Like many GPs in a Healthed survey last week, the Australian and New Zealand Society for Geriatric Medicine president-elect and geriatrician Professor Susan Kurrle supports mandatory health checks for doctors aged 70 and up.

Complaints against late-career doctors are dramatically higher than their younger peers, prompting AHPRA and the Medical Board to consider requiring mandatory health checks every three years from age 70, and every year from age 80.

Professor Kurrle, who herself is over 70, was involved in the committee with the Medical Board to discuss managing older doctors in 2019.

She says the disproportionate number of complaints against late-career doctors shouldn’t be ignored.

“If we’re getting more complaints as we get older, then we need to be addressing that issue and addressing it from within the profession,” she says.

“I think it’s a very practical solution. It’s age-related rather than ageist, because these issues do increase as you get older,” Professor Kurrle says.

“Continuous, professional development is now mandatory. So why wouldn’t checking your health also be, at an age when we know you are likely to have more health problems?” she says.

If the assessment stops someone from practicing, “they probably have stopped anyway,” she adds.

Of course there is huge variability between individuals, Professor Kurrle says, noting that only about 3% of people aged 70 to 75 have dementia, but other things such as psychiatric illness can lead to impairment at any age.

“You do get slower. Absolutely, no question about it. We know that normal changes occur with aging in the brain. Decreased ability to multitask… Your brain just doesn’t work quite as quickly. You do have more word finding difficulty and sometimes difficulty with names. They’re reasonably normal age-related changes, but they occur at different ages in different people. And it’s the same with doctors,” she says.

Professor Kurrle says encouraging doctors to find a GP is not just about cognitive impairment, with other health issues such as diabetes, hypertension and CVD increasing with age too.

While you can self-assess cognition with online tools such as Cogstate, mandating the assessment ensures doctors are reviewed every three years, she says.

Older GPs less likely to support the proposed health checks

A survey of more than 1000 GPs following Healthed’s webcast last week found that 59% of respondents supported interventions targeting late-career doctors in an effort to improve safety — while the remaining 41% felt the status quo should be kept. The survey showed a clear trend toward older doctors being less supportive of the Medical Board’s proposals, and younger GPs being more supportive of them.

GPs aged 35-54 were also more likely to agree specifically with the proposed mandatory health checks for doctors aged 70 and older than their colleagues aged 65 and up. Doctors over 65 were more likely to think keeping the status quo was the most appropriate response.

Carrot not the stick

Among those pushing back on mandatory health checks with a GP or other doctor is Professor Karen Price, immediate past president of the RACGP, GP and researcher. She says it’s “good to encourage all doctors to have regular medical checks,” but making them mandatory is another story.

“The evidence is clear that medical people neglect their own care. In my research and experience it seems the nudges to perform self-care are more likely to be enacted when a well-known peer nudges you firmly, than an unknown assailant from the health department.”

“Just as the nudge letters threaten professional identity this will too and will be heavily resisted and will risk harm to those who are potentially high functioning. If we harm doctors, we automatically harm patients and the health system performance,” Professor Karen Price says.

Professor Price says the same regulations apply to doctors who are cognitively impaired in any age group.

“A further reactive burden on those remaining in practice above the arbitrary 70 years of age seems in initial formulation to be political and ageist,” she says.

“Whether you are 30 or 50 or 70, impairment protections and regulations are already sufficient.”

Professor Price says impairment can occur through a variety of mechanisms at any age: “from mental health concerns, to a lack of sleep by a new parent, to ageing related issues which don’t have a decade cut off.”

As for the small percentage who are repeat offenders, she says this “seems to relate more ethical and systems failures than to knowledge impairment.”

“There are already regulations and protections for impaired doctors reporting, so I find this heavy hammer approach a little challenging. There is an increasing punitive mindset occurring in the regulatory bodies which is not well applied to the unregulated commercial market.”

‘Too much regulation already’

Dr Aniello Iannuzzi, a GP and chair of the Australian Doctors Federation, is also sceptical of the proposal, saying the figures from APHRA and the Medical Board lacked detail and “should not be relied on to justify or legitimise a drastic escalation of regulation.”

“The current complaints process makes it too easy to make vexatious complaints,” Dr Iannuzzi says.

“There is no analysis of how these older doctors practice versus younger doctors. There is no discussion about the seriousness of the complaints or the outcomes of the investigations. It strikes me as an emotional headline triggering a very heavy-handed response.” – Dr Aniello Iannuzzi

Dr Iannuzzi says there is already too much regulation at the practitioner, practice and department levels of medical practice.

“We have reached the point where the time, distraction and obsession over compliance is making patient care less accessible, more expensive and possibly even of less quality.”

The Medical Board is also considering two other options— one is to keep the status quo, while the other would require extensive and detailed assessment from a specialist occupational physician.

Neither Professor Kurrle nor Professor Price or Dr Iannuzzi support the latter – and Healthed’s survey found that the vast majority of GPs don’t either, with just 8% saying it would be appropriate to require an assessment from a specialist occupational physician.

What else can be done?

Professor Price says more peer-related support, encouragement and transitions to retirement are needed – and financial difficulties may also be increasing pressure on GPs to work longer.

“It is possible in the GP cohort too that many find themselves with insufficient retirement savings or superannuation benefits given compulsory superannuation occurred part way through this cohort’s working lives… The financial wrecking of general practice in particular remains a health care scandal and needs to be immediately actioned.”

Professor Kurrle also says it’s important to look out for and support other doctors — as well as to be honest with yourself about your changing needs. For example, you may need to reduce the number of people you see in a day or work fewer hours so you’re not pushed as much.

“It’s adjusting your practice to fit the fact that you are getting older,” she says.