Medical Board consults on new approach to keep late career doctors in safe practice

07 Aug 2024

Health checks for doctors over 70 among options being considered

Health checks for doctors over 70 are among options being considered to safely extend the practice of late career medical practitioners, as data reveals the rates of patient complaints jump significantly with increasing age.

The Medical Board of Australia is keen to hear what doctors, patients and the wider health sector think about regulatory options for keeping late career doctors in safe practice.

Proposals for keeping late career doctors in safe practice are now open for public comment.

There is an increased incidence of health impairment as individuals age, and this affects medical practitioners in the same way as the rest of the community. For doctors, the rate of notifications related to health impairments is more than three times higher for those over 70 compared with younger colleagues.

Ahpra’s complaints data shows that doctors aged over 70 are 81% more likely to be the subject of a notification for any reason (not just impairment) than those under 70.

Overall, the rate of notifications about late career doctors has almost doubled over the past eight years, rising from 36.2 notifications per 1000 practitioners aged 70 and older in 2015, to 69.5 complaints per 1000 in 2023. Notifications for doctors in the 70-74 year age bracket have jumped disturbingly, rising more than 130% from 32 notifications for 1000 doctors in 2015, to more than 74 per 1000 in 2023. For medical practitioners aged 80 and over, notifications climbed by more than 180% per 1000 doctors between 2015 and 2023. 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.

To protect patients while also extending the careers of medical practitioners in a safe way, the Board is consulting on a range of proposals to safeguard the health, privacy and independence of late career doctors by managing preventable risks to patient safety.

The Board’s three options to keep late career doctors in safe practice are set out in the consultation regulation impact statement:

1. keep the status quo and do nothing extra to ensure late career doctors are healthy and able to provide safe care
2. introduce an extensive and detailed ‘fitness to practise’ assessment for all doctors aged 70 and older, to be conducted by specialist occupational physicians, or
3. introduce general health checks with a GP for late career doctors aged 70 and older, to support early detection of concerns with the opportunity for management before the public is at risk.

The Board believes Option 3 is best for patient safety and for keeping doctors in control of their careers as they age. The proposal would require doctors from the age of 70 years to undergo general health checks with their GP or another doctor every three years, and yearly from 80 years of age.

Board Chair, Dr Anne Tonkin AO, said measures to identify issues earlier that may impact a doctor’s practice, could prevent future patient harm and provide opportunities for practitioners to take action to extend their careers.

‘It’s in line with all public health screening measures. Early detection means early management, which can mean preventing avoidable risks,’ Dr Tonkin said.

‘We are looking for effective and practical ways to support late career doctors to stay in safe practice, through health checks that will identify and enable doctors to address any risks that come from increasing age.

‘General health checks for late career doctors will give individual doctors and their treating practitioners information to help them manage any health concerns early and re-equip doctors to practise past their 70th birthday.

‘Doctors are often reluctant patients, and we are concerned they don’t always seek the care they need.

‘We’re looking for a way to keep late career doctors in charge of their career. 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 proposed general health checks would be similar to existing Medicare funded general health checks provided by GPs for patients aged over 75.

Under the proposal, results of general health checks would be confidential between the late career doctor and their treating practitioner and would NOT be provided to the Board routinely.

The Board would only be informed if a treating practitioner made a mandatory report about a late career doctor who refused to manage the risk to patients caused by ill health.

The Board’s approach is data-driven and risk-based, aimed at a proportionate response. Extensive research linking increasing risk to patients with advanced practitioner age is detailed in the consultation paper.

There is strong evidence that there is a decline in performance and patient outcomes with increasing practitioner age, even when the practitioner is highly experienced. Importantly, notification rates relating to physical illness or cognitive decline are 15.5 times higher for older doctors than for doctors aged 36 to 60 years (incidence rate ratio = 15.54), according to a comprehensive review of Australian complaints records.

These concerns are also reflected in the type of complaints reported to Ahpra, with the rising rates of notifications for issues relating to clinical care (52% higher), communication (141% higher), and pharmacological or medication (162% higher) for doctors over 70.

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