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January 2, 2013
The image of an older doctor, for many people, is a comforting one. After all, with age comes experience, and older doctors are likely to have seen and treated a wider variety of symptoms and conditions than younger, less experienced doctors. But as many doctors themselves know, older people often miss or ignore the signs of dementia and other age-related disorders that may harm a doctor’s performance. And according to some critics of our health-care system, even perfectly healthy older doctors may be more likely to offer outdated treatments and techniques than their younger counterparts. (When it comes to Type 2 diabetes, for example, some doctors may initially prescribe an older drug rather than metformin if diet and lifestyle changes fail to adequately control blood glucose levels.)
An article published last month in the Washington Post explored these and other issues related to the aging of doctors. According to the article, 42% of practicing doctors in the United States are older than 55 — up from 35% just six years ago — and 21% of doctors are older than 65. Unlike airplane pilots and FBI agents, doctors face no mandatory retirement age, nor are there even periodic evaluations that doctors must pass to retain their medical licenses. While most states require doctors to attend continuing education classes periodically, there are virtually no procedures in place to ensure that doctors understand or even pay attention to what is being taught.
In response to this perceived lack of safeguards, some prominent hospitals and medical groups, including Stanford Hospitals and Clinics in California and the University of Virginia Health System, have begun to require doctors over a certain age (75 at Stanford, 70 at Virginia) to undergo physical and mental examinations. One health-care consultant quoted in the article estimates that only 5% to 10% of medical institutions have such procedures in place. Since the policy was put in place at the University of Virginia, 28 of 35 doctors over age 70 easily passed their examinations, while the remaining 7 decided to retire instead of participating. The retired doctors remain free to practice medicine outside of the University’s health system.
Some hospital administrators don’t agree that age-based safeguards are necessary. One executive at MedStarHealth, the largest hospital network in Washington, DC, and Maryland, argued in the Post article that regular performance evaluations are enough to weed out any doctors who experience age-related decline. Most hospitals, in fact, review performance data about every two years and may decide at that time not to renew a doctor’s privileges. But critics argue that older, less competent doctors may slip through the cracks in these reviews and deserve special scrutiny. A surgeon at the Johns Hopkins Hospital in Maryland argues that since older doctors may not be up-to-speed on the latest treatments and procedures, they should be subject to more oversight than younger doctors.
Of course, whatever age-based screening procedures are adopted by hospitals or medical groups, they cannot stop doctors who leave from continuing to practice elsewhere. And doctors in private practice are probably unlikely to screen themselves for age-related decline.
What do you think — should states adopt screening procedures for older doctors, or set a mandatory retirement age? Should hospitals and medical practices single out older doctors for special scrutiny, or should performance evaluations be standard regardless of age? Would you feel comfortable seeing an older doctor or a younger one — or does age play no role in your comfort level? Have you ever seen an older doctor who you suspect was out of touch with the latest medical knowledge? Leave a comment below!
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