Old doctors who continue to treat patients

Did you know that one-third of the country’s physicians are over the age of 65?

That’s right, there’s a good chance that your doctor is on Medicare.  That’s a concern, because physicians aren’t immune to the ails of aging, and are just as prone as patients to succumb to the effects of Parkinson’s or various types of dementias.

Not comforting if you’re about to undergo an operation, for instance.  And absolutely frightening when you consider baby-boomers and newly insured patients will flood our health system in the coming years.

An eye-opening piece from the New York Times highlights the trend.  It’s up to doctors and medical societies to report doctors who aren’t able to proficiently perform, but few do.  According to the data, the rate of disciplinary action for physicians out of school 40 years was 6.6%.

Various tactics to ensure competency have been slow to take off.  Requiring all doctors to re-certify, for instance, isn’t working, since the vast majority of  doctors practicing are “grandfathered” into not being required to take the test.

Compare that to, say, airline pilots:

Patient advocates note that commercial pilots, who are also responsible for the safety of others, must retire at age 65 and must undergo physical and mental exams every six months starting at 40. Yet “the profession of medicine has never really had an organized way to measure physician competency,” said Diane Pinakiewicz, president of the nonprofit National Patient Safety Foundation. “We need to be systematically and comprehensively evaluating physicians on some sort of periodic basis.”

Hospitals have been slow to confront the issue, not wishing to alienate the medical staff.  Instead of requiring all doctors to re-certify, which is an arduous and time-consuming task, perhaps asking doctors over a certain age to undergo neuropsychological testing may be an option.

If a physician is found to have deficits, adjustments to his schedule can be made to better conform to his abilities.  It beats the alternative, where medical licenses are revoked when patients are hurt by doctors no longer able to properly function.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.baumanmedical.com Alan J. Bauman, M.D.

    Kevin, I read your article on aging doctors with great interest. I’ve also seen that this is a potential problem in the field of cosmetic surgery. As a doc who often trains physicians in the modern microsurgical techniques of hair transplantation (like with the NeoGraft FUE device, for example), I’ve found that many physicians-in-training have difficulty learning the procedure because they simply cannot see the details, like how the hairs exit from the skin. Sometimes it’s not related to their age, but more often than not physicians whose eyesight is ‘not what it used to be’ can have difficulty performing hair transplant surgery or updating their techniques. Many docs who come in for training on NeoGraft FUE don’t even own loupes (a set of surgeon’s head-worn microscopes) that are powerful enough!

    New less invasive hair transplant procedures like NeoGraft FUE have become exponentially more intricate because the instruments used to harvest and implant hair follicles are dramatically smaller and less invasive than they were just a few years back. These new instruments, when used properly, allow the harvesting of grafts as small as individual hair follicles without a scalpel and with no linear scar, and the implantation of those grafts in between existing hair follicles. Leaving the critical artistic part out of the equation for a moment, without the proper magnification and surgical skill, the results of the procedure can be severely compromised.

    Unfortunately, there’s no way to ‘test’ your doctor’s artistic or technical skill beforehand… many times, the only thing a hair loss patient can do is review their doctor’s “before and after” results.

    Even if your hair transplant doctor is certified (and re-certified) by the American Board of Hair Restoration Surgery, there is no testing of dexterity or eyesight–so once again, it’s “buyer beware!!”

    Sincerely,
    Alan J. Bauman, M.D.
    Diplomate, American Board of Hair Restoration Surgery
    Private Practice
    Bauman Medical Group – Boca Raton, FL

  • Jordan

    Peer review?

    I’m not a doctor, but perhaps license renewals should be subject to a background investigation, with confidential interviews with the doctor’s peers to establish continued competency in his specialty? Honest peer review is pretty much the only way to get a feel for how competent a practioner really is.

    This would be opposed due to the extra effort/cost that would be required by the licensing agency.

  • Max

    Make ‘em all recertify in their boards. No more grandfathering. The guys who need it the most are grandfathered. See how they like paying $3500/10 years ($350/yr).

    • jsmith

      The family medicine boards are a joke. I scored over 90th percentile last time and did not study. The worst doc I have known, an older guy we eventually eased out, also passed, but just barely. He said he didn’t study for the boards, and I believe him. This guy did not treat hypertension–he simply ignored it. Pts would come in with bps of 170/100 for 6 months, a year or more, and he simply did not address it. We had a hard time getting rid of him because the administrator (MBA, not MD) at our hospital-owned practice wanted to keep him. He made a lot of money, seeing scads of pts and doing absolutely nothing for them.
      So, don’t hang your hat on the boards, in FM at least.

  • Chad

    Sounds a lot like age descrimination to me.

