Letters to the Editor

I want to thank the Journal and the authors for two excellent articles outlining the issues surrounding senior physician competency and the potential problems assessing fitness to practice (JMR Vol. 107 #2). As former chair and delegate for the AMA Senior Physicians Section I was very involved in the AMA’s effort several years ago that looked at the development of guiding principles and possible recommendations for late career physicians. Screening senior physicians would only be possible if cost effective and did not appear punitive, but unfortunately, there is much cultural resistance to externally derived assessment approaches in the United States. Other countries, such as Canada or Australia, have licensing systems that promote universal screening, but with our state-based system, it would be difficult to implement. I agree with Drs. Bundy and Williams that age alone is not sufficient, that cognitive and physical health both need to be taken into consideration. I have long been an advocate of having some sort of attestation at time of license re-registration — but having it provided by the physician’s personal primary care physician, not the individual physician, as self-reporting is not always reliable. This would accomplish two things: establishment of a primary care physician early in a physician’s career, as well as providing some assurance to the public and the licensing board that the physician is fit to practice. I fully realize that implementation of this would probably be difficult for some boards, but it would also eliminate the need for audits.

More research is needed, since senior physicians comprise a growing percentage of the U.S. physician workforce and we need to have systems in place that avoid unnecessary reductions in workforce. I look forward to comments from others.