Here’s a dilemma: The doctor is 83 years old and still seeing patients. There’ve been no complaints – so far – about the quality of his care, yet hospital leaders sense it’s only a matter of time before a patient is harmed.
How do you transition an aging physician out of patient care in a way that’s both dignified and safe? Dr. Kenneth H. Cohn recently asked this question on the Hospital Impact blog, triggering an interesting online discussion about the difficult balance between protecting patient safety and respecting an aging doctor’s skills and knowledge.
It’s not an idle question. Americans are getting older and this includes doctors. “This challenge of guiding aging physicians will come up with increasing frequency over the next decade,” Cohn notes.
Look no further than here in Minnesota, where nearly one-third of all the state’s practicing physicians in 2008 were 55 or older. Slightly more than 7 percent were over the age of 65.
A report produced by the Minnesota Department of Health on the physician workforce notes these statistics about older doctors: 19 percent of doctors who were actively practicing in Minnesota in 2008 (this was the most recent year in which workforce information was collected) said they planned to retire in the next five years and more than 40 percent expected to retire within the next 10 years. But of even more note, 10 percent of the doctors older than 65 planned to work for at least another decade.
American society is starting to redefine what it means to retire, and I suspect we’ll be seeing an increasing trend of doctors continuing to practice medicine well into their 70s and possibly even 80s. The recession also has caused many doctors to rethink their retirement plans and decide to work longer.
It’s not unreasonable to wonder whether older doctors can continue to keep up and still provide quality care.
Consider a New York Times article published a year ago that explores this challenge. It outlines the case of a 78-year-old vascular surgeon whose skills were called into question after a patient died. He remained in practice for another four years until a competency assessment was finally ordered, revealing serious cognitive deficits. The surgeon was asked to surrender his license.
The article cites a 2005 study that found doctors who’d been out of medical school for 40 years were more likely to face disciplinary action than doctors practicing for only 10 years.
Just because a doctor is getting old doesn’t mean he or she is no longer fit for medicine, the article notes. “But physicians are hardly immune to dementia, Parkinson’s disease, stroke and other ills of aging. And some experts warn that there are too few safeguards to protect patients against those who should no longer be practicing.”
The generation gap isn’t a new issue in medicine. I blogged awhile back about the differences between old and young doctors. Which is better – youth, energy and the latest knowledge or skills acquired and refined through years of experience? How do you help aging doctors recognize their fallibility without selling them short?
Cohn asks this question on his blog and got some thoughtful responses. One physician wrote: “I consider [m]andatory [r]etirement blatant age discrimination that opens up the possibilities of legal suits and rests on the premise that after a certain age, a different standard is arbitrarily applied in the physician credentialing process.”
Perhaps physicians past a certain age could be required to undergo a cognitive assessment to ensure they’re still able to practice skillfully and safely, someone else suggested – but neurocognitive tests aren’t always reliable, plus there’s the issue of who would pay for it, he wrote.
Another commenter offered a different perspective. He wrote that he has a neighbor who’s a doctor and is about to turn 90. “He volunteers at a nearby free clinic 2-3 days a week. They use his considerable experience effectively and they have a dialogue regarding limitations of practice. It is rewarding for my neighbor and provides a real and needed service to our community.”
Rather than putting older doctors out to pasture, we should find ways to make meaningful use of their skills and experience, urged another commenter. Helping them stay productive would benefit society and allow aging doctors “to ride into their sunsets with graceful dignity and a sense of fulfillment.”
Regardless of age, most doctors want “meaningful work that makes a difference in patients’ lives, a sense of community, and regular and reliable feedback that affirms their value,” Cohn concluded. But as they get older, it’s a good time to think about how they want to be remembered, he suggested. “Legacy becomes increasingly important when the marginal value of seeing one more patient diminishes.”