A new report by an American Medical Association council, released Monday, urges doctors to assess elder colleagues' competencies, a recommendation that echoes Stanford Health Center's three-year-old policy of evaluating all physicians over age 75.
Unlike pilots, FBI agents and air traffic controllers, doctors have no mandatory retirement age. Meanwhile, the number of U.S. physicians who are 65 and older has quadrupled since 1975, reaching 240,000 -- one-fourth of all doctors -- although not all are practicing, according to the AMA.
Dr. Frank Stockdale, at his office in the Stanford University Cancer Center on Tuesday, May 26, 2015, talks about his opposition to the hospital's contested policy requiring doctors over 75 years of age to undergo periodic assessment exams as a condition of renewing their privileges. (Karl Mondon/Bay Area News Group)
But the Stanford professors say their decades of experience make them more confident and compassionate practitioners -- and that younger doctors pose a bigger problem.
"It's age discrimination," said Dr. Frank Stockdale, a 79-year-old breast cancer expert who is leading the resistance to age-based testing. Last month, Stanford's faculty agreed, passing a recommendation in the Faculty Senate that university leadership tell Stanford hospitals to end their testing of older faculty.
"If physician testing protects patients, why not test everybody?" asked Stockdale, who started seeing patients when The Beatles debuted on "The Ed Sullivan Show." He estimates he's treated more than 20,000 cases of breast cancer.
At an age when many cherish the chance to relax, these professors at Stanford's School of Medicine are still teaching and conducting research -- both of which involve patient care. If they can't treat patients, their careers come to an end.
They include some of Stanford's most famed practitioners, such as Dr. John Farquhar, a pioneer on the link between obesity, exercise, diabetes and heart disease; prominent rheumatologist Dr. Halsted Holman; Dr. Gerald Reaven, who identified the heart-threatening condition known as syndrome X; Dr. Peter Greenberg, who studies the genetic regulation of bone cancer; Dr. Saul Rosenberg, credited with helping reverse the lethal course of Hodgkin's disease; and Dr. Lucy Tompkins, an expert in antibiotic-resistant bacteria.
"My wife has thought about my retirement," joked Stockdale, who has devoted his life to studying ways to improve breast cancer outcomes. "But it's very hard to give up. I am very good at this. And I enjoy doing it."
Increasingly, hospitals say it's time to pay attention to age-related issues, as more doctors in the baby-boom generation reach traditional retirement ages. Stanford requires a clinical and physical assessment for physicians 75 or older. Screening at some other hospitals, such as the University of Virginia Health System, starts sooner, at age 70.
"We recognized that age-related declines in physical and cognitive functioning can affect professional performances, including our own," said Dr. Ann Weinacker, a Stanford professor of medicine and quality improvement expert.
Doctors may not detect their own shortcomings, she said. There's even an official diagnosis for that: anosognosia, or "failure to recognize or to appreciate limitation."
The influential AMA's policy proposal will be up for a vote by its delegates this week. Age-related changes in hearing, memory, vision and motor skills could potentially affect doctors' competence, the report says, although it notes there is no evidence that links these changes to worse patient care.
The issue has also caught the attention of California's medical organizations: This spring, guidelines for age-based screening were published by the California Public Protection and Physicians Health Inc., a Sacramento coalition of medical and specialty societies, hospitals, liability carriers and large medical groups.
But the Stanford doctors, confronted with a 2012 order to take a mental exam by Stanford Health Center's medical executive committee, flatly refused.
"We don't think there is anything wrong with us," said Stockdale.
So the mental test was abandoned. But the doctors are still angered by the requirement for a physical exam.
"There's no scientific rationale," said 80-year-old Dr. Stanley N. Cohen, whose brilliant insights into genetics in the 1970s launched the multibillion-dollar biotechnology industry. "The hospital has this notion that older physicians pose some special risk. There's no data to support this."
There are already mechanisms in place to catch bad doctors, the doctors say. And Stanford has a strong policy against discrimination. So if the hospital wants routine assessments, said Stockdale, "it should be a process that is the same for all faculty."
"I am far more concerned about younger and middle-aged colleagues who are raising families, seeking tenure and related stress," said nephrologist Glenn Chertow, 52.
Buoyed by their victory in the Faculty Senate, the elder doctors are strategizing their next step -- even as the national tide turns.
"We're still planning secret things, but I can't tell you," Stockdale laughed.
Then he strode down the hospital hall to finish up his work, before catching the next day's flight to Europe.
The Associated Press contributed to this report. Contact Lisa M. Krieger at 650-492-4098. Follow her at Twitter.com/LisaMKrieger.
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