Gray hair in medicine: Declining doctors

This editorial column written by Dr. Bob Hayden previously appeared in the print edition of The GRIP.

You may have heard the expression, “Choose your doctors young, and your lawyers older.” I think that means that medical knowledge was (hopefully) continuously advancing, so doctors less distant from graduation would be more in tune with the latest thinking. Law, on the other hand, would (hopefully) be more stable, so a wizened and wily barrister would be just fine, and maybe preferable if you are a defendant.

That may still be good advice, but now more difficult to achieve. The Journal of the American Medical Association Surgery (JAMA-Surgery) this week reports that the number of physicians practicing in the United States since 1975 who are over 65 years of age has risen 374 percent. That may sound like there are more physicians than there were in 1975, but what it really means is that the ones still here are much older.

In fact, this study tells us that 23 percent of practicing physicians now are over 65 years of age.

Many folks assume that age 65 is the beginning of the golden age of retirement. Baron von Bismark established the age of 70 for the Social Security system in Germany in 1881 to woo the working class away from the rising socialist party and Karl Marx. However, our Social Security Administration says the retirement age here in the States was not based on the German model, but on actuarial studies indicating that by using age 65 as the starting point, a manageable, self-sustaining system could be built with “modest” taxation.   However you look at it, the age 65 seems arbitrary for retirement.

Returning to the JAMA-Surgery article for a moment, we can find a more unsettling reminder of some basic facts of biology. Between the ages 40 to 75, mean cognitive ability declines by about 20 percent. I thought doctors were exempt from all that. Personally, I find the prospect that my doctor (or I) could have forgotten something horrifying.

Here is one of those “facts” that I assume applies to someone else. I won’t mention names here, but you can call me.

Mental deceleration with maturity is the rationale for many professional groups self-imposing retirement for the sake of the public, such as pilots, air traffic controllers, judges, firefighters, etc. This seems wise to me because I am not a pilot, air traffic controller, judge, firefighter, etc. Besides, I want those folks to be at their physical and mental peak when I need them.

There is a doctor I know who was told by his group that he could not do surgery any more because he was 65. Yes, he was 65-years-old…and a marathon runner. He felt great and was still in his prime, so he broke off from the group and practices independently near his former colleagues now.

Gray hair looks good on him. He reads The GRIP, so he is laughing now.

Hospitals are reluctant to impose mandatory retirement on physicians for a number of reasons.

First, many physicians are financially vested in the hospitals. Many sit on boards of directors. Practically speaking for a moment, if you are a hospital, how do you gracefully ask your boss or owner to retire? And there is a shortage of physicians. In small towns, there may be difficulty recruiting.

The “Affordable Care Act,” which was not truthfully named, provides disincentive for people to borrow a half-million dollars to go to school. As long as it appears that the private sector is endangered by socialized medicine, why would anyone choose medicine for a career? The horizon does not look hospitable (pardon the pun) for replacing aging doctors when there are strong prospects that new practitioners will be government employees.

I do not offer advice here about your physician or your choice of caretaker based on this article. It is disturbing to me, in part because what’s left of my hair is graying. My age is drawing dangerously close to that arbitrary line where some see a professional guillotine waiting for them. My plan is not to retire anytime soon. I like the late Paul Harvey’s quip, “He who rests – rots!”

What I do offer is an observation and a query. The observation is that we are short of physicians, particularly primary care physicians, everywhere, including Griffin. The cause is multifactorial, but it is likely to worsen before it gets better. When Obamacare takes its last gasp, perhaps some of our bright, well-motivated students will take the long, cold plunge into academia if there is promise of paying their bills on the far end.

The query I offer is this: Given the decline in physician numbers and the aging population we now have, what will Griffin do when 23 percent of our existing physicians retire?

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