26 March 2018

Evidence backs more checks for older doctors

General Practice Medicolegal

A groundbreaking study showing older male GPs account for disproportionately high numbers of complaints seems to sew up  the case for age-based competency checks.

Preliminary findings from the research informed AHPRA’s proposal last year to subject doctors over 70 years old to checks every three years.

According to lead researcher Associate Professor Marie Bismark, this is believed to be the world’s first such risk-assessment project for doctors that takes account of actual hours worked.

It showed the “true complaint risk” for elderly doctors was much higher than it might seem from looking only at raw numbers of complaints, she said.

“There’s an analogy with elderly drivers,” Professor Bismark told The Medical Republic.

“Overall, elderly drivers don’t have that many accidents, but as soon as you control for the number of hours they are on the road, you can see that their accident rate is higher than for younger drivers.

‘”So it was really important that we do the same thing with elderly doctors, who are on average spending fewer hours each week in clinical practice.”

Across the profession, the analysis found male doctors aged over 65 had a 60% higher risk of notification than colleagues in the 36 to 60 age group. The increased risk for older female doctors was 70%.

The research, conducted under a partnership between the University of Melbourne and AHPRA, is based on records of 12,878 notifications lodged with Australian medical regulators over four years to December 2014.

The analysis, adjusted for “practitioner years” reflecting clinical hours, compared a population of 49,313 doctors aged 36 to 60 and a senior group of 7627 doctors aged 65-plus.

It found the older doctors had twice the risk of complaints related to physical illness or cognitive decline than younger colleagues.

Older doctors also had 40% higher rates of notification for inappropriate prescribing, inadequate record-keeping and unlawful use or supply of medications.

However, the younger cohort attracted significantly more complaints related to mental illness, substance abuse, procedural performance issues, and, more narrowly, for fraud.

The incidence rate of notifications for older doctors was 1.4 times higher than for the younger cohort.

Of all notifications, only 8.5% resulted in regulatory action, such as a reprimand or imposition of conditions.  However, the frequency of regulatory action for older doctors was 1.5 times higher.

The study identified “‘hot spots” of risk for older doctors which suggest that ongoing professional development, education and support are needed to ensure high standards of clinical practice.

“What we see is the (AHPRA) policy proposals are supported by evidence,” Professor Bismark said.

The three-year partnership between researchers and regulators, funded by the National Health and Medical Research Council, was paying off in workforce-related information, she said.

“As we were doing this research and our preliminary findings were beginning to emerge, we were also sharing those with the Medical Board.

“I think it’s a great example of evidence-based policy that the Medical Board has made these proposals that elderly doctors should be subject to some additional checks.”

GPs accounted for 36% of the younger cohort and about 31% of the older group in the study.

Older GPs were targeted in 681 notifications during the four years, compared with 4494 for younger GPs.  Their incidence rate was 60% higher, however, owing to smaller numbers and fewer hours worked.

Overall, some 84% of the older doctors who were subject to notifications were located in metropolitan areas, compared with 16% in regional and remote areas, figures that closely mirror their distribution and activity in those areas.

The authors concluded that many senior doctors provided high-quality care well past the traditional retirement age, noting 86.8% of them were not subject to any complaint.

One “hot spot” for the older group was prescribing and use of medicines.

“Some older doctors are known to maintain registration so they can prescribe for themselves or for families and friends,” they wrote.

While this was considered a breach in good practice, some doctors had been slow to adapt to evolving professional standards.

The research is published in the current Journal of Patient Safety and Risk Management.