Evidence Lacking for AMA Prescription for ‘Senior’ Doctors

Fifty years ago, the American Medical Association decried mandatory retirement as the “arbitrary segregation of individuals because of arbitrarily determined chronological age.”

Now the AMA is working on a plan that will allow it to force “senior/late career” physicians into retirement. At its annual meeting last month, the AMA unanimously adopted a plan to spearhead an effort to evaluate “senior/late career”  healthcare providers’ on-the-job effectiveness. The plan was proposed by the AMA’s Council on Medical Education.

The action comes on the heels of a dispute at Stanford University, where the Faculty Senate in May demanded repeal of a 2013 requirement that medical faculty aged 75 and older undergo enhanced health screening and peer assessment to retain their jobs.

Like Stanford University, the AMA fails to provide any evidence as to why it is necessary to screen “senior” physicians.

The plan has drawn the ire of a group that represents surgeons, the Association of American Physicians and Surgeons (AAPS). In a press release, Jane M. Orient, M.D.,AAPS  executive director, states, ” Most situations are not instantly life-threatening, and years of experience and good judgment count, not lightning reflexes and physical prowess.” She said older doctors, especially surgeons, scale back their practices as needed. “Do a few doctors, young or old, do procedures they can’t handle?” asks Dr. Orient. “Perhaps. But who is to sit in judgment on when their skills have begun to slip?” Orient infers the AMA is seeking to establish a new income revenue stream involving certifying doctors over the age of 65.

The actual AMA report on this issue is not available to the public. It is listed on the AMA’s web site but  a viewer must log in to actually see the report.

The AMA reportedly plans to”identify organizations that should participate in the development of guidelines and methods of screening and assessment to assure that senior/late career physicians remain able to provide safe and effective care for patients.” These organizations must then  “work together to develop preliminary guidelines for assessment of the senior/late career physician and develop a research agenda that could guide those interested in this field and serve as the basis for guidelines more grounded in research findings.”

In the absence of any evidence that a plan is even necessary, one cannot help but wonder about the extent of the role of ageist stereotypes in the AMA’s decision-making. These stereotypes include unsupported concerns that older workers are less competent, can’t learn new things, are rigid and quarrelsome, and refuse to accept they should step down and make room for younger doctors.

Few would disagree that it would be appropriate to protect the public if a need can be demonstrated.  But no doctor would prescribe a potent drug without evidence of need. Is it asking too much of the AMA (and Stanford University) to provide evidence of need before violating  the Age Discrimination in Employment Act of 1967? What’s the oath that doctors have to take – First, do no harm.

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