Here’s one doctor not afraid of the future of healthcare in the U.S.
Meet rheumatologist Dr. Ephraim Engleman who will turn 102 in March.
He said he has no plans on retiring. He drives from San Mateo to the campus of UCSF three days a week. He treats eight long term patients (one wonders just how long term). He spends the rest of his time directing the Rosalind Russell Medical Research Center for Arthritis. He has held that position since 1979.
Dr. Engleman also plays the violin once a week with a chamber music group.
His only ailment: spinal stenosis which forces him to walk stooped over with a cane.
Dr. Engleman graduated medical school in 1937. He said he loves being a doctor. And he is still intellectual and physically able to practice.
His words to his colleagues: If they believe he’s “slipping”, “By all means, let me know – and I’ll get the hell out of here.”
42% of doctors are older than 55. 21% are older than 65.
These percentages are up significantly compared to 2006. And the ranks of “senior doctors” are expected to rise for reasons both personal and financial.
Dr. Engleman’s story is an uplifting one about a doctor who is active, engaged, and able to serve.
But, it’s not the same story for all doctors.
Here’s the challenge. Not all physicians who practice for decades remain competent, either mentally or physically. William Norcross, a geriatrician, and founder of a program at UCSD, evaluates 100-150 physicians annually. He estimates 8,000 doctors have florid dementia. Studies apparently show that up to 1/3 of doctors don’t even have a personal physician.
A growing number of hospitals have adopted policies requiring doctors over a certain age to undergo periodic screening physicals and cognitive testing to renew privileges. At University of Virginia, that magic number is 70. At Stanford, it’s 75.
It was reported that 28 of the 35 UVA doctors older than age 70 completed screening — and all of these doctors passed easily. The other seven decided against participating and no longer have hospital privileges there – though they are free to work elsewhere.
How does this limited screening compare to other industries? Commercial airline pilots must undergo regular health screenings at age 40 and must retire at age 65. FBI agents have mandatory retirement at age 57.
And the challenge is not just health. It’s the techniques doctors use to treat patients. In a 2009 review article entitled The Problem of the Aging Surgeon, orthopaedic surgeon Ralph Blasier opined that “essentially every treatment technique taught 25 years ago has been abandoned and replaced” including treatment of traumatic fractures and joint diseases. “All surgical specialties have had similar turnover of treatment methods.”
Johns Hopkins surgeon and author Marty Makary from wrote that although an older doctor can be a reservoir of wisdom and experience, too often patients receive “Fred Flinstone care” from doctors whose skills have not kept pace. “Some older surgeons are all over minimally invasive surgery…but many doctors have just ignored minimally invasive techniques.” Some of these patients are receiving state of the art care from decades ago.
The question is whether all doctors need to be periodically screened beyond a certain age – or whether only those deemed at individual risk need to demonstrate physical health and cognitive competence.
Dr. Ephraim Engleman loves what he does. And he’s still able to do it well. And apparently UCSF does not require mandatory screening. He said,”I’m glad they don’t do it here.” But he was not opposed to such evaluations. I bet he’d pass with flying colors.
I am 80 years old and worked in a hospital for 25 years which recently closed. I have not been able to find work. The hospital CEO , usually not a physician, is not interested in wisdom and experience. They want a younger image and all patients to be happy with their care. I was not ready to retire.
I applaud Dr. Engleman and wish him well. Freda Lozanoff
I also applaud Dr. Engleman and agree with Freda. I am a physician in my late 50’s. I agree that surgical techniques do change relatively quickly and it is important to keep up with those. However the wisdom of when and on whom and how to use the procedures often comes with experience and age. Last year my father was ill and had renal failure with dialysis, out of a group of more than 5 nephrologists the only one who considered and understood his hemodynamic state was the physician in his 60’s. Experience and wisdom is of incalculable value when it comes to internal medicine and family practice. Warm regards to you all and have a happy holiday season.
Beverly Kanawati
Words of wisdom from one of my mentors:
You spend you entire residency learning how to operate.
You spend the rest of your career learning how NOT to operate.
At the time he made that statement, I did not understand precisely what he meant.
Years later I thought it was brilliant.
Mark Twain once said:
“When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much the old man had learned in seven years.”
i’ve known several elder docs who i would trust with my life and also several younger ones i wouldn’t let touch me with a ten foot pole regardless of how many cute tricks they knew. i thought we had eliminated age discrimination but i guess i was wrong! How stupid do we have to be?! As far as techniques changing so much, i’ve seen the pendulum swinging both ways so maybe and maybe not that old timers are out of date. A lot of the old timers don’t jump on every fad so this makes them somehow “wrong?” It’s saved me a lot of grief in my career by being conservative. Last time i checked anatomy and physiology wasn’t evolving that quickly! And for a final thought, i once overheard a resident patronizingly addressing an elderly surgeon who was being honored for her years of (still unending) service. “I hope I’m as together as you are at your age,” he said. She fixed him with an eagle glare and retorted, “Who says you ever will be at any age?”
So what’s the answer? i think ultimately as with driving or any dangerous occupation, people will have to pass a quick 5-10 second coordination assessment to ascertain whether they are impaired from substances, age-related or physical/mental infirmities before they are allowed to enter the OR or a vehicle. My bet is lots of people will be failing and it probably won’t necessarily be only the oldsters. Those who administer MOC and certifications need to figure out a way to test physicians on whether they have read the literature on new treatments and procedures and evaluated it. i would cherish an open discussion from the entire medical community on the pros and cons of particular treatments because i am sick to death of the industry shills being the ones who guide our profession. It’s one reason i hate going to national meetings; i can pretty much tell you what is going to be said in the presentations and there is precious little debate. Because the elders have seen so much, they are usually less gullible. Just saying.
Dear Doctors
I am a sole practioner lawyer who has a poverty law practice
I accept whoever stumbles down the sidewalk that can figure out how to open the door using the doorknob
I have to hide my car, because if the people see it they stop to talk
I cannot keep up with the people who want to talk, talk, talk
The young lawyers send cases to me that they cannot squeeze money out of so I have plenty of referrals
They all want to talk
Luckily, my wife married me for richer or poorer
I am hoping to stay married to her, because she will have teacher retirement
She also wants to talk
Life is a mystery
Sh