Should There Be a Mandatory Retirement Age for Physicians?

Prof David Kerr discusses when practicing physicians become too old to deliver competent care.
www.medscape.c...
-TRANSCRIPT-
Hello. I am David Kerr, professor of cancer medicine at the University of Oxford. Today I'd like to pose a question: When should doctors retire? When, as practicing physicians or surgeons, do we become too old to deliver competent service?
You will be amazed to hear, those of you who have listened to my videos before - and although it is a matter of public knowledge - that I'm 68. I know it's impossible to imagine, due to this youthful appearance, visage, and so on, but I am. I've been a cancer doctor for 40 years; therefore, I need to think a little about retirement.
There are two elements of this for me. I'm a university professor, and in Oxford we did vote, as a democracy of scholars, to have a mandatory retirement age around 68. This is so that we can bring new blood forward so that we can create the space to promote new professors, to bring youngsters in to make new ideas, and to get rid of us fusty old lot.
The other argument would be, of course, that we are wise, we're experienced, we are world-weary, and we're successful - otherwise, we wouldn't have lasted as academics as long. Nevertheless, we voted to do that.
It's possible to have a discussion with the university to extend this, and for those of us who are clinical academics, I have an honorary appointment as a consultant cancer physician in the hospital and my university professorial appointment, too.
I can extend it probably until I'm about 70. It feels like a nice, round number at which to retire - somewhat arbitrarily, one would admit. But does that feel right?
In the United States, more than 25% of the physician workforce is over the age of 65. There are many studies showing that there is a 20% reduction in cognitive decline for most individuals between the ages of 45 and 65.
Are we as capable as an elderly workforce as once we were? Clearly, it's hardly individualistic. It depends on each of our own health status, where we started from, and so on, but are there any general rules that we can apply? I think these are starting to creep in around the sense of revalidation.
In the United Kingdom, we have a General Medical Council (GMC). I need to have a license to practice from the GMC and a sense of fitness to practice. I have annual appraisals within the hospital system, in which I explore delivery of care, how I'm doing as a mentor, am I reaching the milestones I've set in terms of academic achievements, and so on.
This is a peer-to-peer process. We have senior physicians - people like myself - who act as appraisers to support our colleagues and to maintain that sense of fitness to practice. Every 5 years, I'm revalidated by the GMC. They take account of the annual appraisals and a report made by the senior physician within my hospital network who's a so-called designated person.
These two elements come together with patient feedback, with 360-degree feedback from colleagues, and so on. This is quite a firmly regulated system that I think works. Our mandatory retirement age of 65 has gone. That was phased out by the government. In fact, our NHS is making an effort to retain older elders in the workforce.
They see the benefits of mentorship, experience, leadership, and networks. At a time when the majority of NHS are actively seeking to retire when 65, the NHS is trying to retain and pull back those of us who have been around for that wee bit longer and who still feel committed to doing it.
I'd be really interested to see what you think. There's variation from country to country. I know that, in Australia, they're talking about annual appraisals of doctors over the age of 70. I'd be very interested to hear what you think is likely to happen in the United States.
I think our system works pretty well, as long as you're within the NHS and hospital system. If you wanted to still practice, but practice privately, you would still have to find somebody who'd be prepared to conduct appraisals and so on outside of the NHS. It's an interesting area.
For myself, I still feel competent. Patients seem to like me. That's an objective assessment by this 360-degree thing in which patients reflected very positively, indeed, in my approach to the delivery of the care and so on, as did colleagues. I'm still publishing, I go to meetings, I cheer things, bits and bobs. I'd say I'm a wee bit unusual in terms of still having a strong academic profile in doing stuff.
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