Understanding age-triggered cognitive assessments of late-career physicians

Abstract

Late-career physicians now represent a significant part of the physician workforce in the United States. The American Medical Association Council on Medical Education tracks physician demographic data and found that in 1975 there were 50,993 practicing physicians 65 years or older, but by 2013, this number had risen to 241,641 physicians, a 374% increase. The AMA Council also concluded that aging was associated with decreased processing speed, increased difficulty inhibiting irrelevant information, reduced hearing and visual acuity, decreased manual dexterity and visuospatial ability. There is mounting concern that the effects of aging can adversely impact the practice of medicine by late-career physicians. Although results are mixed, studies suggest late-career physicians have a higher rate of disciplinary action, fail to acquire new knowledge and have greater variability in test scores and their patients experience higher mortality rates after complex surgical procedures. Hospital administrators in their efforts to assess cognition of their aging medical staff are limited by the absence of validated metrics when it comes to older individuals with above-average years of education. Also, attempts to curtail medical practice based on age are fraught with legal implications arising from the Americans with Disabilities Act of 1990 and the Age Discrimination in Employment Act of 1967. We examined the issues hospital administrators face when formulating policies regulating the medical practice of late-career physicians. Our review summarizes the state of the literature of late-career physicians, reviews the legal implications of policies regarding age and the practice of medicine and offers our experience in creating a late-career physician policy for a multi-disciplinary medical staff.