Under a new proposal from the Medical Board of Australia, late-career doctors could have to start sitting fitness-to-practice assessments.
The Medical Board of Australia is taking feedback on whether to institute mandatory health checks for older doctors, after revealing a marked increase notifications for doctors aged 70 years and older.
Doctors will be the only health profession affected; pharmacists, nurses, chiropractors and other members of the regulated professions will continue to practice past 70 with no mandated checks.
Three options are on the table: doing nothing, implementing extensive and detailed “fitness-to-practice” assessments or introducing GP-run general health checkups.
The options
The board has already indicated that it would prefer to go with option three.
Medical board chair Dr Anne Tonkin framed the potential changes as a way to “re-equip doctors to practice” past 70.
“We’re looking for a way to keep late career doctors in charge of their career,” she said.
“By having regular general health checks from age 70, late career doctors and their treating practitioners will be able to make informed decisions about how they practise, and when they retire.”
The results of the general health checks would be confidential; i.e. the treating doctor wouldn’t have to share it with the board.
They would, however, still be required to do a mandatory report of any health concerns that they felt the late-career doctor was refusing to manage and may cause a substantial risk to patients.
Health checks would start when a practitioner turned 70 and be required every three years until they turned 80, after which it would become annual.
The board said it wouldn’t prescribe the contents of a general health check, but did provide a draft pre-consult questionnaire covering vaccine history, sleep habits and screening for various physical and neurological changes.
These include specific questions on genito-urinary health, cognitive function and manual dexterity.
Cognitive function, due to the limited sensitivity of the existing tests in high-functioning professionals, is an area of contention.
“The main aims of cognitive screening are to establish a baseline for longitudinal comparison and to determine existing risk factors,” said the board.
“When impairment in cognitive function is detected, the doctor should be referred to specialists for further testing and/or treatment.”
The draft health check examination form asks the treating doctor to do either a Montreal Cognitive Assessment or an Addenbrooke’s Cognitive Examination, alongside both the Standardised Mini-Mental State Examination and the Clock Drawing Test.
Option two is a little harder line.
Like the health checks, doctors would have to do one fitness-to-practice exam every three years once they turned 70 and annually once they turned 80.
Doctors would have to seek out a specialist occupational or environmental physician – of which there are vanishingly few – for assessment tailored to their practice, on top of a general health check covering all the components laid out in option three.
For example, a surgeon would be assessed on their dexterity, ability to stand, hearing and vision.
It would be time and resource-intensive for the board, which would have to develop a range of clinical assessment resources for every medical specialty.
Again, the results of the fitness-to-practice assessments would be confidential unless it warranted a mandatory report.
The stats
According to the medical board, the rate of notifications about late-career doctors has almost doubled over the past decade, from around 36 notifications per 1000 doctors in 2015 to 70 per 1000 in 2023.
It described the 130% rise in notifications for doctors in the 70-74 age bracket as disturbing.
“For doctors aged 80 and over, notifications climbed by more than 180% per 1000 doctors between 2015 and 2023,” said the board.
“In comparison, notifications about doctors aged under 70 years have increased from 23.4 to 38.3 per 1000 (63%) over the same period.
“While late career doctors make up a relatively small proportion of the medical workforce, health ministers and the community expect the Board to prevent avoidable harm to patients.”
In terms of notification content, doctors older than 70 were the subject of a far higher number of complaints related to clinical care, communication, documentation, medication and health impairments compared to their younger peers.
Related
The response
While this proposal is new, the board has technically been mulling over mandatory health checks for late-career doctors since 2017.
At the time, it accepted an advisory group recommendation to institute three-yearly cognitive screening in principle.
But it didn’t do anything with that recommendation immediately, and with the pandemic requiring all hands on deck, it’s perhaps not surprising that it fell by the wayside.
AMA vice president Dr Danielle McMullen told The Medical Republic that the association had already heard from older clinicians who were feeling “attacked” by the way the issue was being approached.
“Doctors are a professional group and take their ability to practice seriously,” she said.
“Obviously, healthy patients require a healthy workforce.
“But while the AMA … feels strongly about doctors supporting our and the system supporting their physical and mental health as practitioners, we definitely don’t want to a health check process that’s so onerous that it’s an impediment to doctors practicing.”
Some of the options put up by the medical board, she said, looked remarkably like the UK’s infamous revalidation system.
“What we don’t support is processes that resemble revalidation or mandatory retirement of older doctors, nor do we support a complex fitness for practice assessment,” said Dr McMullen.
“If there are discussions about a health check, then it needs to be about health promotion for doctors.”
General practice is likely to be particularly hard-hit – according to the workforce statistics released yesterday, around one in six GPs are already over 65 years.
RACGP president Dr Nicole Higgins called for a balanced approach.
“GPs have told us they’re experiencing more burnout,” she said.
“They’ve told us about the strain notifications can put on their mental health. Mandatory reporting and vexatious notifications add to that strain.”
The proposed focus on early detection, Dr Higgins said, was a welcome indication that the medical board will approach it in a way that supports doctors’ health.
“The health regulator must ensure it’s supporting both safety and our GPs,” she said.
“Any mandatory health checks must support our GPs, not create an additional burden.”
The board is seeking feedback on its proposals until 4 October.
