Prescription for Aging Clinicians

Assessing aging physicians and other clinicians for professional competency can help them transition to more suitable roles and allows employers to preserve working relationships with valued workers.

William Norcross, MD, remembers a phone call from an anxious hospital chief of staff.

"A surgeon [there] had developed [full blown] Alzheimer's," recalls Norcross. "But his colleagues all felt such compassion for him, and he was so loved, nobody had the heart to tell him he no longer belonged in the operating room."

So the surgeon's coworkers found small jobs for him to do, such as holding retractors, which allowed him to still be a member of the surgical team.

But the chief of staff had a bad feeling. "I just want to know, can you conceive of any problems with this?" he asked Norcross.

As founder and Executive Director of the Physical Assessment and Clinical Education (PACE) program and professor of medicine at University of California, San Diego, Norcross helps evaluate troubled physicians referred by state medical boards and hospitals.

While there is no national standardized test for clinicians to ensure their ability to continue on in their jobs, some hospitals do ask their clinicians to regularly be tested for competence.

Norcross describes the tests PACE has created as "a physical, a hearing and vision test, a brief, computerized screening test of neurocognitive function and a paper and pencil screening for depression and substance abuse."

He says the test takes less than half a day to complete, is relatively inexpensive, and is evaluated confidentially by a board of non-competing peers. While Norcross knows that assessing aging physicians and other clinicians can be a controversial topic, he feels passionately that it's the best solution to ensure patient safety.

"If there are age-related deficits, we should learn about them and find accommodations so [clinicians] can keep practicing safely. In some cases, it may be discovered that it's time to retire, but I would want to know that. I think all good physicians would want to know that," he says.

Reasonable Accommodation
In other fields, determining when to retire or shift work responsibilities is a deeply personal question, but in medicine, a practitioner's ability can mean the difference between life and death.

In Norcross' view, it should never get to the point where a clinician makes an error that can be blamed on age. "If it gets to that point, it's too late. As a patient, I don't want that," he says.

In the case of the chief of staff who called on Norcross' expertise regarding the surgeon with Alzheimer's, Norcross could not advise him to allow the surgeon to keep practicing in his current role.

"I admired the team's compassion and willingness to work with him—but, what if something went wrong? It's difficult to recover if you're a story on the front page of the newspaper."

"When [the clinician] can no longer do key, essential functions of working with a patient [it's time to retire]," says Vic Buzachero, corporate senior vice president for innovation, human resources and performance management at Scripps Health. "Or when their interest declines—if they burn out, or other interests develop."

But there are other options for aging practitioners who do not wish to retire completely.

The first option is to consider working fewer hours or different hours. Some older people are still able to work a normal workload, but shouldn't be on call at night. Others can handle working several days a week, but not a full-time schedule.

Buzachero suggests managers allow flexible hours to keep employees working longer. Scripps Health also offers a program that allows employees to retire in phases, so they don't have to stop working all at once.

Some employees might just need a more ergonomic setup, said Buzachero, who has equipped work stations with padded mats for older clinicians to stand on, special computer screens to reduce eye strain.

Another option is to help practitioners change roles A popular choice for older physicians is to become a family practitioner, a specialty where dexterity is not as important as in surgery. Some clinicians find a second professional act in teaching or coaching newer physicians and nurses, in administrative work, or as analysts.

As long as a clinician cares about patients and wants to use his or her talents, they should continue working in some capacity, says Buzachero. "When you can no longer be sensitive, read what a patient needs, or contribute, it's time to retire," he says.

Until then, it's a grave disservice to older clinicians who have wisdom and experience to contribute to be asked to exit before they are ready to go.