There are 90 B.C. doctors aged 80 and older, according to the B.C. College of Physicians and Surgeons.
Older doctors have a duty to retire before declining mental or physical health harms patients, says the College of Physicians and Surgeons of B.C. after receiving about 100 complaints last year from concerned colleagues and patients.
There are 1,724 doctors over the age of 65 practising in B.C., including 174 between the ages of 75 and 79 and 90 aged 80 and over.
“Ideally, every #physician will perform optimally on his or her last day of practice,” says the 2013/14 report from the Inquiry Committee in the College’s annual report.
The committee handles about 1,000 complaints a year on matters relating to doctors’ clinical performance, conduct/ethics, and boundary violations (sexual and other inappropriate relations with patients). There are about 11,500 doctors actively practising medicine in B.C.
“As in the past, the committee investigated a number of complaints alleging deficient performance by older physicians. Many of these triggered … investigations,” according to the committee, which handled about 450 files related to doctors’ clinical performance, including allegations of deficiency on the part of older doctors.
Another 520 files related to conduct, ethics and professionalism, including complaints of poor communication and lack of empathy. There were also 31 files opened about boundary violations, including sexual misconduct, and insensitive or disrespectful behaviour during patient examinations.
The college says experts in occupational performance have shown that older professionals excel when they “stick to familiar tasks and settings.” Yet doctors who are preparing to retire often close their practices and work at walk-in clinics, where they don’t have a history with #patients and make errors they wouldn’t when treating patients they knew well.
B.C. abolished mandatory retirement in 2008 and since then, a growing number of doctors have chosen to continue practising. Dr. Ailve McNestry, deputy registrar of the College, said doctors continue working for the same reasons that others choose to — they derive much satisfaction from it, their identities are wrapped up in their professional lives, and they need or want the income.
The College’s Medical Practice Assessment Committee provides oversight to a program that assesses and educates doctors. The program prioritizes assessment of doctors over age 70, especially those who work in solo offices. While all doctors working in the community (as opposed to hospitals) are supposed to have an assessment every eight years, those in their 70s are assessed more frequently — as are those who have been shown to require ongoing scrutiny.
McNestry said complaints from# medical colleagues as well as patients often reflect a perception that age-related #health concerns — cognition, vision, hearing and mobility — are a factor in declining performance. She is unaware of cases in which doctors with Alzheimer’s or dementia have continued practising. “But symptoms often come on slowly,” she said.
Ageist discrimination exists in medicine, like the rest of society, and McNestry cautions that while the advancing years can be a “high-risk” period for medical errors, “it’s a bit like drivers.
“Just as inexperienced drivers are often high-risk, so too are younger doctors. The (prevalence of) potential risks early in medical careers may be the same as they are late in careers.”
Yet the risks for older doctors have to do with medical conditions, not inexperience. So the college’s assessment program is designed to monitor doctors, especially those working in isolated communities or outside hospitals where they would be continually learning from — and getting scrutinized by — colleagues.
Doctors who are the subject of complaints related to age will be asked to attest to the fact they have a doctor who has deemed them medically fit to practise, much the same as older drivers. Complaints may stem from a formal investigation that can take months as reviewers pore over records to evaluate such things as whether doctors are properly prescribing medications. Some assessments invite input from medical colleagues or co-workers and even patients of the doctor.
McNestry said not all doctors appreciate the evaluations, but “no one practising into their eighties should be surprised about being monitored.”
Dr. Bill Cavers, president of Doctors of B.C., said he agrees with McNestry that some doctors find it difficult to stop practising because “medicine is a lifestyle and identities are often melded to the professional roles.”
Cavers said doctors have an obligation to report colleagues who may not be competent because of advancing age. He’s never called the College himself, but he once spoke to a colleague directly about an age-related practice concern. The associate was a temporary fill-in (locum) for another doctor and he readily agreed to take a leave to pursue remedial courses.
In the 2013/14 fiscal year, 113 doctors participated in remedial education programs, according to the report. Demographics of such physicians are not specified.
Gavin Wilson, spokesman for Vancouver Coastal Health, said about 15 per cent of medical staff at hospitals within the region choose to work past age 65. They “provide an ongoing, valuable service and are in excellent health and want to continue working.”
All surgeons, regardless of age, undergo annual evaluation by their division or department head.
“This evaluation includes a questionnaire regarding practice issues, confirmation that continuing medical education requirements have been fulfilled, a personal interview, and, if necessary, a look at interactions with the other team members and staff,” he said.
The evaluation includes an appraisal of the previous year, including any complaints and outcomes of reviews relating to patients harmed by care. Teaching hospitals also consider whether doctors have contributed academically as instructors or researchers.
From Sun Health Issues Reporter
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