As doctors grow older, hospitals begin requiring them to prove they’re still fit

While few experts would argue that age alone should control who can continue to practice, some studies suggest that doctors’ skills tend to deteriorate over time. A 2006 report found that patient mortality in complex operations was higher among surgeons older than 60 than among their younger colleagues.

To address the problem in a systematic way, a small but growing number of hospitals — including the University of Virginia Health System, Stanford Hospital and Clinics, and Driscoll Children’s Hospital in Corpus Christi, Tex. — have recently adopted policies requiring doctors over a certain age — 70 at U-Va. and Driscoll, 75 at Stanford — to undergo periodic physical and cognitive exams as a condition of renewing their privileges.

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Diane Pinakiewicz, former president of the National Patient Safety Foundation, a Boston-based information and advocacy group, calls the policies “a fabulous idea” that is long overdue. “Without a rule, it’s left to someone’s personal decision” to self-monitor.

New Hampshire health-care consultant Jonathan Burroughs, who has worked with hospitals seeking to implement testing policies for older physicians, estimates that roughly 5 to 10 percent of institutions have adopted them and that interest is growing.

“Colleagues have a code of silence,” said Burroughs, who spent 30 years as an emergency department physician. During his career, Burroughs said he followed several elderly doctors around, quietly correcting their orders to prevent mistakes. Such experiences, he said, are nearly universal in medicine.

“Most medical staffs look the other way, thinking, ‘There but for the grace of God.’ This person has been a good doctor, and we’re not going to betray them,” Burroughs said.

But that kindness can backfire, he added, subjecting patients to potentially disastrous consequences such as serious injury or death, and the faltering physician to a malpractice suit or the loss of a medical license.

John Schorling, a professor of medicine who heads U-Va.’s Physician Wellness Program, said the policy adopted last year was prompted by “general concerns” about patient safety and is modeled on aviation industry practices. “Pilots have people’s lives in their hands, and so do doctors,” he said.

‘Fred Flintstone’ care

But some hospital administrators dispute the need for such testing. Fitness to practice, they maintain, is already paramount in decisions that hospitals make every two years or so to renew a physician’s privileges. And that process, they say, has gotten more stringent in the past decade with the proliferation of performance data on doctors.

“In medicine, I think you need to look at people individually,” said David Mayer, 59, vice president of quality and safety at MedStarHealth, the largest hospital network in the District and Maryland. “To just put a number there and say, ‘You need to be looked at more closely’ because of age is not justified.”

Brian Johnston, chairman of the emergency department at White Memorial Medical Center in Los Angeles, agrees. “It’s just very hard to make a hard-and-fast rule based on age,” said Johnston, 74, who is still pulling regular shifts in the fast-paced specialty. Testing everyone who hits a certain age is “unnecessarily ham-handed.”