  • Marc Gorayeb, MD

    Age discrimination is right! Physicians of a certain age generally know when it’s time to quit. The problem is just the opposite, Kevin. Too many physicians are cutting back when they’ve reached their prime. The more impediments, rules and regulations you impose on physicians, the more you will cause them to just leave the profession. For example, ABEM has made the re-certification process so difficult and time-consuming that I for one will probably not re-certify with this organization.

    • Kevin

      I’m not asking older physicians to re-certify, as I agree that the process is too arduous.

      But neuropsychological testing in elderly doctors is not unreasonable, and will take less involvement on the physician’s part.

      Kevin

  • Max

    Arduous? For who? It’s arduous for every one of us. That’s good. Performing surgery is arduous. Examining patients can be too. If they can’t pass or refuse to, step aside. There are plenty of younger hungry board-certified docs to take up their slack. Pony up the $$ too.

  • ninguem

    >> “………..Did you know that one-third of the country’s physicians are over the age of 65?…………..”

    I don’t know what to make of that factoid. Is that one-third of the nation’s TOTAL physicians, or one-third of the nation’s PRACTICING physicians?

    What is the typical age of a medical school graduate? I’ll guess between 25 and 30. Check the census data, glance at age and demographics of the USA, count the number of Americans age 25-65, and the number of Americans age 65-plus. It looks like about 25%, pretty close, and might be closer to a third if the average age of a graduate is older than 25, or if you count someone as a “physician” when they have completed postgraduate training.

    So I don’t know, just glancing at the numbers, it might be possible to say a third of people in most any line of work is over 65.

  • SmartDoc

    A mentor once told me to pick a primary care doctor my own age whom you could relate to well and who seemed like a decent human being, so that you could grow old together.

    Actually, that is also not bad advice for picking a spouse.

    As far as old physicians are concerned, we need to pray they don’t retire. Newer docs don’t work as hard and we the need the manpower.

  • ninguem

    Most Americans are leaving work at age 65. The docs working at age, so many are covering the free clinics and doing similar uncompensated work. Parts of my med school days were spent with such docs, who loved having students around. That work might be some one or two percent of the totality of medical services, but good luck replacing that one or two percent if you have to pay someone to do the work.

    For some time, I practiced in a very remote but very beautiful area. People liked to retire there. This included docs. After a while, the retired docs realized they got bored golfing every day. They saw a need for services for the rural poor, and begged to be allowed to volunteer.

    A license in my state is rapidly approaching a thousand dollars a year. Spend a thousand dollars a year, for the privilege of working for free? Not to mention malpractice insurance and medicolegal risk.

    They start to say why bother, and retire at the age when most everyone else retires.

    Be careful what you wish for, we might miss having those older docs.

  • PAULMD

    I think recertifying regardless of age is a reasonable thing to do. I don’t want my commercial airline pilot to have been excused from his FAA physical for his “grandfathered health”. The 4 digit price for the recert process is a money grab though.

  • http://www.medinewsdigest.com Yves

    Haven’t heard? The government is planning to push the retirement age to 68… Seriously I would rather have the experience, care and manners of an alert 70 years old MD, than the aloofness of many of the younger generation.
    (Disclosure: I am turning 65…)

  • http://www.littlepatientbigdoctor.com Haleh Rabizadeh Resnick

    Medicine is as much an art as a science. An older doctor has the benefit of experience on his side and provided he has kept up with new advancements, I’d take an older doctor over a young cowboy any day.

    On the other hand, I certainly hope that if a surgeon’s eye sight or steady hand is not there any longer that he’s no longer practicing.

    Haleh
    littlepatientbigdoctor.com

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    The average age of practicing primary care physicians in my state is over sixty years old. Many, like myself , are grandfathered in to our specialty. Most of us know our limitations and consult and ask for help in those areas we need help. Most of us older guys ( I am 60) work endlessly and expect to, study continuously, read the literature daily, and teach students so we are challenged and have to stay sharp. I hope to remain healthy enough to continue to care for patients, teach and keep current with MKSAP each time it comes out. If you compare the knowledge base and diversity of care and procedures my generation of physician was expected to master to todays individual coming out of training with reduced work requirements during their training you might wonder who the clinically competent physician really is?

    • elmo

      Then following your reasoning Dr Reznick why SHOULD you be able to grandfather out of the boards? IMO you shouldn’t (and I graduated before the hour limits). Either you stay uptodate on your board certification or you don’t. Grandfathering is nothing more than a cop out set up by and for the old boy MD club in the 80′s.

  • gzuckier

    The problem I’ve seen with elderly, well respected MDs is that they tend to cling to philosophies and treatment modalities no longer supported by evidence based medicine. Too aggressive with invasive treatments for things like back or prostate surgery, and too inclined to let things slide for things like hyperlipidemia.

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