversight in place. Hospitals have administrative entities that review difficult or problematic cases. If they find a physician of any age who is having problems, they address those problems as they arise.

Clinicians should also take steps if they see that a colleague is beginning to show signs of age-related decline – but again, peer responsibility applies to any age. We know that there are physicians at all stages of their careers who can develop an illness or condition that can impair judgment or cognition, or might develop a substance abuse or mental health problem. The same type of collegial responsibility that applies in those cases applies to age-related decline as well.

References

  1. American Medical Association. Competency and the Aging Physician. Report 5 of the Council on Medical Education (A-15). Chicago, IL; AMA: 2015.
  2. Katlic MR, Coleman J, Russell MM. Assessing the Performance of Aging Surgeons. JAMA. 2019 Feb 5;321(5):449-450.
  3. American Association of Medical Colleges (2019). New Findings Confirm Predictions on Physician Shortage. Available at: https://news.aamc.org/press-releases/article/2019-workforce-projections-update/. Accessed: June 22, 2019.
  4. Dellinger EP, Pellegrini CA, Gallagher TH. The Aging Physician and the Medical Profession: A Review. JAMA Surg. 2017 Oct 1;152(10):967-971.
  5. American College of Surgeons. Statement on the Aging Surgeon. Available at: https://www.facs.org/about-acs/statements/80-aging-surgeon. Accessed: June 21, 2019.
  6. Sataloff RT, Hawkshaw M, Kutinsky J, Maitz EA. The aging physician and surgeon. Ear Nose Throat J. 2016 Apr-May;95(4-5):E35-48.
  7. World Health Organization. Ageing and Health. Available at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed: June 15, 2019.
  8. Hartz AJ, Kuhn EM, Pulido J. Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates. Med Care. 1999;37(1):93-103.
  9. O’Neill L, Lanska DJ, Hartz A. Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology. 2000;55(6):773-781.
  10. Prystowsky JB. Are young surgeons competent to perform alimentary tract surgery? Arch Surg. 2005;140(5):495-500.
  11. Tsugawa Y, Newhouse JP, Zaslavsky AM, Blumenthal DM, Jena AB. Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ. 2017;357:j1797.
  12. Powell DH, Whitla DK. Profiles in Cognitive Aging. Cambridge, MA: Harvard University Press; 1994.
  13. Boom-Saad Z, Langenecker SA, Bieliauskas LA, et al. Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists. Am J Surg. 2008;195(2):205-209.
  14. Rosengart TK, Doherty G, Higgins, Kibbe MR, Mosenthal AC. Transition Planning for the Senior Surgeon: Guidance and Recommendations From the Society of Surgical Chairs. JAMA Surg. 2019 May 15. [Epub ahead of print]
  15. Richter R. Young scientist helps design software that measures a surgeon’s skill. Available at: https://stanmed.stanford.edu/2018fall/young-scientist-artificial-intelligence-measures-surgeons-skill.html. Accessed: June 22, 2019.

Table

Recommendations of the Society of Surgical Chairs

  • Mandatory cognitive and psychomotor testing of surgeons by at least age 65 years, potentially as a component of ongoing professional practice evaluation
  • Career transition discussions with surgeons beginning early in their careers
  • Respectful consideration of the potential financial needs, long-standing work commitments, and work-life concerns of retiring surgeons
  • Creation of teaching, mentoring or coaching, and/or administrative opportunities for senior surgeons in modified clinical or nonclinical roles.

Rosengart TK, et al. JAMA Surg. 2019 May 15. [Epub ahead of print]

This article originally appeared on MPR