Second org raises AHPRA health check ageism concerns

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AHPRA Political RACGP Workforce

By

Holly Payne

Less than half of 1% of older doctors have notifications made against them for health impairments. So why the fuss, the RACGP asks.

The RACGP has joined the AMA in voicing “serious concerns” that AHPRA’s plans to mandate health checks for doctors over the age of 70 could constitute age-based discrimination. 

Unlike the medical association though, the college categorically did not support any form of compulsory health assessment. 

AHPRA announced in August this year that it would likely be introducing some form of assessment for older doctors, citing increasing rates of notifications for doctors once they hit 70.  

It set out three proposals to manage doctors over the age of 70: keep the status quo, introduce comprehensive fitness to practice testing or require regular general health checkups. 

“In an inclusive and diverse society, there is no place for ageism, and we have serious concerns that this proposed policy is ageist,” the RACGP said. 

According to the regulator’s analysis, the number of notifications received per 1000 doctors in 2023 jumped from 38 in the below-70 cohort to 70 in the 70-and-older cohort.  

The notifications gap has been increasing over the last decade.  

These figures, along with research completed in 2018, “confirm[ed]” the Medical Board of Australia’s view that late career doctors experience physical illness and cognitive decline at a higher rate than their younger peers.  

Therefore, it concluded, health checks were one way to assist in identifying these issues before potentially unsafe practice occurs.  

In its submission to AHPRA’s consultation, the RACGP questioned this logic.  

The biggest source of notifications for doctors of all ages in 2023 related to clinical care (16 per 1000 for younger doctors, 24 per 1000 for older doctors), followed by pharmacy and medication (5 per 1000 for younger doctors, 12 per 1000 for older doctors). 

For older doctors, communication was the third most common cause of notifications, at 11 per 1000 doctors. 

Doctors over the age of 70 received about 2.6 notifications per 1000 doctors relating to a health impairment. 

If there were 70 notifications per 1000 older doctors in 2023, then the 2.6 notifications per 1000 older doctors that related to health impairments represent just 3% of the total.  

It’s unclear, then, why health assessments would be the solution to the higher incidence of notifications. 

“[AHPRA’s analysis] shows a higher incidence of notifications for older doctors,” the RACGP said.  

“However, no evidence is provided to demonstrate the effectiveness of mandatory health checks in reducing patient harms and notifications.  

“It is unclear if notifications received by AHPRA were specifically related to the physical or cognitive decline of the doctor, or the age of the doctor, and could be avoided with a mandatory health check based on the doctor’s age.” 

Rates of health impairment-related notifications were high across other disciplines in 2023 as well. 

Related   

Proposed health checks could be ageist, AMA says

‘Unacceptably short’ feedback window on AHPRA changes

AHPRA moots checkups for docs over 70

According to AHPRA’s 2023 annual report, 17.3% of the 216 notifications against paramedics were about a health impairment and 14.2% of the 2884 notifications made about nurses were about a health impairment.  

In addition to not presenting any evidence that health checks will actually reduce notifications against older doctors, the RACGP said, AHPRA may not have considered that a number of GPs would rather retire early than face increased administration.  

The college also pushed back against the idea of screening for dementia.  

It’s not the first organisation to raise questions around whether a mandatory health assessment policy would be age discrimination; the AMA called on the regulator to seek and publicly release legal advice on the matter.  

The Medical Republic asked AHPRA whether it had done so; it declined to comment until the “appropriate full and thorough analysis” had been completed and the board had decided on a way forward.  

It has already indicated that its preferred pathway would be general health assessments every three years for doctors over 70, to be increased to yearly for doctors older than 80.  

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Philip Morris
Philip Morris
9 hours ago

In recent discussions about professional regulations, a contentious proposal has emerged from the Medical Board of Australia. This proposal suggests mandating repeated medical examinations and cognitive testing for doctors aged 70 and older. This initiative has sparked a debate about whether such measures are a necessary safeguard for public safety or an unjust form of age discrimination.
 
Understanding the Proposal

The Medical Board of Australia has expressed concerns that existing regulatory frameworks might not be sufficient to identify doctors with health issues that could impact patient care. They argue that by instituting mandatory examinations and cognitive assessments for older doctors, they aim to mitigate risks associated with aging practitioners.
However, this proposal raises critical ethical questions. Profiling a specific age group based on the assumption that they inherently pose a higher risk is a form of age discrimination. This is particularly concerning given the lack of robust evidence supporting the claim that all doctors over 70 are a significant threat to patient safety.
 
