I Think It Is Probably Appropriate To Check Aging Doctors For Fitness To Practice.

This appeared last week:

‘Lacking evidence and probably ageist’: RACGP hits out at medical board’s mandatory health checks for older doctors

'We have serious concerns that this proposed policy is ageist,' says college president Dr Nicole Higgins.

Paul Smith

17 October 2024

The RACGP says the Medical Board of Australia’s push on mandatory health checks for older doctors is backed by no evidence and is probably ageist.

The board wants all doctors aged 70 and over to go through a health assessment at least once every three years as a condition of their registration.

In its consultation paper, it says so-called late-career doctors are 81% more likely to be subject to a complaint than their younger colleagues.

But in a fiery response, college president Dr Nicole Higgins has accused the medical board of failing to show any evidence that mandatory health checks will reduce patient harm or notifications (see box below for the board’s statistics).

“It is unclear [based on the board’s consultation paper] if notifications received by AHPRA were specifically related to the physical or cognitive decline of the doctor, the age of the doctor, and could be avoided by a mandatory health check based on the doctor’s age,” she wrote.

She says that, according to the consultation paper, only 2.58 notifications per 1000 doctors over 70 were for health impairments (0.26%).

“In an inclusive and diverse society, there is no place for ageism, and we have serious concerns that this proposed policy is ageist.”

It is important to “foster a culture that encourages and supports doctors to take good care of their health”, Dr Higgins says.

“Mandatory reporting laws do not help build this culture. Fear of mandatory reporting leads health professionals to avoid getting the help they need.”

She also says the medical board needs to provide information on the medicolegal position of GPs treating older doctors.

“For example, if an assessing doctor has concluded a health professional is fit to practise but AHPRA determines a notification or suspension is required.”

The board’s consultation paper, released two months ago, suggests GPs are only expected to make a notification if the doctor refuses to deal with a health impairment and there is a serious risk of patient harm.

It says it does not want to see the results of any assessment.

However, it expects late-career doctors to declare in their annual registration renewal that they have completed the appropriate health check, including, as now, any declaration that they have an impairment that “detrimentally affects, or is likely to detrimentally affect, their capacity to practise medicine”.

One key element of the board’s plan is that the health assessments conducted by an older doctor’s GP should include cognitive screening.

It acknowledges that the Mini-Mental State Examination commonly used by GPs is flawed.

But it suggests the adoption of either the Montreal Cognitive Assessment or the Addenbrooke’s Cognitive Examination, saying both have “very good sensitivity in detecting mild cognitive impairment”.

The college says any demands for health checks should be evidence based and consistent with the college’s Red Book.

“The Red Book does not recommend screening for dementia in the general population.

“A case-finding approach to dementia is recommended, being alert to risk factors, signs and symptoms of dementia with the best time to identify dementia risk factors earlier in life.”

The college’s stance on mandatory health checks contrasts with the position of the AMA, which says it does not support retaining the status quo in its own submission.

While the AMA’s submission does not explain what system it does want, it stresses there should be no requirement for older doctors to undergo cognitive screening.

“A better model would not include specific cognitive function screening in the health check, but it would make it clear in resources for GPs that they should consider cognition and use their clinical judgement regarding screening and/or write a referral for formal assessment if required,” its submission states.

The medical board’s statistical breakdown on the risk of older doctors In 2023, there were 6975 practising doctors aged 70 and over, including 1035 aged 80 and over. The board’s consultation paper says those aged 70 and over are 81% more likely to be the subject of a complaint than their younger colleagues. It refers in particular to the differences in the rates of complaints about clinical care (15.9 per 1000 doctors under 70 vs 24.2 per 1000 late-career doctors), communication (4.7 vs 11.3) and pharmacy and medication (4.6 vs 12.2). It needs to be stressed that one doctor may be generating more than one notification. In absolute numbers, older doctors last year generated 168 notifications relating to clinical care, 78 relating to communication and 85 relating to pharmacy and medications. There is no detail on the extent to which these notifications are linked to health impairments. The board’s paper stresses that, in terms of overall notifications, 23% of the complaints against late-career doctors resulted in some from of regulatory action — in the vast majority of cases, the imposition of conditions or cautions. The consultation paper says this compares with 14% of the notification against younger doctors. Source: Health checks for late-career doctors impact statement; 7 Aug 2024.

More information:

• Health checks for late-career doctors impact statement; 7 Aug 2024.
• AHPRA news; 7 Aug 2024.

Here is the link:

https://www.ausdoc.com.au/news/lacking-evidence-and-probably-ageist-racgp-hits-out-at-medical-boards-mandatory-health-checks-for-older-doctors/

I have to say I am on the Medical Board’s side here. Anyone over 70 or so should be able to demonstrate they are still cognitively intact, Just how you do this is the trick I reckon – but just like with pilots etc. we need to protect the public against failing cognition!

What do you think?

David.