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MEDICAL careers, like the human life cycle, have a beginning, a middle and an end.
Following a prolonged gestation of training, practitioners move on to their discipline of choice where they provide clinical care to patients, education and training to junior colleagues, and administrative support to hospitals and other medical organisations over decades of hard work.
At some stage every doctor starts to think about slowing down, or contemplates full retirement.
But moving from full-time practice to full retirement in one step is not a good thing — it’s not good for the practitioner’s physical and mental health, and not good for the profession either. It is also government policy to encourage older workers and professionals to stay in the workforce longer, beyond current retirement age if possible.
Despite this encouragement for older professionals to remain active in their field, in the medical arena we have a situation that is hostile to older doctors. When medical practitioners retire they are no longer able to prescribe, refer or undertake any other form of “practice”.
The Australian Health Practitioner Regulation Agency (AHPRA) is currently looking into the definition of “practice”. The current definition is broad and covers “any activity in which a practitioner uses their professional knowledge”.
But does this mean older doctors can continue to use their accumulated medical knowledge, skills and wisdom for work such as teaching, examining, mentoring, tutoring, assisting with tribunals, and advising government, non-government, voluntary and private/business organisations on medical matters? Uncertainty prevails for many doctors who cease clinical practice and find themselves in this situation.
My solution to the current problem of how older doctors can remain registered is to develop a new category of medical registration — termed “senior active” — that could be based on the MBA’s limited registration in the public interest.
This senior active registration should have unlimited duration and allow doctors to remain on the register of medical practitioners. Doctors could participate in activities (either remunerated or as a volunteer) using their medical knowledge, skills or wisdom, outside the care of individual patients.
There is also an opportunity here to have a group of registered practitioners available to assist in times of local, state and national disasters, providing the community with a precious medical resource.
Senior active doctors could, without fee or reward, refer an individual to a fully registered medical practitioner and prescribe drugs in extenuating or emergency situations, including renewal of a prescription provided by a fully registered doctor within the previous 6 months.
To undertake this limited prescribing, they would have to have undertaken professional education activities on prescribing therapeutic substances in the previous 12 months.
Registrants over the age of 80 years should be required to undertake a compulsory annual medical check by a general practitioner.
They should also have the discretion to prescribe for themselves, or for their immediate family. This level of discretion is available to all doctors in fully registered medical practice despite the general advice from the AMA and medical boards not to do so except in emergency or extenuating circumstances.
To deny this discretion to senior active doctors would raise the question of age discrimination.
The success of this category will depend on the restrictiveness of the practice definition and how much it will cost.
If the total cost for the registration fee, indemnity insurance and professional education expenses was kept within reason (say, below $500 a year) then the category may appeal to senior doctors to maintain their registration after leaving full registration status and before moving to full retirement.
Professor Philip Morris is qualified in psychiatry and addiction medicine and has a private psychiatric and medicolegal practice on the Gold Coast. He is professor at the Faculty of Health Sciences and Medicine, Bond University.
Posted 28 November 2011
Not sure about this. I agree with Sue Ieraci (28/11/11). A much more in-depth assessment than an annual GP check is necessary to pick up cognitive problems that may impede the safety of elder doctor prescribing. eg the question of INFLUENCE from a loved relative is difficult to assess at that level. A MMSE of 30/30 does not exclude problems of cognition either. Maybe there needs to be a “capacity to practice” performed in those who wish, after they turn, say, 80 years of age, to be able to partially practice. Or when they retire and want special privileges to continue minimal practice.
In reference to the comment by anonymous above. Only a fool would believe that superstitious old nonsense cliché about “The doctor who self treats has a fool for a doctor”. Doctors are highly trained. Of course we can do simple things for ourselves. It’s almost immoral and unethical to prevent doctors using their skill for even the simplest of things. Show some initiative, anonymous. If a doctor is so self indulgent that s/he must make another doctor do EVERYTHING then I don’t want to pay for it via the medicare subsidy.
Both Sue Leraci and anonymous (26/11/11) have missed the point that Prof Morris made that AHPRA should provide for registration of doctors who wish to stage their withdrawal from fully active practice with criteria appropriate to the nature and amount of practice they wish to continue. To write repeat prescriptions and referrals with the report to go to the doctor’s GP, for example, regular consultation with the senior active doctor’s GP or specialist should be considered adequate CPD and recency of practice. The cost of indemnity should be minimal. Both Prof Morris and the Australian Doctors’ Fund (ADF) have proposed such graded criteria for registration. Prof Geoffrey Dobb, Vice-president of the Federal AMA, in the October issue of “Australian Medicine” wrote eloquently on this topic in his Vice-president’s Message. It is long overdue for AHPRA and Medical Board of Australia (MBA) to confer with these and other clear thinkers to negotiate a sensible solution to utilise the valuable contribution to the medical work force that senior active doctors offer.
This is an excellent and well thought out proposal from Philip Morris which deserves the strongest possible support from the AMA leadership, who seem to have abandoned our senior colleagues to the bureaucrats of AHPRA.
To Sue Ieraci I say that if a very subtle cognitive defect is missed in an annual examination, it is very unlikely to be significant in terms of impacting on one’s ability to write referrals or repeat prescriptions – and subtle cognitive defects can occur in younger medicos as well.
To anonymous I say that I can understand why you might want to remain anonymous. Any busy clinician will tell you that their family miss out on enough of their time without having to drag your young child with acute otitis media or tonsillitis to an emergency department in the middle of the night because you’re not supposed to prescribe for a family member. Protect us from bureaucrats who wish to control our every action.
I fully agree with Ken Sleeman (28/11/11) that the universities should make more use of older doctors. I am 83 and have been a clinical tutor in a medical school for many years. I do not need medical registration & believe that I still have something to offer the students.
I understand your sentiments, Dr Ray, but I’m not sure that staffing our EDs with retired obstetricians would produce better results!
As my 8th decade all too rapidly draws to a close, I am acutely aware that my brain does not function as well as it did. However, Dr Sue, we oldies only want to write the repeat scripts we forget to get from our overworked GPs who are a considerable distance away. Permit me to also point out that without the seniors of the profession the clinical side of the AMC exams would collapse. The O&G commitment of the cognitive fit in NSW to the last exams in Sydney was two specialists.
As a group we feel unreasonably denigrated by the members and bureaucrats of AHPRA as brain dead and a danger to the community and can hardly conceal a wry smile when we repeatedly read of the blunders by the cognitively fit in the state’s A&E departments.
What is an “older” doctor? One who has ceased clinical practi ce but who wishes to be involved in other ways or one who is over 80?
Very few doctors over 80 would wish to remain clinically active but all would have a wealth of knowledge to pass on.
Universities should use this resource; with a reasonable honorarium, old doctors could enjoy the cut and thrust of student discussions without the pressures of non compliant patients or the need to keep up with possibly better drugs and investigations.
It is not appropriate for medical practitioners to prescribe for self or immediate family at any stage of their career. The doctor who self treats has a fool for a doctor. In fact in some states of Australia self-prescribing is illegal.
My personal opinion is that if a medical practitioner wishes to continue to practice they should maintain their registration and meet all the obligations that this requires. Medicine changes too rapidly to risk practice by those who do not meet these requirements for education and insurance. How many GPs would feel comfortable telling their older colleague they are not fit to practice? The burden of mandatory reporting is already too great.
“Registrants over the age of 80 years should be required to undertake a compulsory annual medical check by a general practitioner.” But would a health check by a GP really reveal subtle cognitive decline in an over-80-year old? I would be interested to know on what research or knowledge of cognitive function in the elderly Dr Morris makes his recommendations.