I read an article recently about a 100-year-old doctor named Howard Tucker who is still practicing medicine in Cleveland. Dr. Tucker began working as a neurologist in 1947, when Harry Truman was president.
Though he is obviously an extreme example, Dr. Tucker represents an important demographic trend: The United States has a growing number of older doctors. Even as baby boomer doctors pass retirement age, many are electing to continue to practice medicine. A survey in 2020 found that almost a third of licensed doctors in the United States were 60 years of age or older, up from a quarter in 2010.
Given the alarming levels of burnout and attrition in the U.S. health care work force, this trend isn’t entirely unwelcome. The Association of American Medical Colleges has predicted a shortage of 38,000 doctors or more within the next 12 years. A recent survey of health care workers found that one in five doctors (and even more nurses) were considering leaving their practices within two years. Old doctors are certainly better than no doctors.
But aging inevitably brings physical and mental decline, which can affect physician performance and put patients at risk. Air traffic controllers are required to retire at age 56, and airline pilots must stop flying commercial flights at age 65. Doctors face no such restrictions, even though their decisions are also crucial for people’s lives. Should they?
As a doctor myself, I think a mandatory retirement age would be a crude and unfair solution. A better approach would be to mandate periodic competency assessments (say, every two or three years) after a certain age (say, 65 or 70). These competency exams would gauge rudimentary mental and physical capacities for practicing medicine. They might include, for example, neuropsychiatric testing to help in the detection of low-level cognitive impairment, as well as vision testing.
It’s important to be frank about aging. According to a recent study in JAMA Neurology, one in five adults over the age of 65 may be living with cognitive impairment that is out of proportion to normal age-related changes. The problem gets worse the older we get. About 40 percent of Americans over age 85 are believed to have measurable cognitive impairment. Age may be just a number, but it is one highly correlated with physical and mental decline.
Now that I’m in my 50s, these issues have taken on greater urgency for me. As a son who witnessed his father’s decline from Alzheimer’s, I worry about my own potential future deterioration. And as a doctor, I know that I cannot always rely on my medical colleagues to raise the alarm.
That said, growing older can also bring great benefits, including the accrual of experience and judgment — wisdom that may compensate for a certain amount of cognitive decline. I have worked with many excellent internists who practiced into their 80s. And age is hardly the only factor in predicting cognitive decline; there’s also illness, addiction and the lack of social or family support.
Youth, in turn, is no guarantee of competency. While I have worked with physicians in their 60s who began making uncharacteristic mistakes, I have also encountered medical graduates in their 30s whom I would not trust to care for a member of my family. Chronology isn’t everything.
Given such variability, mandatory retirement based on age seems unfair, not to mention politically impractical. (Not surprisingly, the American Medical Association is firmly opposed to forcing older physicians to retire.) However, leaving the decision of when to retire to potentially impaired physicians seems equally problematic. This is why mandated periodic competency assessments are a good idea.
The tests used to make such assessments would have to be validated and vetted for transparency and fairness, of course. The results would also have to be interpreted in the context of an individual physician’s specialty: The visual acuity or stamina required to perform complex surgery is different from that needed for office-based practice, for example.
If test results were to indicate significant impairment, transitional strategies such as cutting back on workload, avoiding invasive procedures and using assistants and aids should be considered before mandating retirement.
There is no data published on the number of hospitals that mandate competency assessments for older doctors, but it appears to be very low — perhaps a few dozen hospitals at most across the country. There are obstacles to implementing such testing more broadly. One barrier is physician resistance. Last year, the American Medical Association, acknowledging the importance of the issue, published guidelines for age-based screening but fell short of calling for a mandate. There has also been legal pushback. In 2020, the Equal Employment Opportunity Commission sued Yale New Haven Hospital, claiming that its cognitive and vision testing requirements for older employees violated federal anti-discrimination law. (The lawsuit is ongoing.)
This circling of the wagons is self-serving and shortsighted. In medicine, patient safety should be the primary concern.
Why not require competency assessments for all doctors? Why start only at age 65? Because a younger age would greatly increase the chance of false positives — practitioners deemed impaired who really are not, with long-term consequences for otherwise promising careers — as well as needlessly strain hospital resources. In addition, younger doctors must already pass periodic certification exams that test knowledge in their particular medical specialty.
It’s not just medicine. Age-based competency testing should also be extended to other professions in which age-related impairment can result in serious harm to others, such as law, accounting and even politics. It would be neither fair nor proper for doctors to be singled out for such evaluations.
With the aging of the U.S. physician work force, it’s just a matter of time before outside agencies impose mandatory retirement or some other crudely designed bureaucratic solution. Hospitals should act to institute thoughtful and nuanced programs of competency assessment before anyone tries to do it for us. It would be good for patients and doctors alike.
Sandeep Jauhar (@sjauhar) is a doctor in New York and the author of the forthcoming book “My Father’s Brain: Life in the Shadow of Alzheimer’s.”
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