Older doctors may face mandatory review

OLDER doctors could face a mandatory performance assessment when they reach a certain age, says the head of the Medical Board of Australia.

Dr Joanna Flynn, the board’s chair, said that in the future the board may look at targeting performance assessments at high risk groups including older doctors.

“Not in the next 3 years, but beyond that we may want to take a more active approach, in partnership with colleges and the AMA.”

She said a mandatory assessment was somewhat analogous to the mandatory driving test that older drivers are required to sit in some Australian states.

Some jurisdictions, particularly in Canada, had introduced mandatory peer assessments once doctors reached a certain age, Dr Flynn said.

For example, in Quebec regulators recently issued data about the performance of older doctors in general, which showed some decline with age, Dr Flynn said. The regulators sent the data to older doctors, asking them to reflect on their own performance and advising that assessments would be conducted, prompting some doctors to restrict their practice or retire.

Dr Flynn emphasised that all doctors, regardless of age, needed to recognise and work within the limits of their competence, as specified in the Medical Board’s code of conduct. (1)

She also encouraged doctors to seek advice from colleagues about their skill and health, especially when performing challenging or unfamiliar tasks.

“We rely on doctors to exercise good judgement and it can sometimes be helpful to have the stimulus of knowing that there is data to suggest that doctors’ performance in certain areas declines as they age”, she said.

Dr Flynn’s comments come in response to two MJA articles looking at work transitions in older doctors.

Professor George Skowronski, professor of critical care at the University of NSW, and Dr Carmelle Peisah, associate professor of psychiatry at the same university, wrote that older doctors were affected by several age-related sensory and cognitive changes, such as a decline in processing speed and memory. (2)

There was a need for strategies that capitalised on older doctors’ strengths while supporting areas of decline, “trading off the benefits of experience against declining stamina and performance”, they wrote.

They also noted that older doctors were more likely to face disciplinary action.

However, Dr Flynn said that out of 90 000 doctors in Australia, only about 2500 faced complaints each year. This was such a small proportion that “it doesn’t tell you what the vast majority of people are doing”.

She said it was important to retain experienced doctors, particularly given workforce shortages, provided they were practising safely.

Dr Flynn ruled out a mandatory retirement age, emphasising that the cognitive and physical ageing process was highly variable. She said any initiative needed to be respectful and not age-discriminatory.

In another article in the MJA, Dr Bruce Waxman, director of general surgery at Southern Health, Melbourne, wrote that retention strategies for older doctors could include a phased withdrawal from operating, with enhanced roles in teaching, administration or medicolegal work. (3)

Professor Simon Willcock, professor of general practice at the University of Sydney, told MJA InSight that more support was needed for career transitions that played to the strengths of older doctors.

“The challenge to the profession is to come up with career development paths and get away from the rigid disciplinary silos”, he said. Enhancing flexibility in this way could also improve performance.

“If you look at the people before the boards, they’re often suffering burnout, substance abuse, depression — which are more likely to happen if people feel they’re locked on a treadmill”, he said.

In his article, Dr Waxman said the Royal Australasian College of Surgeons senior surgeons group had developed a draft position statement to provide guidance to ageing surgeons.

The position statement recommended an annual health check from a GP, a performance review including a practice visit, and CPD modifications for surgeons not practising clinically.

Professor Willcock said a mandatory medical check when doctors reach a certain age, such as 75 years, could be useful, but he did not support a re-registration performance assessment.

- Sophie McNamara

1. Medical Board of Australia: Good Medical Practice: A Code of Conduct for Doctors in Australia
2. MJA 2012; 196: 505-507
3. MJA 2012; 196: 498

Posted 7 May 2012

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