Instead of retiring at age 65, many doctors choose to continue practicing medicine well into their 70s and 80s. A national trend to test the competency of these older physicians appears to be gaining momentum, especially among some of the nation's largest hospital systems. Hospitals report growing concern that the mental and physical skills of some of their older physicians have deteriorated to the point of putting patient safety at risk. Paying special attention to "weeding out" impaired physicians once they have reached a certain age is proving to be a sensitive issue, to say the least.
According to MedpageToday, the most commonly used tool to screen older physicians is the MicroCog, "an hour-long computerized test with five question domains: attention and mental control, memory, reasoning and calculation, spatial processing and reaction time." With a proctor sitting nearby, the doctor being tested is otherwise alone in the room in front of a computer, not allowed to have pen and paper or use a mobile device for assistance. As noted above, the MicroCog is a screening tool, not a "diagnostic" tool. If the test reveals possible impairment, the doctor must undergo additional testing to confirm (or disconfirm) the MicroCog findings. As expected, the MicroCog is not 100% accurate: 4% of test takers are erroneously identified as being impaired, and 17% of impaired physicians are not identified as having a problem.
There are sharply differing views on whether or not doctors should be subjected to age-triggered competency testing. Doctors themselves have mixed feelings on this issue, as revealed in interviews conducted by MedpageToday: "If a doctor is showing signs of dementia, whether old or young, then they should have a cognitive test," said Dr. Albert Ray, partner emeritus with Southern California Permanente Medical Group. "But as a screening tool to pick on older doctors just because of age is discriminatory. I don't believe it is evidence-based," says Dr. Ray. Many physicians interviewed stressed that any age-related slowness or forgetfulness is overwhelmingly offset by their experience and knowledge of their patients, which makes them better doctors than their younger colleagues."
MedpageToday reports that the 3000-physician Scripps Health hospital network in San Diego is, "preparing to launch a system-wide cognitive screening program for all physicians age 70 years and older." The Stanford University health system had planned to screen its faculty members when they reached 74.5 years of age, "but had to rescind [the plan] after some physicians loudly complained of age discrimination." The policy was replaced with "peer assessment, history, and physical exams, minus the MicroCog." The Society of Surgical Chairs, a division of the American College of Surgeons, recently recommended that surgeons undergo "mandatory cognitive and psychomotor testing" by "at least age 65."
In a viewpoint article published in the Journal of the American Medical Association, Joel M. Kupfer, MD, of the University of Illinois College of Medicine at Peoria said: "Concerns about the competency of aging physicians are not new. Numerous reports have suggested a link between poor clinical performance and physician age." On the other hand, says Dr. Kupfer: "Older physicians bring valuable skills, clinical expertise and life experiences that can be gained only by years of practice. Younger physicians bring vitality and innovation. Rather than isolating aging physicians, acceptable standards should be developed that can be applied to all physicians, regardless of age, wherever and whenever they work."
Ken Teufel, MD