Statistics show that in 2015, the number of practicing doctors above the age of 65 was 23% of all health professionals. This percentage has increased by more than 374% since the year 1975. More than ever, we are left to wonder: what is the appropriate physician retirement age?
There is concern regarding the ability of medical professionals to continue practicing medicine after the age of 65 years. With the mean cognitive ability declining by 20% between the ages of 40 and 75 years, there is a concern as to whether this influence the treatment provided by older generation physicians. In addition to the decline in cognitive abilities, older physicians tend to use older methods of treatment that could be outdated and provide feedback that may not meet the health norms of the conditions seen and experienced today. Their reluctance to change may hamper policy development in a hospital.
While there has been much discussion concerning the possibility of mandatory age restrictions to work at hospitals, it was met with resistance and the possibility of age-discrimination lawsuits. More work needs to be done to reach a consensus on the best approach to the physician retirement age.
Relevant studies and their implications were discussed by a team of researchers from Washington University in a recent review published in JAMA Surgery. According to their review, the American Medical Association Council on Medical Education contends that aging is associated with decreased in physical capability. These skills are decreased processing speed, limiting the ability to complete complex tasks, increased difficulty inhibiting irrelevant information, increased influence by the order in which information is received, reduced hearing and visual acuity, and decreased manual dexterity and visuospatial ability.
The capacity to perform as a surgeon declines as the surgeon increases in age and this is confirmed by research that shows an increase in the number of cardiovascular deaths, a greater probability for arterial ligations, and higher patient mortality rates after the removal of the pancreas for older age physicians. Furthermore, their study reviews a test done by researchers Powell and Whitla that shows that as physicians age there is an increase in the variability of cognitive skills associated with increased age. While the researchers do admit that there might be many other contributing factors (e.g., failure to refresh knowledge of current medical treatments), the results of the study are still relevant and important.
Following the results of these studies, the American College of Surgeons recommends that physicians above the ages of 65 have a voluntary and confidential baseline physical examination, with regular reviews every six months after that. Also, the California Public Protection and Physician Health program recommends that physicians be considered by their peers and support staff to evaluate the level of competence. While there are few hospitals in the United States with a mandatory physician retirement age, the implementation of these tests will help benefit the interests of the patient and the overall population health outcomes. While respecting the experience of aging physicians and the unique insights they provide, it may be useful to consider teaching and mentor roles. Doctors, hospital administrators, and policymakers have much to consider in determining the appropriate physician retirement age.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Reference:
Dellinger, E. Patchen, Carlos A. Pellegrini, and Thomas H. Gallagher. “The Aging Physician and the Medical Profession: A Review.” JAMA surgery (2017).
