9 Principles to Guide Physician Competency Assessment at All Ages
Seniors make up about 30% of the medical workforce in the United States. They are the backbone of patient care and medical education, especially given the Association of American Medical Colleges projected shortage of at least 37,800 physicians by 2034. Yet more physicians elderly felt harassed. years by calls in various circles for an assessment of skills according to age.
They even faced suggestions of a mandatory retirement age. The Federal Aviation Administration has long banned older pilots from leading most commercial flights. The maximum age for pilots is 65 years old.
Being older can limit what a doctor can do comfortably — standing for long periods to perform surgery, for example — but aging doesn’t necessarily lead to cognitive impairment, said Jenny L. Boyer, MD, PhD. She is a psychiatrist with the Veterans Affairs Department of the West Texas VA Health Care System and chair of the AMA Senior Physicians Section (AMA-SPS) Board of Directors.
“Some people lose the cognitive abilities needed for performance, and others less so,” noted Dr. Boyer. Determining a physician’s competence should be done on a “case-by-case basis,” noting that the process “is not about age. It has to do with ethics, in that physicians should routinely perform self-assessment.
In fact, physicians can have their competence affected by countless factors unrelated to age. “Head injury, stroke, lupus, multiple sclerosis, psychosis, paranoia” are just some of the conditions that could possibly affect a doctor’s skill, Dr. Boyer said. .
The AMA Council on Medical Education and AMA-SPS have worked for years to ensure safe and effective patient care by experienced physicians. Together, they formed a working group to study the matter in 2015 and again in 2018. The board then submitted a report to the WADA House of Delegates ahead of the special WADA meeting in November 2021.
“Although age alone cannot be associated with reduced competence, the variation in cognitive abilities as physicians age suggests that the problem cannot be ignored,” says the report (PDF), whose recommendations were adopted by delegates at the meeting.
“The primary driver for setting guidelines should be to fulfill the profession’s ethical obligation to public health and patient safety,” the report notes.
The report outlines a set of guiding principles that were developed with the help of “content experts who research physician competencies and administer assessment programs,” it says. These principles provide guidance and serve as benchmarks for screening and assessment for all physicians, not just older adults.
Delegates adopted a policy stating that any program to assess or screen physician competencies should be:
- Based on evidence. Guidelines for screening and assessing physicians across the professional continuum should be based on evidence of the significance of cognitive changes associated with aging that may impact physician performance. Some physicians may suffer from declining professional performance with age, acquired disability, or other influences. Research also suggests that the effect of age on a physician’s competence can be highly variable. Since large variations are observed in cognitive performance with aging, age alone should not be a precipitating factor.
- Ethics. Guidelines should be based on the principles of medical ethics. Self-regulation is an important aspect of medical professionalism. Physicians should participate in the development of guidelines and standards to monitor and assess their own competence and that of their colleagues.
- Relevant. Guidelines, procedures, or assessment methods should be relevant to physicians’ practices in order to inform judgments and provide feedback regarding physicians’ ability to perform tasks specifically required in their practice environment.
- Accountable. The profession’s ethical obligation to public health and patient safety should be the primary driver for establishing guidelines and making informed decisions about the results of physician screening and assessment.
- Fair and equitable. The goal of screening and assessment is to optimize physician competence and performance through education, remediation, and modifications to a physician’s environment or scope of practice. Unless public health or patient safety is directly threatened, physicians should retain the right to modify their practice environment to enable them to continue to provide safe and effective care.
- Transparent. Selection and evaluation guidelines, procedures or methods should be transparent to all parties, including the public. Physicians should be aware of the specific methods used, the expectations and performance standards against which performance will be judged, and the possible outcomes of screening and/or assessment.
- Support. Education or remedial practices that result from screening or assessment procedures must be proactive, ongoing, and promote physician well-being.
- Non-binding. Screening procedures and mechanisms that are markedly different from “reasoned” assessments should not result in undue cost or burden to physicians. Hospitals and health care systems should provide readily available screening assessments to their employed physicians. Similar screening procedures and mechanisms should be available to physicians who are not employed by hospitals and health care systems.
- Due foraccess. Physicians subject to screening and assessment must be afforded the protections of due process, including a fair and objective hearing, before any action may be taken against the physician.
Delegates also asked WADA to encourage the Council of Medical Specialty Societies (CMSS) to develop educational materials regarding the decline in cognitive and psychomotor performance throughout a physician’s career and the impact that results in the quality and safety of medical practice.
AMA Academic Director Sanjay Desai, MD communicated the new AMA policy and need for educational materials in a January 20 letter to CMSS CEO Helen Burstin, MD, MPH.
Learn more from the AMA about why physician competence should be a priority, every day.