Courting controversy – mandatory health checks for older practitioners.
As the Medical Board proposes mandatory health checks for older doctors, is there an argument for a similar approach by the Dental Board?
This week the Medical Board of Australia released a consultation paper proposing the introduction of mandatory health checks for late career doctors to ensure they can continue to safely treat patients. These health checks, if approved, would be mandatory for doctors aged over 70 years. This proposal comes following analysis of notifications data which found that medical practitioners in this age group are 81% more likely to be the subject of a patient complaint compared with younger doctors.
The data is concerning – the frequency of notifications (mostly related to clinical care, communication and medication errors) regarding older doctors has nearly doubled, from 36.2 per 1,000 practitioners in 2015 to 69.5 per 1,000 in 2023 for doctors aged 70 years and older. Complaints against doctors aged 70-74 years increased 130%, and complaints against doctors aged 80 years and older increased 180%. For comparison, notifications about younger doctors (under the age of 70 years) only increased 63% over the same period (from 23.4 to 38.3 per 1,000 practitioners). This suggests that factors associated with ageing (and not a broader community trend of increasing complaints) is behind this trend.
The Medical Board was also 1.7 times more likely to take regulatory action for notifications made against late-career doctors than their younger counterparts, and in many cases no action was taken because the doctor retired after the complaint was made and before action could be taken. Older doctors were 15.5 times more likely to have a notification relating to physical illness or cognitive decline than for doctors aged 36 to 60 years.This clearly points to concerns about patient safety and health outcomes.
The discussion paper outlines three possible options – (1) do nothing, (2) introduce a ‘fitness to practise’ test for doctors 70 and older, or (3) require general health checks for doctors 70 and older. The Medical Board says it favours the third option because it ensured patient safety whilst allowing older doctors to remain in control of their career.
The Medical Board said that ‘any process that routinely screens older doctors in Australia needs to balance the responsibility to protect patients from harm from undetected poor performance, with the costs and benefits … it must be fair to all doctors, including those who have no performance concerns, and avoid unnecessary loss of workforce.’
This is the second time that the Medical Board has proposed health checks or fitness to practice tests for older doctors, with a similar proposal in 2017 met with strong opposition from doctors’ groups and then delayed by the pandemic.
Other occupations in Australia already have either mandatory retirement provisions or health checks. Judges and magistrates must retire between the ages of 65 and 72 years, depending on the state or territory, and following a constitutional referendum in 1977, Federal and High Court judges must retire at the age of 70 years. Given the significance of the decision making, these rules are designed to ensure that judges are mentally and cognitively able to undertake their duties. Pilots are required to undergo periodic medical examinations, and this frequency increases to 6-monthly after the age of 60 years. Some airlines also require their pilots to undergo mental health checks.
The Ahpra Code of Conduct currently puts the onus on practitioners to maintain their health and wellbeing. This includes that practitioners:
seek expert, independent, objective advice when they need healthcare, and be aware of the risks of self-diagnosis and self-treatment
do not rely on their own assessment of the risk they pose to patients if they know or suspect that they have a health condition or impairment that could adversely affect their judgement, performance or the health of patients.
The evidence suggests that this self-regulatory approach is not working in the best interests of patient care.
So where does this leave the dental profession? Dental practitioners practice a profession that requires a high level of cognitive ability combined with manual dexterity skills. It is a physically, mentally and emotionally demanding profession. Communication is also a critical skill (and is often cited as lacking in many complaints and notifications).
In 2022 there were 1,655 dentists aged 65+ years (making up 8.4% of all registered dentists), an increase from 1,094 in 2013 (7.1%). That number is likely to grow over the next decade. Data on complaints and notifications is scant, but we published a recent study in 2018 that analysed Ahpra data from 2011 to 2016, and found (after adjusting for age, sex, practice location and jurisdiction):
The overall complaint rate for dental practitioners was 42.7 per 1000 practitioners per year (higher than for any other health profession)
Dentists - 56.9 complaints per 1000 practitioners per year
Dental prosthetists - 50.0 complaints per 1000 practitioners per year
Oral health therapists, dental therapists and dental hygienists - 11.2 complaints per 1000 practitioners per year
Practitioners aged 66+ years had 1.8 times the risk of a notification compared with those aged 35 years or younger
Given the nature of dental practice, the ageing workforce and the existing notifications data, is there a compelling argument that if medical practitioners are required to undergo mandatory health checks, that dental practitioners should follow suit?
Hi Matt, Yes, the issue has a degree of controversy. Having reached the age where I now know all the answers (over 70) but are no longer are asked any questions - I appreciate the apprehension my fellow senior colleagues may have to mandatory health checks for continuity in practise certification. There is a creeping degree of both discrimination and ageism in regulatory authorities using an arbitrary age - 65, 70, 75 - to determine a professional’s capacity to provide a professional service. Statistics, as you are well aware, only paint part of the physical and cognitive abilities of the life-cycle. Individual recognition of declining capacity - in relationship to the senior section of the life-cycle, is probably the most critical element of deciding when and how to limit one’s professional practice. And it is this issue which all professions should be turning their attention to, rather than the regulatory approach. What quantity and quality of continuing professional education programs are directed to promoting a better understanding of ageing and its impact on professional and social issues? What processes do organised dental professions have for advice to older practitioners - provided in a non-threatening fashion? The professional “boomers” are increasing in numbers, and as these ageist issues impact on us, we are becoming increasingly aware of the need to walk warily through introducing further restrictions on our end of the life-cycle. On the other hand, as clearly illustrated in the recent US presidential scenario, some tests-of-capacity, are needed.
Clive Wright, Emeritus Professor and retired practitioner.
And you did not mention the PI providers. They have a view and data on practitioners who have over 40 years experience. I believe the risk is higher!