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.