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Nov 13 2015

The elephant in the room: Ways to cope with the needs of our most experienced physicians

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A few weeks ago, I spent a weekend visiting with my cousins, Dan Gasby and Barbara Smith, best known as B. Smith. Over the last few years, I’ve watched them make a difficult and delicate transition, shifting from their very active and often glamorous public life to a still active, though more private, mindful existence made necessary by the emergence of Barbara’s early-onset Alzheimer’s Disease. It has been moving, if not a little heartbreaking, to watch this wonderful couple adjust with as much grace as possible to the reality of Barbara’s illness and diminished executive capacity and memory. In spending time with them, I found myself appreciating the small moments of connection, even as I recognized how very different their lives are now.

The personal experience of watching a loved one change to accommodate an unrelenting illness has caused me to think on professional transitions in a new way. All medical professionals who practice clinical medicine will eventually transition from active practice to something else, whether that is a part time schedule, a nonclinical professional position or some other role. Some will make the transition by choice and some will make it by necessity. Even licensees fortunate enough to enjoy perfect health into their 60s and beyond will eventually need to wind down their clinical practices to travel or just to slow down and enjoy life.

Inspired by my cousins, I decided it was time for NCMB to initiate a discussion about how licensees can take control of their own destinies and make decisions about career longevity on their own terms. In October, I convened a roundtable discussion at the Board’s offices in Raleigh entitled, “Switching Gears: Longevity in Practice.” Board Members and a panel of invited guests representing interests from across the spectrum in medicine met for an open discussion. Guests were asked to respond to two questions: Is there a role for NCMB in addressing the issue of longevity in practice? If so, what ways could the Board get involved or otherwise support licensees?

This is a timely issue in medicine worldwide. It almost always gets distilled down to a discussion about the aging physician, although the matter is significantly more complex than the question of age alone. This June, for example, the American Medical Association (AMA) voted during its 2015 annual meeting to develop recommendations for assessing the competence of older physicians, noting that about one in four physicians in the U.S. are age 64 or older. AMA specified that such guidelines are to include recommendations for what age it is appropriate to begin assessments, and the content of examinations used to gauge competence.

Unlike industries such as aviation, where pilots must be regularly assessed from the age of 40 on, there are currently no national or state-based standards for when physicians should be subject to screening. Some hospitals and health systems in the U.S. require physicians who reach a certain age to pass cognitive assessments in order to maintain clinical privileges, though not surprisingly this has been somewhat controversial. NCMB has monitored these developments and tried to keep abreast of resources that may be useful. Board Members feel strongly that there should be compelling objective evidence that cognitive assessments for our most experienced physicians are needed before NCMB embraces the concept of screening.

Whatever AMA comes up with may be a useful resource as NCMB and others move ahead in dealing with what some call the “gray tsunami” of aging physicians. I know I’m not alone in thinking it important not to limit the discussion in North Carolina to age, as there is no clear evidence that age alone has a direct relationship to clinical ability. It’s also important that we don’t sit on the sidelines and wait for others to work through these challenging issues.

There was universal agreement among the parties who gathered for NCMB’s roundtable that there is a role for the Board to play in helping licensees to navigate late career pathways. Many expressed gratitude that the Board had extended the invitation to discuss this.

How NCMB should get involved is a more difficult question, but one the Board is committed to answering. Acting as a convenor and moderator, and as a gatherer of resources, are natural roles and ones I see the Board continuing as it pursues ongoing conversations on this subject. One comment that several roundtable participants made is that some experienced physicians may “hold on” to their clinical careers longer than they want to or is appropriate because it is all they know. Being a physician is not just a job. For many of us, it is an integral part of identity. It makes sense that individuals who have dedicated their lives to the practice of medicine may not want to let it go. I am intrigued with the idea of helping licensees envision new professional roles that are less demanding than long days in the clinic. Many roundtable participants and audience members suggested that experienced physicians would be valuable as mentors to physicians who are just starting out or who are in an early stage of their careers.

The Board will keep licensees informed as it moves ahead with this initiative. NCMB’s licensees work every day to ensure that patients have long and healthy lives. The Board will do what it can to help licensees do the same.

On a personal note, I am about to make a transition of my own, from Board President back to regular Board Member (as Immediate Past President I will continue to serve on NCMB’s leadership team for the next 12 months). As I pass the gavel to my colleague, Pascal O. Udekwu, MD, I want to call one last Board President’s privilege and take a moment to thank the many people and institutions that helped to bring me to this point in my career, from my high school guidance counselor, the late Mrs. Shirley Freeman in Burlington, to my Chair of Medicine at Northwestern University in Chicago, the late Dr. Roy Patterson. I have had the privilege of knowing people who believed in me and encouraged me to pursue my dreams. I also wish to thank the many leaders I’ve encountered while serving with NCMB, who have led with vision, dedication and strength. These individuals include recent past Board Presidents Janice Huff, MD, Ralph Loomis, MD, Will Walker, MD, and Paul Camnitz, MD.

Finally, I would like to extend a very special thank you to my husband, Paul, for taking this journey with me, my mother for her never ending support, and my cousins, Dan and Barbara, for being great examples of living life with purpose. Since Barbara’s diagnosis, they have been working with the Alzheimer’s Foundation to increase awareness about the disease and have used their influence to help raise funds to support Alzheimer’s research.

I have worked in several different healthcare environments over the course of my working life. Serving on the Medical Board has been and continues to be one of the highest honors of my career.

Best Regards,
Cheryl Walker-McGill, MD, MBA

 Comments on this article:

More important to me than kicking out older physicians is to address the changing face of medical care in this state. When you go to the ER or see your regular physician (and in fact most specialists as well) you will, for most of us these days, see a midlevel who has two years of training outside of college and function as doctors. Some are truly excellent, and many should not be doing this job, are clearly undertrained. On the other hand, a seventy year old physician who can still walk and is willing to work, there are not that many out there, is often a treasure of knowledge and experience. If we think they are senile we can choose to see someone else.

By john gusdon,m.d. on Nov 16, 2015 at 11:53am

An exceedingly complex, multifaceted and difficult area. I would be pleased to be involved in further round table panels and discussions.
Can we depend on all older physicians or for that matter any physician to work within their capabilities and limit their practice?
This issue makes MOC shrink in comparison.
Now remind me again, how is it that we determine these issues in local, state and national politicians? I guess it is by a vote of the people.

By Eugene M. Bozymski MD on Nov 16, 2015 at 2:03pm

Why are we always looking to fix something that isn’t broken?  Is there any evidence to suggest that there is an epidemic of aging, cognitively impaired physicians?  Aren’t there already local mechanisms in place to identify impaired physicians (CPI committees, credentials committees, the PHP, hospital-based behavioral committees)?  Furthermore, most physicians currently practicing are subject to board recertification, MOC, and a host of alphabet soup programs to assure our “competence”.
Enough of these new initiatives.  Stop the circular firing squads, please.

By Robert Appel MD on Nov 16, 2015 at 8:56pm

I was eighty yrs. old on 11/08/15.Came to Lumberton in 1970 in solo IM.[Now in Raleigh}  Keep my license up as a retiree so that I will be forced to read and do my CME.  Wow has medicine changed since finishing MUSC in 1963. Not all has been good.  Thanks to the NCMB for their work, often in their thankless position.  Thanks Dr. Walker-McGill.  Thought provoking article.

By George S. Nettles MD on Nov 17, 2015 at 1:30pm
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