Case Scenario

One of my practice partners noted in the electronic health record that our older colleague, M.C., recently prescribed a questionable medication to a patient. During discussions with other physicians in the practice, we recalled several conversations with M.C. in which he has talked about outdated treatments. My colleagues and I are unsure about whether M.C. is just not staying current with updated guidelines or whether he might have some cognitive issues. M.C. is well past traditional retirement age, and he has asserted that he will never retire. What are our professional obligations in this situation? Do we handle this ourselves, or do we turn to others? Who determines when a physician is no longer able to practice safely?

Commentary

There are many reasons why a physician's competence to practice medicine may decline over time. Optimal retirement age varies by person, and most medical practices do not have built-in retirement mandates. Age-related decline in cognitive function among physicians, even to the point of overt dementia, may become increasingly common as the U.S. physician population ages. Current estimates are that over the next 10 years, more than 40% of practicing physicians will be 65 years or older,¹ an age group in which 11.7% of individuals self-report cognitive decline. ² Although cognitive impairment is less common among highly educated individuals (such as physicians),³ population data indicate that as many as one in five physicians older than 70 years may have mild cognitive impairment, and about one in 15 may have some form of dementia.⁴