Tuesday, January 25, 2011

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."


  1. There is no evidence that meeting the requirements of MOCA equates to competency. You may think/hope it does but that doesnt mean squat. It makes a nice show for the public but I would challenge you to show me any study from any specialty showing that requiring a recert test every 10 years ensures more competent doctors. The one thing you can be sure of is that MOCA is a huge money maker for the bureaucracy of the ABA.

  2. If it's a huge money maker, then why not have everyone do it? Think of how much the ASA and ABA would rake in. Since not everyone has to do it, sounds like what ZMD said, our older colleagues are being "look out for" and as you said yourself, it doesn't prove competence, so on the other hand why require it at all, except for the money?

    Currently recertification costs about $8-10K over 10 years with the most recent fee structure. $2100 exam fee, $1500 for simulation (nice little win fall for those academic departments, but your not even graded on it, so it's meaningless), $350-400 for 80 ACE/SEE/Safety CMEs through ASA (Again a nice win fall for the ASA), $1200 est for remaining 270 CME if done through ACE/SEE. Jensen Review Course, $1025, review books $570 Mocha Blue, Other Books $200 est. Travel expenses $2000. Total ~$9000. Nice that many I work side by side with don't have that expense. The cost is just ridiculous.

  3. Simulation -- glad I am on the inside raking in all the Benjamins!

    So let me get this straight. You make about 250K/yr = 2.5million over 10 years and recert costs 8-10K over the same time some of which no doubt you write off.

    My heart bleeds. GIVE ME A BREAK!!!!