MOCA For Everybody

Seems like I'm not the only one who has concerns about the ability of aging doctors to do their jobs. I recently posted about older colleagues who have difficulty intubating patients, the cornerstone of anesthesiologists' responsibilities. Today the New York Times has a lengthy article about senior doctors who are not mentally or physically fit to treat patients safely.

The article talks about old surgeons who are incapable of operating or internists who are too confused to manage their patients but refuse to retire. It mentions that there are no protocol for forcing a doctor to stop working. While airline pilots have to take a competency test every six months after the age of 40 and mandatory retirement at 65, no such rules apply to doctors. One medical group was concerned enough about the abilities of one of their colleagues that they requested he retire. Only they didn't have the guts to tell him directly so they held a retirement party for him as a hint. The trouble was the colleague ignored their farewells and kept right on working. It took the intervention of an outside consultant to step in and gently but directly confront the doctor about his need to retire.

The general population probably doesn't realize that older doctors probably haven't cracked open a journal or textbook in years. Thanks to their peers at their respective medical boards, the older generation of doctors have all been grandfathered into lifetime board certificates while we younger generation are forced to recertify periodically, every ten years for anesthesiologists. It's ironic that the ones with the most current medical information has to retake a test every ten years while those who haven't been to school in decades can just coast until they wish to stop working. Sure the senior doctors have to take some CME courses to maintain their state medical licenses. But most people don't know that the state medical boards don't care what CME you're taking. You could be an anesthesiologist and take a CME course in Hawaii on skin psoriasis and it would still count towards the license requirements.

The article is correct in that doctors protect their own and are reluctant to force a colleague, and friend, out.  The physicians who are the heads of their medical groups are also from the older generation, most likely having worked with their impaired colleagues for decades. They can have trouble firing one of their friends, and possibly seeing their own professional mortality in the process. I could tell horror stories about the complications caused by anesthesiologists who should have retired ten years ago but which are glossed over by management whereas a younger anesthesiologist with similar complications are raked over the coals or fired.

The solution to this problem is to take retirement out of the hands of the physicians. Since doctors seem incapable of policing themselves, they need an objective unemotional method for weeding out the bad apples. A psychological analysis for mental competency may be too subjective. An arbitrary retirement age will discriminate against doctors who are still highly productive. But if all doctors are required to take periodic board recertifications to prove their abilities, that would take the agony of forcing a doctor to retire out of the hands of their friends. Are you listening American Board of Anesthesiology? MOCA recertification for every single anesthesiologist, regardless of when they finished residency, would help ensure that every anesthesiologist in this country is competent to safely administer anesthesia to patients and gently ease the incompetent ones out. This idea should be one more to consider since we consider ourselves "Leaders In Patient Safety."