The World Medical Association and the ageing physician

As our population ages, so too do our doctors. But ageing physicians should still play an active and leading role in our health care workforce, writes Steve Robson.

The World Medical Association (WMA) held its General Assembly in Porto, Portugal, in the second week of October. There were a number of hot topics during the meeting schedule — artificial intelligence was perhaps the hottest of all — but ageing and its consequences was near the top of the list too.

Across the world demographics are changing, sometimes quickly. Globally the population is ageing and fewer births are occurring in many parts of the world, not only in high-income countries. With this transformative trend in mind, the WMA made some changes to its statement on ageing.

Doctors are hardly immune from ageing and, hand in hand with the general statement, the WMA updated its specific resolution on ageing physicians: “The number of physicians at or near retirement age is increasing in many parts of the world, and many of these physicians still play an active and leading role in their respective fields.”

With an aging medical workforce and a concurrent global shortage of doctors, the WMA’s statement aims to acknowledge that older doctors have a key role to play in the medical workforce, stressing that, “they provide competent care as well as improve patient access to medical care.”

At a time of medical workforce constraints, where shortages of doctors have led governments around the world to seize the opportunity to offer up patient care by substituting with lesser-trained and less experienced professional groups, the WMA statement urges “avoidance of policies that mandate age-specific retirement for physicians.”

Strong doctor leadership

The importance of doctors leading health care was emphasised by outgoing President Dr Ashok Philip of Malaysia. In his valediction he made the following important points:

“Healthcare needs teams. There is no arguing with that. However, teams need leaders, and those leaders must be doctors. No other health care professionals have the breadth and depth of training to fill this role better.”

“Unfortunately, it seems that everyone wants to be a doctor — without going through the studying and training needed … the attempted inroads are everywhere. The push to replace doctors with “physician assistants” or “physician associates” is widespread. These people are supposed to support doctors, but it seems that often they begin to believe and act as if they are the experts.”

The WMA strongly advocates for doctor leadership in health care across the world. In a time of undersupply, it was vital to have a useful and nuanced statement on the role of older doctors. The WMA framed the issue as one in which it is possible to support “professional autonomy, and [address] the matter of continued competency evaluation, to preserve patients’ access to care, patients’ right to freedom of choice, as well as patient safety and medical care standards.”

Rejecting ageism

When the Medical Board of Australia released suggestions for how to ‘manage’ older doctors, the Board’s approach was criticised for taking a negative approach and even being ‘ageist.’

The WMA, by contrast, makes a clear statement that older doctors — like me — don’t necessarily belong on the shelf: “ageing physicians can play a valuable role contributing their experience and knowledge of the healthcare environment, of their patients, and of the interpersonal dynamics and the patient-physician relationship.” That is good news for the thousands of older doctors around the country who still wish to make a contribution, and for the patients who continue to value their care.

Certainly, as doctors age there may be concerns about professional performance. This is not restricted to doctors — it is a common issue across many professional and other groups. Handling concerns about the potential for age-related performance decline can be challenging. For this, the statement offers advice:

“The World Medical Association believes that when there is concern about a physician’s competence, the physician’s colleagues and internal management should examine whether the concern is well-founded and if so, whether the issue can be resolved quickly and through internal processes without risk to patient safety. If such efforts do not resolve the problem, it may be necessary to report the physician to the relevant authorities in good faith and in the best interests of the physician and of their patients.”

This, however, is not about throwing colleagues under the bus. “It is imperative that this approach be marked by the utmost benevolence and collegiality. Appropriate personal support to the physician should be ensured.”   

Supporting older doctors

To support the ongoing work of older doctors around the world, the WMA makes a number of clear recommendations. Any assessment of the performance of older doctors should be based on “the principles of evidence-based competency evaluation of the individual physicians, and strive for professional autonomy in this matter.” A profession-led response is very good medicine.

Some doctors will not want to slow down their professional activity as they get older, so the WMA statement suggests that hospitals and clinics always “ensure appropriate and balanced evaluation of the working ability of ageing physicians that wish to continue their medical practice.”

Ageing should not be the same as ossifying — continued lifelong learning is a fundamental principle of medical practice. Completing professional development activities also is required for registration. The statement is explicit that older doctors should aim to “maintain professional skills with appropriate continuing professional development activities, in order also to adapt to new technologies, treatments and healthcare protocols and ensure up-to-date and safe medical care.” 

Every doctor has an obligation to stay up to date, no matter their age. However, after decades of professional experience the older doctor might take a slightly different focus. In recognition of this the WMA promotes “tailored continuing professional development activities to support ageing physicians and the maintenance of their professional aptitude, for them to provide high quality care throughout their practice careers.”

Ageing affects each of us in different ways, and being attentive to how we are affected is important. The onus also is on individual doctors to recognise the effects ageing is having on their own professional capacities: “physicians should report to the appropriate authorities conditions or circumstances which impede a physicians from providing care of the highest standards, as set forth in the WMA’s International Code of Medical Ethics.”

In all of its statements, the WMA puts doctors at the heart of health care and asks our profession to stand proud and value what we have to offer society. Certainly, the ranks of older doctors are expanding, but with some sensible guidance there is no reason that that people in my age group shouldn’t continue to make a big contribution to the health of the nation — and the world.

Professor Steve Robson is Australia’s delegate to the WMA.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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