Beware Old Boomer Doctors

Even as news about shortages of physicians spreads, as Americans in huge numbers become aging baby boomers they need to pay increasing attention to the age of their physicians. As of 2008 just over 20 percent of US physicians were over 65. Should patients be concerned about senior citizen doctors? You betcha!

The more you pursue the question of whether older doctors pose hazards, the more disturbed you will become.

Four years after a 78 year old vascular surgeon in California screwed up but continued operating he finally had to undergo a competency assessment. That original event was a surgery on a woman who developed a pulmonary embolism and died. The surgeon had not responded to urgent calls from nurses. He underwent a neuropsychological exam which found that he had visual-spatial abnormalities, was unable to perform fine motor movements, could not retain information, and had an unusually low verbal I.Q. In other words, he failed because he had a cognitive deficit, and was asked to surrender his license

The Great Recession has impacted physicians also, meaning that many older ones are not retiring, but are continuing to practice either full time or part time even as they grow considerably older.

All of us must recognize that physicians are no more immune to a host of terrible diseases than the rest of us, including dementia, Parkinson's disease, stroke and other ills of aging.

Combine that reality with the frightening fact there really are few safeguards to protect patients against physicians who should no longer be practicing because of inadequate mental or physical capabilities, or just because they do not possess the very best and latest information pertinent to their practice.

A terrific study published in 2005 found the following: More than 70 percent of doctors showed declines in performance over time. An earlier 2000 study of heart attack patients, mortality rates rose by 1 percent for every two years since a patient's doctor graduated from medical school. Young doctors are more likely to use "evidence-based medicine," which is treatments and drugs that are based on clinical trials, while older doctors bases decisions more on training and experience. Young doctors are more comfortable using hand-held computers, electronic medical records and searching the Internet.

A New York Times article noted these two studies: A 2006 study found that in complicated surgeries, patients' mortality rates were higher when the surgeon was 60 or older, though there was no difference between younger and older doctors in routine operations. A 2005 study found that the rate of disciplinary action by a state medical board was 6.6 percent for doctors out of medical school 40 years, compared with 1.3 percent for those out only 10 years.

The British National Patient Safety Agency has reported that general practitioners over 60 were seven times more likely to be referred for problems than the under 40s.

Specialty boards do not necessarily require recertification of older doctors that have been grandfathered in. For example, less than 1 percent of the 69,000 so-called grandfathered members of the American Board of Internal Medicine have voluntarily sought recertification which is a tough process.

Though patients may not easily detect age-related performance deficiencies in their doctors, fellow doctors and nurses in theory may notice problems, but taking action to remove substandard physicians takes a lot of courage, which typically may be lacking. Consider this case in a medical center in New England. Physicians noticed cognitive changes in the 77-year-old chairman of internal medicine. He was highly respected and worse yet had trained most of the physicians at the center. What were they to do? Even giving him a retirement party did not induce him to quit. It took an intervention, where four or five of the doctor's close colleagues confronted him as compassionately as they could. This finally caused him to voluntarily turn in his medical license.

Only 5 percent to 10 percent of hospitals around the country have started to address the issue of aging physicians systematically. At Driscoll Children's Hospital in Corpus Christi, Tex., has a policy which states that when doctors 70 and older are up for reappointment, they must undergo cognitive and physical exams that assess skills specific to their specialty.

Considering the many problems we all face with health insurance and finding doctors that will accept whatever insurance we have, especially Medicare and Medicaid, paying close attention to whether older doctors can be totally trusted is a huge challenge. Experience versus competence, that is the issue all patients must ponder. Does society need more rigorous competency testing for older doctors? Until that happens, old doctors need to revisit their most fundamental professional and ethical responsibility: First, do no harm. Put that above your egos and financial objectives.