Policies addressing cognitive decline in aging physicians were uncommon in the U.S. and similar countries, a comparative policy analysis showed.
Healthcare’s Self-Regulation
Unlike safety-critical fields in other industries, healthcare has historically relied on self-regulation and peer review rather than proactive cognitive screening, though some hospital systems screen physicians independently, reported Nathan Stall, MD, PhD, of the University of Toronto, and co-authors.
Lack of Standardization
No Group of Seven (G7) country has established a standardized, nationwide framework to directly evaluate the cognitive health of aging physicians, the researchers stated. In contrast, mandatory retirement is required for most judges, commercial pilots, and air traffic controllers across all G7 countries.
Public Expectations
“Physicians take great pride in the knowledge and skills they acquire over their career, and self-regulatory models will remain important components of physician oversight,” Stall and colleagues observed.
“However, the public expects and the high standards of medical professionalism require more nuanced protective measures to account for the complex and individualized nature of cognitive aging,” they wrote.
Institutional Initiatives
Some institutions, like the Yale New Haven Hospital in Connecticut, implemented their own age-based cognitive screening programs, the researchers noted. Between 2016 and 2019, Yale New Haven implemented a screening strategy as part of recredentialing of clinicians ages 70 or older.
In 2020, a study of 141 of these physicians suggested that 13% had cognitive deficits that were likely to impair their ability to practice medicine independently and the hospital was sued by the Equal Employment Opportunity Commission on the basis of age and disability discrimination.
Importance of Screening
Two things stood out in the Yale New Haven study, said Thomas Gallagher, MD, of the University of Washington in Seattle. “One was the proportion of screened physicians who had cognitive impairment that was noteworthy,” he told.
“It also struck me that none of those physicians were on the radar screen of the medical staff leadership in any other way,” Gallagher pointed out.
“This is why screening is such an important thing to do,” he emphasized. “But professional societies like the American College of Surgeons or the American Medical Association have stopped short of recommending mandatory screening because I think a lot of physicians have concerns about the fairness of these programs.”
Prioritizing Patient Safety
In a recent paper, Gallagher and colleagues highlighted that patient safety should be prioritized in screening programs for late-career clinicians. “The patient’s interests should be first, but that doesn’t mean we should ignore the interests and the needs of physicians,” Gallagher said. “Taking steps to ensure that programs are fair to physicians can increase their buy-in and acceptance.”
Demographics of Aging Physicians
About 24% of active physicians are ages 65 or older, according to the AAMC. To analyze regulatory frameworks addressing cognitive decline in aging physicians in the U.S. and other G7 countries, Stall and colleagues assessed 342 policy documents, government reports, scholarly works, and other official federal or jurisdictional documents.
Availability of Cognitive Screening
Approximately 25 U.S. health systems in 14 states had publicly available age-based cognitive screening policies for clinicians ages 70 to 75, including academic hospitals and clinics in various states. Of these, only five specified validated screening instruments like the Montreal Cognitive Assessment or MicroCog as part of age-based assessments.
Continuing Medical Education (CME)
Continuing medical education (CME) credits were required in 46 states for physician license renewals; some states were exceptions. License renewal was compulsory in all states and applications required self-disclosure of impairments that may affect clinical performance.
Limitations of the Analysis
The analysis had several limitations, the researchers acknowledged. It relied on publicly available policies which may have led to internal institutional guidelines being omitted. Physicians are not a homogeneous group and cognitive demands vary by specialty, they added.
“One of the things you learn as you talk with organizations that have developed late-career practitioner programs is that when they launch the programs, there’s often a preemptive wave of retirements,” Gallagher noted.
Conclusion
Identifying the balance between necessary screening and the potential impact on physician retention remains a challenge in the ongoing discussion around cognitive health in aging physicians.
Disclaimer: The information provided in this article is for educational purposes only and is not intended as medical advice. Always consult a qualified healthcare provider for any health-related questions or concerns.
Fuente: https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/123025
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