Mandatory Medical Examinations for Doctors Aged 70: A Debate on Discrimination versus Safety
By Dr Philip Morris MBBS BSc med PhD FRANZCP FAChAM
In recent discussions about professional regulations, a contentious proposal has emerged from the Medical Board of Australia. This proposal suggests mandating repeated medical examinations and cognitive testing for doctors aged 70 and older. This initiative has sparked a debate about whether such measures are a necessary safeguard for public safety or an unjust form of age discrimination.
Understanding the Proposal
The Medical Board of Australia has expressed concerns that existing regulatory frameworks might not be sufficient to identify doctors with health issues that could impact patient care. They argue that by instituting mandatory examinations and cognitive assessments for older doctors, they aim to mitigate risks associated with aging practitioners.
However, this proposal raises critical ethical questions. Profiling a specific age group based on the assumption that they inherently pose a higher risk is a form of age discrimination. This is particularly concerning given the lack of robust evidence supporting the claim that all doctors over 70 are a significant threat to patient safety.
Examining the Data
The Board’s own data from 2015 to 2023 reveals some intriguing patterns. The rate of notifications of medical complaints increased similarly for doctors both below and above 70 years old, indicating no disproportionate rise in issues among older doctors. Specifically, from 2015 to 2019, notifications increased by 70% for those under 70 and 73% for those 70 and older. From 2019 to 2023, the rates plateaued, with a slight decline for younger doctors and a modest increase for older doctors.
Furthermore, the nature of regulatory actions in 2022-23 showed that younger doctors faced more severe sanctions than their older counterparts, suggesting that the perceived risk might be higher among younger practitioners.
A Fair Approach to Regulation
If the goal is to enhance patient safety, a more targeted approach would be more effective and fairer. The Medical Board already possesses substantial authority to evaluate doctors of any age who exhibit signs of impaired performance, such as through multiple complaints or significant lapses in care. This strategy would allow for a nuanced assessment without age profiling.
The current proposal does not address the variability in individual health and performance among doctors of all ages. Without clear evidence linking age directly to increased risk, enforcing blanket medical examinations and cognitive tests on older doctors appears to lack justification.
Challenges with Cognitive Testing
The cognitive tests proposed by the Board, such as the Montreal Cognitive Assessment (MoCA) and the Addenbrooke’s Cognitive Examination, have not been validated specifically for assessing the capacity of physicians. The lack of norms and the potential for test familiarity among doctors undermine the reliability and relevance of these tests in determining a doctor’s professional competency.
Moreover, cognitive tests often fail to capture the full range of skills required in medical practice, such as interpersonal communication, practical problem-solving, and emotional intelligence. They also tend to overlook the context in which a doctor works, which is crucial for a comprehensive evaluation of their capabilities.
The Value of Experience
Older doctors bring invaluable experience, mentorship, and continuity of care to the medical profession. Their contributions are critical, especially in an era of physician shortages. Discriminatory practices that target this group could drive experienced professionals away from the field, potentially harming the quality of patient care and the overall healthcare system.
Alternative Solutions
Rather than imposing mandatory repeated testing on all older doctors, a more balanced approach would involve regular health check-ups for all practitioners, regardless of age. This could ensure that all doctors, young or old, maintain their health and capability without singling out a specific age group.
Additionally, focusing on targeted assessments based on frequent notifications and performance concerns, rather than age, aligns better with principles of fairness and evidence-based regulation. This approach would help maintain high standards of care without resorting to age profiling.
Conclusion
Mandatory medical examinations and cognitive testing for doctors aged 70 and over raise significant concerns about fairness and discrimination. The evidence does not support the need for such blanket measures, and a more nuanced approach would better serve both practitioners and patients. Ensuring regular health check-ups for all doctors and targeting assessments based on specific performance issues would provide a more equitable and effective strategy for safeguarding patient care. This would be consistent with the Medical Board of Australia’s Code of Conduct that requires
“all doctors to have their own general practitioner (GP) to help them take care of their health and wellbeing throughout their working lives. Healthy doctors are the cornerstone of Australia’s healthcare system.”
The Medical Board of Australia should reconsider its approach and adopt practices that uphold the principles of fairness and evidence-based regulation, rather than implementing age-specific mandates that may inadvertently lead to discrimination and loss of valuable experience in the medical field.