AMA Report Calls for Age-Based Competency Testing for Doctors

With an aging workforce, there’s concern among doctors that the quality of patient care provided by senior practitioners may decline. The American Medical Association has agreed to lead the effort to evaluate older physicians.

Like many others, the medical profession is graying. Acknowledging the possibility that patient care could be affected as doctors get older, the American Medical Association last week adopted a plan to evaluate senior healthcare providers’ on-the-job effectiveness.

That plan, proposed by the association’s Council on Medical Education and approved by a unanimous vote at AMA’s annual meeting, will give guidance to state medical boards about the maintenance of licensure (MOL) process. AMA groups will develop preliminary assessment recommendations. Testing, the report said, should include a review of the doctor’s physical and mental health and treatment of patients.

Unfortunate outcomes may trigger an evaluation at any age, but perhaps periodic reevaluation after a certain age … may be appropriate.

To practice, all doctors must meet state licensing and continuing medical education requirements. While some hospitals require age-based screening, no national policy exists to ensure that older physicians are still practicing safely. Medical licenses must be renewed every year or two, but after the initial exam no competency-based test is administered. AMA is planning to change that.

“[P]hysicians should be allowed to remain in practice as long as patient safety is not endangered,” according to the report. “Unfortunate outcomes may trigger an evaluation at any age, but perhaps periodic reevaluation after a certain age … when incidence of declines is known to increase, may be appropriate.”

According to AMA data, the number of U.S. physicians 65 and older has quadrupled since 1975 and now totals about 240,000, or roughly one out of every four doctors. And while aviation and military personnel—fields where error can result in the loss of life—are subject to mandatory retirement ages, physicians can practice as long as they’d like.

A similar policy was proposed by the Federation of State Medical Boards with input from AMA, according to an AMA statement, but the framework is relatively new and no state has implemented it. With the newly passed AMA policy, the group said it can continue to work with state medical societies and medical boards as they begin to work age-related MOL policies in.

The plan was met with some resistance outside of the conference halls. A group of Stanford University doctors said the policy constituted age discrimination. The same group of doctors was subject to an age-based policy introduced at Stanford Health Center in 2012 that required doctors age 75 and older to go through a special assessment every two years. The review included a physical exam, cognitive screenings, and peer assessments of their performance—similar testing requirements that AMA’s new policy would include.

“There’s no scientific rationale,” Stanford’s Dr. Stanley N. Cohen, 80, told the Santa Cruz Sentinel. “The hospital has this notion that older physicians pose some special risk. There’s no data to support this.”

The AMA report acknowledged that no direct link between age and patient safety has been established. However, the move to develop the guidelines could “head off a call for mandatory retirement ages or imposition of guidelines by others,” it said.


Rob Stott

By Rob Stott

Rob Stott is a contributing editor for Associations Now. MORE

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