Examining the Data

The Board’s own data from 2015 to 2023 reveals some intriguing patterns. The rate of notifications of medical complaints increased similarly for doctors both below and above 70 years old, indicating no disproportionate rise in issues among older doctors. Specifically, from 2015 to 2019, notifications increased by 70% for those under 70 and 73% for those 70 and older. From 2019 to 2023, the rates plateaued, with a slight decline for younger doctors and a modest increase for older doctors.
Furthermore, the nature of regulatory actions in 2022-23 showed that younger doctors faced more severe sanctions than their older counterparts, suggesting that the perceived risk might be higher among younger practitioners.
 
A Fair Approach to Regulation

If the goal is to enhance patient safety, a more targeted approach would be more effective and fairer. The Medical Board already possesses substantial authority to evaluate doctors of any age who exhibit signs of impaired performance, such as through multiple complaints or significant lapses in care. This strategy would allow for a nuanced assessment without age profiling.
The current proposal does not address the variability in individual health and performance among doctors of all ages. Without clear evidence linking age directly to increased risk, enforcing blanket medical examinations and cognitive tests on older doctors appears to lack justification.
 
Challenges with Cognitive Testing

The cognitive tests proposed by the Board, such as the Montreal Cognitive Assessment (MoCA) and the Addenbrooke’s Cognitive Examination, have not been validated specifically for assessing the capacity of physicians. The lack of norms and the potential for test familiarity among doctors undermine the reliability and relevance of these tests in determining a doctor’s professional competency.
Moreover, cognitive tests often fail to capture the full range of skills required in medical practice, such as interpersonal communication, practical problem-solving, and emotional intelligence. They also tend to overlook the context in which a doctor works, which is crucial for a comprehensive evaluation of their capabilities.
 
The Value of Experience

Older doctors bring invaluable experience, mentorship, and continuity of care to the medical profession. Their contributions are critical, especially in an era of physician shortages. Discriminatory practices that target this group could drive experienced professionals away from the field, potentially harming the quality of patient care and the overall healthcare system.
 
Alternative Solutions

Rather than imposing mandatory repeated testing on all older doctors, a more balanced approach would involve regular health check-ups for all practitioners, regardless of age. This could ensure that all doctors, young or old, maintain their health and capability without singling out a specific age group.
Additionally, focusing on targeted assessments based on frequent notifications and performance concerns, rather than age, aligns better with principles of fairness and evidence-based regulation. This approach would help maintain high standards of care without resorting to age profiling.
 
Conclusion

Mandatory medical examinations and cognitive testing for doctors aged 70 and over raise significant concerns about fairness and discrimination. The evidence does not support the need for such blanket measures, and a more nuanced approach would better serve both practitioners and patients. Ensuring regular health check-ups for all doctors and targeting assessments based on specific performance issues would provide a more equitable and effective strategy for safeguarding patient care. This would be consistent with the Medical Board of Australia’s Code of Conduct that requires:

“all doctors to have their own general practitioner (GP) to help them take care of their health and wellbeing throughout their working lives. Healthy doctors are the cornerstone of Australia’s healthcare system.”

The Medical Board of Australia should reconsider its approach and adopt practices that uphold the principles of fairness and evidence-based regulation, rather than implementing age-specific mandates that may inadvertently lead to discrimination and loss of valuable experience in the medical field.

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Geoffrey Hawson
Geoffrey Hawson
8 hours ago

Well done College of GP’s.

The MBA CRIS document obscures data by using rates not absolute numbers. This creates issues as detailed below. ASADA (Australian Senior Active Doctors Association) has made a comprehensive analysis of the document. A couple of issues are

1.     The MBA uses the number 15.54 as the increased rate of notifications (physical illness or cognitive decline) for doctors over 65 from an article by Thomas et al in 2018. While not disputing the calculations, there were 72 notifications for physical illness or cognitive decline in the >65 vs 24 in the < 60 group. Not quite 15.54. Also not pointed out, is the increased number of notifications in the <60 cohort for mental illness and substance misuse. An increased rate of 16 times hidden in an IRR of 0.58. These discrepancies occur when rates are compared vs absolute numbers. It does not pass the Barbecue test.

2.     The CRIS document emphasises the number of complaints in the over 70 (485) in 2023 but not does report the number in the under 70’s, which we estimate as approximately 5130. Despite having a higher rate of complaints, if the public needs protection, surely it should be protected from the cohort with the largest number of complaints, the younger cohort.

ASADA’s complete submission can be seen on my LinkedIn page at

https://www.linkedin.com/posts/activity-7249626773632475137-C266?utm_source=share&utm_medium=member_desktop
 
 

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