AMA Misses Mark by Aiming at Older Doctors

On June 8, 2015, the American Medical Association adopted a resolution to implement competency testing for older doctors. This resolution arises in a setting in which approximately 25% of our nation's doctors are age 65 or older and 42% are age 55 or older. Although the American Board of Medical Specialties and a small number of hospital systems have required periodic competency testing of elderly doctors, the retirement age of doctors has largely been left up to the individual doctor, leading to circumstances where incompetent, and sometimes demented, physicians were caring for patients.The AMA has not worked out the details of what competency testing will entail, but its report suggests that testing may be appropriate starting at age 70 with a battery of tests to assess both physical and mental abilities.

Competency testing for physicians done at regular intervals is a good thing for patient safety, but is it wise to limit required testing to older doctors? We live in a nation where upward to 100,000 patients die in U.S. hospitals each year due to preventable medical mistakes with many more patients suffering permanent and disabling injuries due to preventable mistakes. Certainly there are anecdotal reports of the occasional physician who is too old and feeble to practice, but the bulk of the malpractice in this country is committed by physicians who are years away from Social Security eligibility. In 2011, for example, the New England Journal of Medicine published an analysis of malpractice claims submitted to a large national insurer between 1991 and 2005. The insurer covered over 40,000 physicians during this time period. The data revealed that 36% of physicians in low risk specialties faced a malpractice claim before age 45 and that 88% of physicians in high risk specialties faced a claim before age 45. Before age 65, 75% of physicians in low risk specialties faced a claim and 99% of those in high risk specialities faced a claim. The study is entitled "Malpractice Risk by Physician Specialty," N. Eng. J. Med. 2011 Aug. 18; 365(7): 629-636.

The American Board of Medical Specialties has been applauded for requiring vigorous recertification of its members, but this may be required only every 6 to 10 years in some specialties. Adding another layer of competency testing for older doctors may improve patient safety, but still falls short of a uniform system to regularly assess the competency of our entire physician population. If patient safety is the paramount goal of the AMA, it should require regular assessment of competency of its entire membership and, in particular, its youngest members.