Airline pilots have to retire at age 65. Air traffic controllers have to retire at age 56. Yet, doctors are allowed to keep on working well past any predetermined retirement age.
“Given the high-risk nature of practicing medicine, some are asking if mandatory cutoff ages and cognitive and physical examinations” should be required for all aging physicians, especially surgeons “whose slightest slip-up can cause irreparable harm to patients” (Modern Healthcare, June 11, 2016).
Doctors are living longer and retiring later. Over the past decade, the median retirement age for U.S. physicians has increased from 63 to 68 (Association of American Medical Colleges). More than 99,500 U.S. physicians are still practicing medicine into their 70s and beyond (Federation of State Medical Boards).
For many of these physicians, age is more than “just a number.” According to a 2015 AMA report, “poorer performance on quality measures such as mortality and length of stay were more apparent for clinicians age 60 and older.” In January of this year, the American College of Surgeons recommended that surgical specialists over the age of 65 voluntarily undergo confidential physical exams at regular intervals.
“The general public thinks we police ourselves better than we actually do,” says Dr. Mark Katlic, chief of surgery at Sinai Hospital in Baltimore. “It’s a fact of life” that physical and cognitive function decline with age, says Dr. Katlic, but “doctors don’t always believe it.” Most physicians know of an elderly colleague who should have retired sooner. “There was a surgeon who fell asleep during an operation; another who couldn’t remember the way to his own office and had to be led there by residents; and an obstetrician who did not have the physical dexterity to deliver a baby” (documented incidents reported in Modern Healthcare).
Stories such as these have prompted health systems to create policies requiring clinicians of a certain age to undergo physical and cognitive testing and, in some cases, more specific testing of clinical judgment. One of the leaders in this movement is LifeBridge Health, which operates several medical institutions in the Baltimore area. Another is the Virginia Health System in Charlottesville where physical and cognitive exams have been mandatory since 2011 for all staff physicians 70 and older. Others with similar policies include: Stanford Hospital and Clinics in Palo Alto, California; the Children’s Hospital and Medical Center in Omaha, Nebraska; the University of Pittsburgh Medical Center; and the Texas A&M Rural and Community Health Institute in College Station, Texas.
Approaches to evaluating aging doctors vary from institution to institution. Some call for physical health and clinical skills screening every two years beginning at a certain age. Some institutions allow aging practitioners to be evaluated by their own primary care physician; others contract with outside physicians to do the exam. The comprehensiveness of the exams vary as well, some lasting a half-day, others several days. The LifeBridge aging-surgeons program takes two days, is open to physicians from anywhere in the country, either coming voluntarily or because of a hospital’s recommendation or policy. The cost for the LifeBridge assessment is $17,000.
Making these exams mandatory is a “touchy subject,” says Dr. Ann Weinacker, vice chair of medicine for quality implementation for Stanford Health Care (Modern Healthcare). Although late-career practitioner policies are proliferating around the country, “it’s not easy to implement, and it’s not always popular,” says Dr. Weinacker. After all, being a physician “is not just what we do, it’s who we are. The idea of someone saying ‘you can’t do that anymore’ is frightening.”