NATIONAL HARBOR, Md. -- A set of guiding principles from an American Medical Association council on assessing the competency of senior/late career physicians failed to gain adoption at the AMA's interim meeting here.
In a floor vote of 281-222 on Tuesday, delegates sent the report back to the Council on Medical Education, which issued the guiding principles. Some hospitals and health systems already require competency testing by older physicians, but there are currently no standards for these tests.
There are currently more than 120,000 practicing physicians 65 and older in the U.S., according to the council. Chairperson Carol Berkowitz, MD, stressed that the report does not mandate age-based competency testing. Instead, it sets out guidelines for any organization or hospital that decides to put in place a testing process to ensure it is "fair, evidence-based, and equitable."
In committee discussions Sunday, Marlys Witte, MD, a delegate of the Organized Medical Staff section, questioned how one major benefit of aging -- wisdom -- could be measured. The report mentions "a global deterioration scale" and imaging procedures such as MRIs.
"What are the biomarkers of wisdom?" Witte asked pointedly. "Is it some light in the amygdala? Is it some glowing through the frontal lobes? Is it some global enhancement scale that comes with age... that relates to judgment? I think the AMA should take this job on very seriously, to really talk about how we might measure wisdom."
Ann Murray, MD, an alternate delegate for the American Academy of Neurology, called the intention of the report "noble," but still opposed adoption.
She explained that competency is important for the medical community at any age, and that as a neurologist, she frequently sees younger patients with multiple sclerosis who have cognitive changes as do elderly patients with Parkinson's and Alzheimer's.
"When I see physicians with such disorders, I have to rely on the current competency evaluations to ensure competence. I do not make these patients jump through additional hoops to prove their competence, and I think that it's a really slippery slope to start doing that to any group of people, especially our colleagues, solely based on the number of birthdays they've had," Murray said.
Louito Edje, MD, a delegate from Ohio, who spoke from the House floor and voted for referral, said that the nuances of aging weren't reflected in the report, and that a faulty process might cast out individuals who have no decline in competency.
Other delegates expressed concerns that such guidelines might exacerbate the physician shortage, or encourage age discrimination.
But others spoke in support for the guidelines. Barbara Schneidman, MD, MPH, of the Senior Fellows Section, said she believed the council "got it right."
Henry "Hank" Dorkin, MD, an alternate delegate from the Massachusetts Medical Society, said the report was "well thought out," and supported its adoption. But he also acknowledged during a committee meeting on Sunday that the report could potentially be used as a "cudgel" to push certain individuals out of a practice.
Nonetheless, "I think it's important that we do [create the guidelines], because if we don't do it, it will be done to us," Dorkin said. "As we say often, 'If you're not at the table, you're on the menu.'"
Joyce Frieden, News Editor, contributed to this story.