Our population is aging. No surprise then that Canada's doctors are getting older as well. Turns out a surprising number of MDs just don't know when to quit. Milk has a 'best before' date. Which makes us wonder whether doctors should have one too.
On this week's show, we explore the impact of aging MDs on your well being. A group of residents from McMaster University in Hamilton tell me how they gauge the skills of their aging mentors. The Registrar of the College of Physicians and Surgeons of Ontario explains how the College keeps tabs on doctors whose skills may be failing. And, I chat with regular contributor Dr. Paul Freedman about older colleagues he's seen up close who should have retired.
Tune in Saturday, March 19, 2011 at 11 am (11:30 am NT) and again on Monday, March 21, 2011 at 1130 am (330 pm NT) on CBC Radio One. Or, click below to listen to the show right now, or download the podcast:
Stories like these warm our hearts. They seem unusual. But they may not be in the years to come. What caught my eye is the number of MDs of retirement age still tending to the sick. A recent study by the Canadian Institute for Health Information found more than two-thirds of working physicians who were between the ages of 70 and 79 back in 2004 were still in practice four years later - in 2008.
Nurses don't linger in practice - in part because hospital and union rules don't allow it.
Why do physicians stick around? Some who lost money during the last recession may stay in practice to rebuild their retirement nest egg. Others who work in under-serviced parts of Canada may be prevailed upon not to hang up their stethescope.
Given the increase in the number of older physicians still in practice, there's growing interest in how competent they are.
A 2006 study published in the Annals of Surgery found that for some complex procedures, surgeons older than 60 years, particularly those with low procedure volumes, have higher operative mortality rates than their younger counterparts. However, for most procedures, however, surgeon age is not an important predictor of operative risk.
A 2005 study found that older doctors were more likely than younger ones to be investigated and disciplined by licensing bodies. In the US, the rate of disciplinary action was 6.6 percent for doctors out of medical school 40 years, compared with 1.3 percent for those out only 10 years.
Unpublished data from a colleague suggests the same problem exists in Canada as well.
I don't want to be ageist about this. Examples like the hundred year-old doctor are truly inspiring. But other stories might make you frightened - perhaps a bit angry - if your doctor is getting a little long in the tooth.
Provincial Colleges of Physicians and Surgeons exist to protect the public by keeping tabs on physicians. In my opinion, their record on monitoring the competence of MDs is spotty. Ontario has a program of mandatory peer assessments of all physicians over the age of 70. However, these assessments consist of a review of a small selection of the doctor's patient records plus an interview that usually lasts for an hour or so. The Ontario College does not actually observe the doctor in practice.
Given that, the odds of catching a dangerous pattern of practice seems rather low to me.
Meanwhile, many of us notice colleagues whose clinical judgment may be impaired by age, yet are afraid to speak up about it. When it comes to the question 'how am I doing?' the maxim 'no news is good news' seems the order of the day. As we age, many of us practice harbouring a fear that gnaws away at us that we won't know when it's time to retire unless someone tells us.
There's a way to shore up the scrutiny of older physicians without being ageist. Why not check all doctors - regardless of age - on a regular, mandatory basis. Let's use tests that accurately measure competence. Let's make it easier to match practising MDs with high quality education programs that help them brush up on their skills. And let's take the shame out of asking doctors to brush up.
If the cost is expensive, doctors and other health professionals should pay for it themselves. They make enough money as it is. And once they see the benefits of remedial education, the good ones will clamour for it.