When is it time for a rheumo to retire? The MBA has its sights on doctors 70 and over.
When is it time for a rheumo to retire?
The pace of change in new technology and clinical evidence is accelerating, making it harder for older doctors to stay on top of things.
“From what I’ve seen over the years, the main issues become ones of cognitive ability,” says Associate Professor Leslie Schrieber of the University of Sydney, a consultant rheumatologist at Royal North Shore Hospital, Sydney.
“Sometimes it gets down to whether feedback about them – for example, from a hospital department or from colleagues – is well received. They might then take steps to remediate it, or they might think about revising their career.
“We had one instance where someone totally lacked insight and wouldn’t accept there was a problem, and it got down to getting a lawyer along and an AHPRA representative to interview him. He scored 100 on an IQ test, which is within the community average – but you probably need an IQ of 120 to work effectively as a consultant physician.”
Currently, there’s no regulatory barrier. AHPRA does not conduct age-based assessments or specify a retirement age. Doctors can continue to practise so long as they comply with the MBA’s registration standards and requirements of the National Law.
“I think if you have a mandatory retirement age, that’s ageism,” says Professor Craig Anderson, director of the George Institute’s neurological and mental health division. “If you’ve got adequate energy, capacity and intellect and you’re enjoying it and there’s adequate support from colleagues, that’s fine.
“I think AHPRA’s general mandate is a good thing, but it’s a bit light – AHPRA only really gets involved when there’s a problem. There’s probably a lot of GPs out there, for example, who are only just coping who AHPRA would only know about when there’s a complaint.”
Since 2017, however, the MBA has been eyeing mandatory health checks for doctors aged 70 and over.
The board has, in principle, accepted an advisory group recommendation that from age 70, doctors should have a confidential health check, including “cognitive screening”, once every three years. They should also have a formal performance review process that would come with CPD credit.
Should legal obstacles stand in the way of mandating health checks, the MBA would consider further research into any age-related risk posed by doctors over aged 70 continuing to practise.
“There is strong evidence that there is a decline in performance and patient outcomes with increasing practitioner age, even when the practitioner is highly experienced,” the board says.
While the MBA sounds like it means business, the proposal is still only under consideration.
Age-related decline can show itself in any number of areas, says Professor Anderson.
“It’s going to manifest in very subtle ways like fatigue, or maybe errors in documentation, putting the wrong date of birth on a script pad, or forgetting to lock the fridge or to put something in by the due date.”
But he warns rheumatologists not to count on colleagues flagging any changes in behaviour, since approaching someone to express their concern can be difficult and seen as intrusive.
Professor Schrieber agrees.
“Someone I trained with at another hospital unfortunately started to lose the plot a bit,” he says. “Other colleagues covered up for him for a while, but it reached a point where a group had to go and actually see him and they had to do something. Eventually they talked to his wife as well as to him and I think he, probably reluctantly, stopped practising. I imagine that’s fairly unorthodox!
“You probably need a mentor, maybe a former trainee, to just see how you’re going – someone who’s willing to be open and honest with you and could say, look, I don’t think you’re practising at an acceptable level.”
Testing cognitive and other abilities has sometimes been suggested as an alternative to a mandatory age for retirement.
Queensland GP Dr David King, who has done assessments for AHPRA, says testing brings “problems with validity, accuracy and reliability”.
“But we do know from evidence that elder GPs, although they’re more experienced, can get a bit behind with new knowledge. I’m getting towards that stage where I’m struggling to keep up with new technology and change.”
The pace of change in medicine increased during the pandemic, with telehealth and e-prescribing two areas that challenged older doctors.
“A number of people are notified who are in their 70s, some even into their 80s,” says Dr King.
“Some decide to retire before we can actually get to visit them because they realise they’re no longer up to it. There are many reasons: with many of them, their record-keeping is an issue, or they’re one-finger typists and they’ve tried to have dual systems with written notes and someone else transcribing.”
Professor Schrieber says rheumatologists typically scale down their practice before retirement.
“I think the usual pattern is for people to contract from full-time work to part-time to three or so days a week to keep their hand in,” he says, “but I also think they reach a point where maybe financially it’s no longer possible – if you’re in private and you have to compete for how much you have to earn to pay for your rooms, etc – and people probably just get tired and worn out at some point.
“One of my colleagues said what’s important is that you still have value,” he says. “Whether that means you play a role as a mentor, a teacher or in some other way – even if you’re not really practising – somehow at least you’re not dead. And you still have some value; because medicine is so all-embracing, it’s very hard to just turn your back on it completely.
“I don’t know how you do it, and if there is a formula,” Professor Schrieber says. “But rather than retirement being this subject we should never discuss because it’s too ugly, we need to be more aware of it and to confront it.”
