Elderly doctor alleges discrimination by Collège
At 80, Peter Neumann has been practising medicine for a halfcentury, and hopes to stick it out for a few years more.
“I love my patients,” the Montreal pediatrician says. “I don’t want to desert them. And I’m good at it.”
The Quebec Collège des Médecins takes a different view. It ordered Neumann to undergo 40 days of remedial training after an inspection prompted by his advanced age found several alleged shortcomings.
He has appealed that decision, and is waiting to learn whether the Supreme Court of Canada will hear the case, and his complaint that the regulator discriminated against him for being elderly.
“Quebec has a vendetta against older physicians,” Neumann charges. “I’m still as competent as I ever was.”
His case, not previously reported, underscores the delicate balancing act that medical colleges increasingly have to play as the number of practising, senior-citizen doctors tops 12,000 (hundreds of them in their 80s or 90s) — but at the same time, millions of Canadians remain without family physicians.
A number of provincial regulators now do “peer assessments” on MDs like Neumann once they reach 70, assigning another physician to pore over a sample of cases and see how the older MD handled them.
At least two colleges have published reminders that older physicians should think seriously about when to hang up their stethoscopes — and not wait until they start making age-related mistakes.
But like Neumann, a 76-yearold Toronto doctor went to court to challenge an Ontario College of Physicians and Surgeons order that he obtain a physician “supervisor” to look over his shoulder as he practices, based on allegations of troubling flaws in his practice.
And while many older physicians do not question the idea — in principle at least — of automatic assessments of senior doctors, some do suspect the whole process is built on an ageist foundation.
“We’re being persecuted now simply because we’re older, and I resent that,” said a 79-year-old radiologist in Atlantic Canada, who asked not to be named. “We have a real age bias presenting itself in provincial licensing authorities.”
The colleges insist that ultimately it is ability — not age — that determines whether a physician can keep practicing. But they say there is good reason to at least keep a closer tab on them.
“Any fair assessment of the evidence would accept that advancing age correlates with a decline in practice,” says Gus Grant, registrar of the Nova Scotia college.
“But not in all cases, and not in all domains.”
The number of physicians 65 and older has certainly climbed steadily over the last decade — to 12,128 last year from 5,400 in 2004, according to the Canadian Physician Survey.
Many are considerably over 65. A 2012 newsletter of the Quebec college noted the province had 100 physicians between 80 and 84, and 30 over 85. The oldest was 97.
And the elderly MDs had not slowed down much: almost half the over-80s had billing revenue above the average for doctors of all ages, the college reported.
The reasons for hanging on past traditional retirement age vary. Some stick to the work because the 2008 market meltdown set back their self-funded retirements. Others feel “an obligation to keep right on to the limit,” says Ernest Prégent, the Quebec college’s director of practice improvement.
But many doctors have simply been consumed by the profession for decades, still love it and “don’t want the party to ever end,” says Galt Wilson, senior deputy registrar of British Columbia’s College of Physicians and Surgeons.
“The only thing they really know in any detail is medicine,” echoes Merv Shaw, head of the senior and retired physicians section of the Nova Scotia medical association. “And then all of a sudden that stops.”
Convincing some reluctant physicians to fade into retirement before they make mistakes is “exactly analogous” to one of the worst jobs GPs have: telling an elderly patient he or she can no longer drive, says the B.C. college’s Wilson.
Still, should being old even raise suspicions about a physician’s abilities?
There seems to be little debate around doctors whose jobs involve technical, procedural tasks, like surgery. Regulators say those specialists accept retirement most readily, aware their fine motor skills may go before cognitive ability.
In fields where cutting people open or peering into a microscope is not part of the routine, decisionmaking and analytic ability may also suffer with age. But some argue that being older in those specialties can be better, the increased experience and practice making for sharper judgment.
“It’s just simply not the case that reaching a certain age necessarily renders you incompetent,” says Chris Simpson, president of the Canadian Medical Association.
Gordon Dickie, a London, Ont., family physician, had actually retired in 2006, then went back to work in 2008 at a local rehabilitation hospital, and still practises part-time today at age 70.
“There are senior doctors in specialties who are really expert, and you wouldn’t want to sort of fire them on the basis that they’re old,” he says.
And yet, the cold light of empirical evidence suggests some vigilance is warranted.
A 2005 review of previous research in the Annals of Internal Medicine concluded older doctors have less factual knowledge, are less likely to follow the best standards of care and might have poorer patient outcomes.
More troubling, a commentary the same year in the Canadian Journal of Family Physicians raised the spectre of doctors with Alzheimer’s, noting that dementia affects 13 per cent of the general population over 65. Separate research estimates that 8,000 American doctors have dementia — suggesting there could be hundreds in Canada.
Quebec and other provinces consider risk factors apart from just age before ordering inspections. Those factors include being in a solo practice — so less likely to learn from colleagues — or not keeping up with continuing education, said Prégent.
And the regulators say their first step is to come up with ways the older physician can make themselves better.