Being a physician in today’s world is challenging. Doctors face a myriad of healthcare legislation, fluctuating reimbursement, complicated care delivery models and increased productivity expectations.
In the workplace, physicians are expected to see more patients per week at a faster pace, work longer hours, take more calls, and handle a growing volume of paperwork. There is also the requirement that physicians stay up-to-date with the latest developments in their specialty, as well as complicated billing requirements. Add to that list endless hours of regulatory training and the demands of EHR and clinical integration, and anyone can understand why the American physician is burned out!
According to research published in Mayo Clinic Proceedings, a doctor’s work-life balance is worsening, with the percentage of physicians who say they are suffering burnout rising to 54% in 2014 from 45% in 2011. This burnout is said to have effects on quality of care, patient satisfaction, turnover, and patient safety.
Physician burnout has been a hot topic in the news for the past couple of years. The AMA has even come out with an effort to help physicians with burnout through “AMA STEPS Forward,” a program to help physicians find new fulfillment in their practice and handle common practice challenges. Keeping physicians practicing medicine is of extreme importance, given the expected physician shortage. According to a report published by the Association of American Medical Colleges, by 2025 we will have a shortfall of between 12,500 and 31,100 primary care physicians and a shortfall of between 28,200 and 63,700 non-primary care physicians.
In a country of burned out physicians in short supply, it is somewhat surprising to now see the AMA turn their attention to “older” physicians and take the position that physicians should be meeting certain age-related competency guidelines to assure patient safety. With 25% of physicians already over the age of 64, and 42% older than 55, this concept is one which will impact the majority of providers in the near future. Given how burned out physicians already are, having their competency questioned is likely to cause some acrimony.
Testing physicians for competency based on age is not a new concept. Many hospitals have such programs already. Similarly, other professions involving public safety, such as aviation, require competency testing based on age as well. The AMA explored this issue in detail at the 2015 AMA Annual Meeting, where delegates voted to develop formal guidelines on competency, focusing largely on physician changes in hearing, sight, memory, and motor skills, without any clarity as to what age would trigger these types of issues or any specialty-specific concerns. The suggestion is that age 70 would trigger the first review, followed by periodic reevaluation.
The AMA’s plan will allegedly include testing a physician’s physical and mental health, as well as a review of physician cases. While well-intended, the review of every physician within an age group, without any report of deficiencies or objective reason to question competency, seems a waste of resources. No doubt physicians themselves will be the source of funding for such competency testing (directly or indirectly), which only adds insult to injury. With existing peer review, quality assurance oversight and maintenance of certification, the need for independent competency guidelines is not entirely clear.
The challenges of physician burnout and age related competency are closely related. Both can affect a patient’s health and safety, and both are a large concern in a country where there is a dire need for physicians to keep practicing longer. One thing for certain is that the approach to age-related competency or burnout needs to be one that supports and helps physicians, rather than a strategy that could leave physicians feeling attacked. Physicians already face “investigation” related to patient care and decision-making at most hospitals, and such formal inquiries are often mired in politics, leading to outcomes that are shockingly unjust and can ruin a physician’s career and reputation. If physicians become subject to a review based on age alone, without any particular indication of a competency issue, the concern is that such evaluations would lead to similar outcomes. While any AMA recommendation would advocate unbiased and independent review of physician competency, the reality could be quite different.
There is no easy answer to the issues of physician competency and burnout. There definitely needs to be a discussion about how to provide the best quality of care to patients while helping physicians stay happy and healthy in their profession. As doctors age and healthcare becomes a tougher profession to work in, there are sure to be some high priority issues for the medical community to address.