18 on Yale New Haven staff retire after tests

Clinicians 70 and older took battery of cognitive exams

NEW HAVEN — After taking a battery of cognitive tests, 18 members of Yale New Haven Hospital’s medical staff who were age 70 or older retired because their results showed they would have problems in performing their jobs.

About five years ago, the hospital’s Medical Executive Committee decided to create the mandatory tests to ensure that all its doctors and other clinicians who reached their 70th birthday were able to competently solve problems, assess information and reach conclusions.

The tests were given between October 2016 and January 2019 as clinicians came up for reappointment. A report on JAMA Network published this month described the program and its results. “Of the 18 people we thought shouldn’t be practicing, none of them had been brought to our attention ahead of time,” said Dr. Leo Cooney, a geriatric specialist at the hospital who led the committee

that oversaw the program.

A total of 141 medical professionals were tested, 125 of them doctors. The rest were nurse practitioners, dentists, psychologists, podiatrists, a physician associate and a midwife.

Cooney said not everyone who had to undergo the testing thought it was a good idea.

“I think it’s controversial when you start to evaluate people who have not had problems,” he said. However, he said, “I don’t think there’s discrimination because there have been scores of studies that have shown that older physicians have more problems than younger physicians.”

A 1994 study of 1,000 physicians showed that cognitive abilities begin to decline after age 70 and the “total cognitive score” was 30 percent less for those 75 and older than for 40-year-olds.

The tests were adapted by Keith Hawkins, a neuropsychologist at the Yale School of Medicine, Cooney said. “He took tests that evaluated different components of your … problem-solving ability, ability to collect and assess information, come to appropriate conclusions,” Cooney said.

The battery of 16 tests, similar to IQ tests, took about 45 minutes, but additional tests were conducted if a doctor showed signs of trouble in one section.

Cooney said the results

“I think it’s controversial when you start to evaluate people who have not had problems ... I don’t think there’s discrimination because there have been scores of studies that have shown that older physicians have more problems than younger physicians.”

Dr. Leo Cooney, who led the committee that oversaw testing

were looked at in relation to each clinician’s job and that each person was able to meet with Hawkins. “He goes over the nuances of the test results,” Cooney said. “It’s not passfail. It’s looking for problems, particularly problems that are germane to the practice of medicine.”

Doctors who disagreed with the findings could bring their concerns to the credentials committee, he said. “This is an art, not a science. We don’t use cutoffs. We look at what someone’s cognitive ability is, we go over what they do,” he said.

Cooney said the results were seen only by the individuals and the review committee that oversaw the process, including Hawkins and Cooney. “The difficult part of this is there’s not great information in the literature that tells us at what level you should be practicing,” he said.

Cooney is 76 and was used as a subject in developing the tests. “As I came up for reappointment, I did the test and it was fine. I did OK,” he said. He was one of 89 medical professionals who did well. A second group of 34 had “a little memory problem, so we decided to see them in a year rather than two years,” Cooney said.

For seven, overall scores were not poor, but “there were significant problems in certain areas of cognition.” They were given three hours of more comprehensive testing and three of that group were advised to retire.

Finally, 19 of the clinicians had low global scores. Twelve were advised to retire and the rest were tested further. Of those seven, three went on to retirement.

“Most of the people, once they realized they had a problem, they took action,” Cooney said. “Of the 18 people we thought should retire, five were between 70 and 74, four were between 75 and 79 and nine were 80 or older,” he said. The oldest was 92.

The individuals were given a choice of having a proctor oversee their work rather than retiring, Cooney said. One of the 18 chose that option but later retired, he said.

Cooney