Should doctors who forget where exam rooms are be allowed to stay in practice? How about a physician who forgets to leave his hospital patients in the care of another doctor when he heads out of town for vacation? A provocative piece published in the Washington Post on Tuesday in conjunction with Kaiser Health News raises those questions and points out that most hospitals don’t have policies in place to require that doctors maintain their cognitive abilities and medical skills as they age.
Here’s one of the experts quoted in the piece:
"The public thinks that physicians' health and competence is being vigorously monitored and assessed. It isn't," said geriatrician William Norcross, 64, founding director of a program at the University of California at San Diego that performs intensive competency evaluations of doctors referred by state medical boards or hospitals. The program -- known as PACE, for Physician Assessment and Clinical Education -- is one of about 10 around the country. Norcross, who evaluates 100 to 150 physicians annually, estimates that about 8,000 doctors with full-blown dementia are practicing medicine.Some hospitals have introduced new policies that require doctors over a certain age—70 at the University of Virginia Health System and 75 at Stanford Hospital in California—to undergo regular physical exams and cognitive assessments in order to renew their privileges, Sandra Boodman wrote in her article.
She also highlighted 101-year-old rheumatologist Ephraim Engleman, who still treats a handful of long-time patients. He said he has no plans to ever retire.
I asked around to see whether hospitals in Massachusetts had any aging policies in place. A Massachusetts General Hospital spokesperson told me that the hospital doesn’t have any requirements targeting doctors of a certain age, but that the institution does require an Ongoing Professional Practice Evaluation which supervisors complete for medical staff every year.
It’s like an annual performance review, and if physicians fail they become part of a special evaluation group that addresses their deficiencies. If their skills don’t improve, they may lose their jobs.
Dana Farber Cancer Institute “requires all medical staff members, regardless of age, to undergo a health status assessment every two years,” said spokesperson Bill Schaller. “They also are required to reapply for their medical staff appointment every two years.” The hospital also performs performance quality assessments on a routine basis.
Brigham and Women’s Hospital also doesn’t have a formal policy geared at older doctors—nor does the hospital conduct regular assessments of its physicians’ overall health or cognitive function. “If there are concerns about deteriorating skills for physicians of any age we would have them undergo a Focused Professional Practice Evaluation, which is sanctioned by the Joint Commission,” said spokesperson Tom Langford.