A Voice Against Age-Based Testing for Physicians

In June of 2015 the AMA recognized that the number of physicians over age 65 has quadrupled since 1975, now accounting for one out of four physicians. Apparently the AMA leadership finds the sheer number of older physicians a cause for concern.  The organization is working to develop guidelines to routinely assess competency of physicians based solely on age, guidelines which will likely translate to state licensing and practice regulations.  This is a disturbing trend.

I may be overly sensitive as I hit the “Big 6-0” this year, but still something about this focus on aging concerns me.  It feels like discrimination.  In my 30 years of practice, I have worked with physicians of all ages, both young and senior, and I have never observed any correlation between advancing age and incompetence.  On the contrary, as a rule, I have seen that physicians, at least radiologists such as myself, expand their knowledge and skills year by year, incorporating new information to build on an ever-broadening base, with improved clinical judgment and acumen as they progress through their careers.  To suggest that this extraordinary accumulated wealth diminishes to any significant degree simply by the roll of the calendar is insulting.

This issue has been simmering for more than a decade.  There are a handful of studies that used to give credence to the notion that physicians practicing after age 60 are failing mentally and physically and need close monitoring.  Some groups are suggesting that there should be mandatory annual neuropsychiatric testing of all physicians after age 60 or 65.  Even now, some hospitals require this sort of testing (at a significant financial cost to the physician annually) as a requirement of hospital staff privileges.  And this type of testing is now being used in specific instances to decide older physicians’ fitness to work when they experience bad outcomes.

One group involved in neuropsychiatric testing is the UC San Diego Physician Assessment and Clinical Education Program (PACE).  Here are a couple of published examples they have used to demonstrate the value of age-based testing:

A 78-year-old vascular surgeon had a patient who developed pulmonary embolism after surgery.  The surgeon failed to respond to urgent calls from nurses and the patient died.   He was eventually forced to undergo testing by the state medical board which showed some cognitive and motor deficits, and it was concluded that the adverse outcome in the patient was physician-age related and the surgeon had to relinquish his medical license.  In this instance I am unclear as to the specific correlation between mental and physical aging (in an otherwise satisfactorily performing surgeon) and failure to answer a call.

Another surgeon had a bad outcome, the first in 40 years of practice, which led to his being tested by PACE.  Here there were actually two bad outcomes as he was simultaneously presented with two very difficult patients and neither did well.  Neuropsychiatric testing confirmed that he had some age-related deficits.  PACE researchers maintain that older physicians rely mainly on oft-repeated experiences or “crystallized knowledge,” and are less able to absorb to novel information, and this, they concluded, was the explanation for the adverse outcome for this surgeon with an otherwise spotless 40-year career.  I wonder how they can be so sure a younger, less experienced surgeon would have done better in this extraordinary situation.

This is what frightens me.  After a certain age, any adverse outcome, malpractice claim, disciplinary action can easily be an excuse to test the physician, and any discovered deficit can be used to force a physician out of practice.  If annual testing is required those results can and certainly will be used to force skilled, successful physicians into retirement.

The promoters of this ageist agenda commonly cite the mandatory retirement requirement for commercial airline pilots as precedent for expansion of similar policy to physicians.  For pilots, the ostensible major concern is for “sudden catastrophic medical incapacitation” with cognitive decrement also mentioned.  However, if you research the history of commercial air safety, you find there is tenuous evidence to suggest that older pilots are a hazard, and the majority of pilots and aerospace physicians argue that the age-based mandatory retirement rule is arbitrary and prejudicial, and they are of the opinion that this is a political issue rather than one of safety and medicine. 

As a physician, I certainly believe that we are obligated perform at a high standard, and regular monitoring and testing is important, but it should be equally imposed regardless of age.   Senior physicians with their years of experience and accumulated knowledge make a tremendous contribution, and as a whole are at least equally qualified as their younger counterparts to provide excellent medical care.   

Age-based routine physician competency testing is discriminatory and should be vigorously opposed. 

Diana Artenian is a radiologist with the Portland VA Medical Center in Portland, Oregon.