Robert Sataloff, MD, DMA
How do you frame the problem of aging physicians?
Aging among physicians is a challenge for physicians, for department chairs who have to do credentialing, and for patient care. The problem is that there is no good system to assess physicians’ competency, and there are no good data to guide us. The problem is only going to get worse. By 2050, the global population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015.7 So it is clear that we are facing a very serious problem.
Is there any evidence base regarding the clinical outcomes of older physicians, compared to their younger counterparts?
There is much conflicting literature regarding whether older physicians—especially older surgeons—perform better or worse than younger physicians, in terms of clinical outcomes. For example, some studies8,9 found higher mortality rates for older surgeons performing cardiovascular procedures, while other studies suggested higher morbidity and mortality rates in younger surgeons.10 A 2017 study of over 700,000 hospital admissions found that patients’ adjusted 30-day mortality rates increased with a physician’s age, from 10.8% for physicians under age 40, to 11.1% for those between 40 and 49, 11.3% for those between ages 50 and 50, and to 12.1% for physicians age 60 or above.11 Interestingly, this finding did not hold true for physicians who saw a high volume of patients.
There is considerable variation between studies, with many factors that are not delineated well – for example, whether older physicians had electively decreased the number of high-risk complicated cases that they took on. So reading and understanding the literature on this subject is much more complicated than just looking at the conclusions.
Have any studies focused on physicians’ cognitive abilities and skills per se?
The AMA Council on Medical Education reviewed existent data and concluded that aging is associated with decreased processing speed that might interfere with being able to execute complex tasks, increased difficulty in inhibiting irrelevant information, reduced hearing and visual acuity, and decreased manual dexterity, as well as visuospatial ability.1
In particular, a test of cognitive ability called the MicroCog test was administered to 1002 physicians and 581 non-physicians, ranging from 20 to 80 years old. Although physicians scored better than non-physicians at all ages, there was nevertheless a decrease with age in cognitive function in both groups.12
Another study compared the performance of 3 groups of surgeons on a cognitive test (CANTAB) and found that the younger group (ages 20 to 35 years) outperformed the mid-career group (ages 46 to 60 years) and the mid-career group outperformed the senior surgeons (ages 61 to 75 years) in reaction time, rapid visual information processing, and the visual paired associates learning tasks. However, when surgeon group performance was compared with age-matched controls, the surgeon groups performed significantly better than the non-surgeons of the same age.13
Can cognitive tests, such as the one used in the previously mentioned study, determine the fitness of a physician to practice?
It would be nice if there were some test that you could give to physicians and surgeons to know whether it is safe for them to practice, and many institutions have instituted neuropsychological testing at ages 65 or 70. However, that’s problematic because nobody knows whether the cognitive abnormalities found in a 65-year-old were present in the same person at age 30 or 40, without any negative consequence on the physician’s ability to practice. So, if we are going to use cognitive testing in any meaningful fashion, we need to carry out long-term studies in which we follow people from medical school to older age, not only to find out whether there are cognitive changes but also whether those changes correlate with any difference in patient outcomes.
It seems as though hospital systems are beginning to use cognitive tests just because they exist, but there is no valid way to know how to use the results. There are manual tasks for surgeons—simulators, like those used in the airline industry for pilots – but they are neither standardized nor widely available.
This article originally appeared on MPR