Is It Time for an Aging Physician Policy?

The largest American generation, baby boomers, including many of your organization’s providers, is getting older. The Journal of the American Medical Association recently published that 23% of practicing physicians were age 65 or older in 2015. Why is this of interest?

Many professions, especially those involved in public safety, have a mandatory retirement age. My son, a federal firefighter, has a mandatory retirement age of 57. The FAA has set mandatory retirement for airline pilots at 65 (it was 60 until 2009) while air traffic controllers must retire no later than age 56.

Yet there is no standard retirement age for health care professionals who not only manage our health but also literally hold our lives in their hands at times.

Why Think About Aging Physicians

There are three main reasons a health care organization should proactively have a plan for aging physicians. The first is patient care. The credentialing, privileging and measurement processes are not designed to help providers maintain their privileges; they are established to protect patients.

It’s also important to protect the organization from incompetent medical care due to aging effects. Not only from a reputational aspect but also regulatory. Although current rules and regulations regarding privileging providers require competency they don’t necessarily catch aging-related issues.

Last, but not least, an aging provider policy protects the physician from practicing when judgment and/or skills are compromised.

Risks of Aging Physicians

The problem with getting older is that there’s no set point in life where people are no longer competent. No one knows if or when a physician’s knowledge or skills will deteriorate.

Whether it’s the 60th, 65th or 70th birthday, no magical change occurs rendering a person unable to do their job. That’s why up to 10% of hospitals had already implemented an aging physician’s policy as of 2014, according to the American Medical Association.

Aging Physicians Policy

Organizations drafting an aging provider policy should include providers impacted by the policy in the formulation process along with younger providers who may be involved in the assessments.

The policy should include these five elements.

1. 1. At what age does the policy apply along any other parameters for the requirement.
2. 2. What is included in an assessment. Specify what evaluations will be required including mental, physical and skills-based.
3. 3. Specify who and how the results of the assessments are reviewed.
4. 4. Detail the consequences of not participating in the required assessment.
5. 5. The frequency of the evaluation. Commonly this is at each recredentialing or reappointment cycle.

Policy Considerations

As you explore putting a policy regarding aging physicians in place there are questions that require consideration.

• Legal Concerns: First, you want to be cognizant of the physician’s legal rights. It’s important to ensure the policy is objective enough that it doesn’t violate the Age Discrimination in Employment Act or other anti-discriminatory laws that are enforced by the Equal Employment Opportunity Commission.
• Internal or External Assessment: Decide if the assessments will be fully managed within your organization’s resources, by contracting with an outside physician assessment program or a combination of internal and external assessments.
• Cost: Assessment programs can be expensive when you add the expenses for the assessment, resulting education if needed and reassessment. You’ll need to determine who’s going to end up with the bill. Is it the provider, the organization or a combination of both? 
• Implementation: Most providers impacted by the new policy will understand and be supportive of it. However, it’s very likely there may be some concerns. It’s critical to involve the providers giving them the chance to review the proposed policy, ask questions and provide feedback before it becomes adopted.  

Summary

In a 1994 study by Dr. Douglas Powell, he found physicians over 55 showed evidence of cognitive function decline. An aging physician’s policy assists in ensuring due diligence is performed while respecting the physician’s dignity and rights.

This balance is essential because most providers will have many more productive years ahead of them as did Dr. Georgeanna Seeger Jones and Dr. Howard Jones who achieved the first test-tube baby in the United States in 1981…after being forced to retire due to a mandatory age limitation at another institution.