For years, a debate has raged: At what point does a physician’s age begin to affect his or her ability to practice medicine competently? The question comes down to patient safety.

Age and competency

As we age, many of us lose certain faculties, which increases the likelihood of mistakes. But ageing doesn’t affect everyone uniformly.

To address this, here’s a rundown of some of the latest research regarding age and competency, along with details on what some institutions are doing to tackle the issue. 

Evidence of a link between age and competency

A case study 

A study published in Clinical Ethics epitomises the problem posed by an ageing physician population. A practising pulmonologist, age 80, began to present symptoms of short-term memory impairment. After under-scoring on mental status tests, he started taking donepezil to improve mental function. But 6 months later, after his mental status scores declined, he still refused to retire, despite a presumptive diagnosis of senile dementia.

Reviews and analyses

1. The study found that while non-analytic knowledge appears to remain constant as doctors age, analytic processing tends to decline. Likewise, one review concluded that physician performance decreases with increasing age. 
2. However, other studies have found that this isn’t a black-and-white situation. One study tested the cognitive functioning of a cohort of 1,002 physicians and 581 non-physicians. Researchers found that each group tended to exhibit decreased cognition as they age, but there was far more variability among the doctors compared with the other group. In fact, some of the physicians retained their full cognitive abilities despite their age. 
3. Authors of the Clinical Ethics case study point out that declines in faculties occur in different ways for different people For some, it may be a decline in strength; for others, eyesight; others still, cognition. As such, physicians in certain specialities may be perfectly fine to continue their practice.

How and when do we assess physicians' abilities as they age?

Research suggests that doctors have “limited capacity to assess their own competency." Physicians also tend to harbour a reluctance to report their impaired colleagues, partially as a result of a culture that presents elders as mentors. The authors of the Clinical Ethics case study conclude that cognitive screening should be applied, but the framework remains a subject of debate.

An ongoing call for screenings

In 2015, the AMA Council on Medical Education released a report which urged institutions and policymakers to create “guidelines/standards for monitoring and assessing both their own and their colleagues’ competency.” The council followed up with a report published in 2018 that once again cited evidence indicating physical health and some cognitive abilities decline with ageing, which can put patient safety at risk. 

However, while the report restated the need to screen for competency and even provided some guidance for how to craft related policy, it didn’t offer any formal guidance on how or when these screenings should be applied. To date, there remains no national standard.  As a result, some organisations now implement screenings of their own. 

What hospitals are doing 

1. Among the healthcare organisations that now assess the competency of their clinical staff is Yale-New Haven Hospital. As noted in an article published in JAMA, the hospital’s medical executive committee voted to introduce a neurologic and ophthalmologic exam for any applicant for reappointment over the age of 70. Data collected from 141 test results showed that nearly 13% of these applicants had “cognitive deficits that were likely to impair their ability to practice medicine independently.”
2. Similarly, a review published in the World Journal of Orthopedics in April analysed nine policies designed to assess the competency of practising surgeons. All these policies included a medical exam featuring general health, cognition, vision, and hearing testing. The authors concluded that forced retirement after a certain age wasn’t necessary for all surgeons—and that competency testing was effective at showing who requires remediation or retirement.
3. As noted by the AMA Council on Medical Education, without a mandated national standard, it’s on physicians to push for administrations to develop evidence-based standards for monitoring and personal competency tests.

How COVID-19 plays into the equation

1) Early in the pandemic, governments across the country put out calls for retired doctors to return to the workplace to help handle the steep influx of patients. In many cases, physicians answered. In New York, for example, more than 50,000 retired healthcare professionals responded to the state’s plea for more workers.

This, of course, raised an important question—one asked by the authors of an article published in International Psychogeriatrics: Will these retired physicians lack the competencies to practice safely, without putting patients at risk? The article cited research that found ageing is associated with changes in physical and cognitive functioning that affect skills germane to clinical work. And the question of competency is particularly pertinent during a time when clinical staff are battling a deadly novel virus.

The authors, however, concluded that bolstering staffing was vital early in the pandemic. As such, the researchers offered guidance on precautions to take when hiring once-retired healthcare workers:

1. Require retired clinicians to work with an actively licensed supervising professional to ensure competency levels are up to snuff.
2. Deploy returning doctors not to the frontline, but to leadership, supervision, consultation, public relations, mentorship, teaching, and research roles.

2) The flipside of COVID’s impact is that it prompted many other physicians to consider calling it a career. According to the findings of a survey published in September 2020, 19% of clinicians decided or were planning to retire early because of COVID-19. While the evidence is unclear, COVID-19’s risks to the elderly might have pushed older doctors away from the clinic.

Indicators that doctors are past their prime

This story is contributed by Alistair Gardiner and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.