As doctors age, worries about their abilities grow

[fishsticks2629]

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Good article from the NYtimes.. Give it a read

http://www.nytimes.com/2011/01/25/health/25doctors.html?_r=1&ref=science


I personally think their should be some federal requirments for doctors over a certain age. It would suck to hurt a patient before anyone realized there was some sort of cognitive problem.

 

[devilpup]

This is sad and disturbing... You know there are recertification requirements for most specialities.

I heard that only ~74 % of IM docs are passing recertification on their first try. Not sure how i feel about this number considering how fast medicine is changing.

 

[Charles_Carmichael]

Saw that article as well. I actually agree with some of the commenters that if you're worried about this in physicians, you'll have to start being worried about it in a lot of other professions as well. It's not really fair to single out physicians when so many other jobs have a critical impact on people's lives as well.

 

[deleted307836]

Saw that article as well. I actually agree with some of the commenters that if you're worried about this in physicians, you'll have to start being worried about it in a lot of other professions as well. It's not really fair to single out physicians when so many other jobs have a critical impact on people's lives as well.

Um, when surgeons <60 y.o. have better mortality rates, I'll take the younger guy 😉.

I think it's totally fair to single out physicians (ok, maybe dentists too) in this regard -- few other people have such direct control over our health.

 

[phnerd1105]

Great read. There definitely needs to be a more frequent program to assess physician's mental and physical capabilities. It doesn't even have to be a recertifcation test. Just something to monitor your skills after 40.

Hell, I would want to know if my skills are deteriorating with age. I wouldn't want to put my patients at risk. Wouldn't everyone?

 

[Charles_Carmichael]

Um, when surgeons <60 y.o. have better mortality rates, I'll take the younger guy 😉.

I think it's totally fair to single out physicians (ok, maybe dentists too) in this regard -- few other people have such direct control over our health.

Citation to a good study please (ie. one that takes confounders into consideration before drawing conclusions). I'm only asking because I would imagine that the experience that the older surgeon has will offset any potential loss of motor skills (no hard data from me about this though).

I respectfully disagree with your latter statement. I think the guy who fixes my brakes has a far more immediate impact on my life that a physician does. And I would contend (without any hard data on hand) that Americans visit car mechanics more often than physicians. Should we be testing the cognitive and motor skills of mechanics as well?

 

[Long Way to Go]

Citation to a good study please (ie. one that takes confounders into consideration before drawing conclusions). I'm only asking because I would imagine that the experience that the older surgeon has will offset any potential loss of motor skills (no hard data from me about this though).

Err, it's in The New York Times' article:

"In 2006, a study found that in complicated operations, patients’ mortality rates were higher when the surgeon was 60 or older, though there was no difference between younger and older doctors in routine operations."

 

[DoctwoB]

Err, it's in The New York Times' article:

"In 2006, a study found that in complicated operations, patients’ mortality rates were higher when the surgeon was 60 or older, though there was no difference between younger and older doctors in routine operations."

And as always, the devil is in the details

From the study:
"The effect of surgeon age was largely restricted to those surgeons with low procedure volumes"

something tells me operative volume is the key factor here, and there are very few "part time" younger surgeons, hence the age related disparity.

 

[Charles_Carmichael]

Err, it's in The New York Times' article:

"In 2006, a study found that in complicated operations, patients' mortality rates were higher when the surgeon was 60 or older, though there was no difference between younger and older doctors in routine operations."

Key conclusion:

"For some complex procedures, surgeons older than 60 years, particularly those with low procedure volumes, have higher operative mortality rates than their younger counterparts. For most procedures, however, surgeon age is not an important predictor of operative risk."

You mean to tell me that someone who has a low volume on a certain complex procedure is probably not going to be as good at it as someone who does it everyday?! No way! That's like saying oncologists are not as good as cardiologists in dealing with cardiovascular problems (I know, I know...no oncologist is going to attempt to take care of a patient's CV problems. I'm just using it as an extreme example to make my point).

 

[deleted307836]

Citation to a good study please (ie. one that takes confounders into consideration before drawing conclusions). I'm only asking because I would imagine that the experience that the older surgeon has will offset any potential loss of motor skills (no hard data from me about this though).

I respectfully disagree with your latter statement. I think the guy who fixes my brakes has a far more immediate impact on my life that a physician does. And I would contend (without any hard data on hand) that Americans visit car mechanics more often than physicians. Should we be testing the cognitive and motor skills of mechanics as well?

Do you have issues with the study provided in the article? 😕

Of course there should be minimum competence standards that must be met in such professions -- but just because there aren't in some professions doesn't mean medicine can't either. IMHO, surgery demands a synthesize of intellect and fine motor skills that auto mechanics does not, and the culture of medicine is such that it can be hard to call doctors out on deteriorating abilities. Creating check points to make it easier to assess doctors as they age could only help.

 

[deleted307836]

.

 

[Charles_Carmichael]

Do you have issues with the study provided in the article? 😕

Read my latest post. I don't have issues with the study. I have issues with how the journalist presented the study.

In the future, it's best if you read the study itself rather than base conclusions off of what a journalist (or anyone else) wrote.

 

[Charles_Carmichael]

And as always, the devil is in the details

From the study:
"The effect of surgeon age was largely restricted to those surgeons with low procedure volumes"

something tells me operative volume is the key factor here, and there are very few "part time" younger surgeons, hence the age related disparity.

👍

Exactly.

The difference in age only really becomes apparent when volume is taken into account. If you look at the charts, even younger surgeons, if they have a low volume with a certain procedure, have a much higher (statistically significant) mortality rate/etc when compared to younger surgeons with a high volume.

 

[fishsticks2629]

👍

Exactly.

The difference in age only really becomes apparent when volume is taken into account. If you look at the charts, even younger surgeons, if they have a low volume with a certain procedure, have a much higher (statistically significant) mortality rate/etc when compared to younger surgeons with a high volume.

What charts? Can you provide a reference?

 

[Charles_Carmichael]

What charts? Can you provide a reference?

The charts in the study that was linked: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856535/?tool=pubmed

I was looking at Figure 2 when I made my previous statement.

"Among low-volume surgeons, surgeons over 60 years of age had higher mortality rates for each procedure, differences that were both clinically and statistically significant. Among high-volume surgeons, however, there were no significant differences in mortality rates for CEA and CABG. For pancreatectomy, indeed, there were nonsignificant trends toward lower mortality rates in older surgeons."

 

[ACSurgeon]

The funny thing is, many older doctors have been "grandfathered" into having a lifetime board certification and not being required (although encouraged) to recertify.

This should be a non-issue 20 years from now though...

 

[DrBowtie]

I would have taken Debakey at 90+ easily.

 

[Unclipped]

I think you will all be singing a very different tune in 30/40 years...

 

[HINKLO]

Very pertinent:

http://www.rochester.edu/news/show.php?id=3752

 

[willen101383]

Great read. There definitely needs to be a more frequent program to assess physician's mental and physical capabilities. It doesn't even have to be a recertifcation test. Just something to monitor your skills after 40.

Hell, I would want to know if my skills are deteriorating with age. I wouldn't want to put my patients at risk. Wouldn't everyone?

After age 40???

I will have been attending for 5 years when I am 40. Its the 40 and 50 year olds that IMO make the best docs. Even guys in their 60s. Hell...my dad is turning 60 this year but he still sees just as many pts as the younger guys in his practice and is still reading journals/doing CME every day. Once you start getting past retirement age you start running into those guys who are just practicing to practice and dont really stay up to snuff on the new stuff.