Retirement is ideally a personal choice, and incentives to work longer are probably not the way to stop workforce shrinkage.
When is it time for a dermatologist to retire?
The pace of change in new technology and clinical evidence is accelerating, making it harder for older doctors to stay on top of things.
“Dermatology is full of people still working to an older age,” says Clinical Associate Professor Kurt Gebauer, director of Fremantle Dermatology. “I think someone in Melbourne just retired or may still be alive and working at 92. We have a doctor at our practice who is eighty-something. So it’s something we do know a lot about.”
Currently, there’s no regulatory barrier to older practitioners continuing to work. AHPRA does not conduct age-based assessments or specify a retirement age. Doctors can continue to practise so long as they comply with the MBA’s registration standards and requirements of the National Law.
However, they can find themselves frustrated by other aspects of the regulations.
“AHPRA’s got it in for all the doctors and the rules are onerous,” Professor Gebauer says. “If I decide to retire and I hand in my registration, I’m not allowed to teach, I’m not allowed to mentor, I’m not allowed to do anything – which is just bizarre because no other profession has that onerous rule. That’s something that really frustrates a lot of doctors.”
“I think if you have a mandatory retirement age, that’s ageism,” says Professor Craig Anderson, director of the George Institute’s neurological and mental health division. “If you’ve got adequate energy, capacity and intellect and you’re enjoying it and there’s adequate support from colleagues, that’s fine.
“I think AHPRA’s general mandate is a good thing, but it’s a bit light – AHPRA only really gets involved when there’s a problem.”
Since 2017, however, the MBA has been eyeing mandatory health checks for doctors aged 70 and over.
The board has, in principle, accepted an advisory group recommendation that from age 70, doctors should have a confidential health check, including “cognitive screening”, once every three years. They should also have a formal performance review process that would come with CPD credit.
Should legal obstacles stand in the way of mandating health checks, the MBA would consider further research into any age-related risk posed by doctors over aged 70 continuing to practise.
“There is strong evidence that there is a decline in performance and patient outcomes with increasing practitioner age, even when the practitioner is highly experienced,” the board says.
But while the MBA sounds like it means business, the proposal is still only under consideration.
CPD can also be a challenge for older doctors.
“Everyone has to do CPD but it’s getting harder and harder to do and more and more expensive,” Professor Gebauer says. “There are also newer things coming into CPD, which will be a challenge. Until now, you just had to do some reading or sit in a conference; most of the colleges have now changed and we’re moving to a new CPD programme where I think we’ll need to get patient feedback and pick out several items in our practice that we then need to audit.
“There are also a lot of new drugs that are a big deal for dermatology and, for example, this year we’ve had new medications for atopic dermatitis. Most of those are immune-mediated. I’m 60, and one of the things that was obvious to me when I was a junior hospital doctor was that immunology was going to explode. And that’s one reason I went into dermatology, but anyone who’s older than 60 totally missed anything about immunology.”
Professor Anderson says changes can come on gradually rather than all of a sudden.
“It’s going to manifest in very subtle ways like fatigue, or maybe errors in documentation, putting the wrong date of birth on a script pad, or to put something in by the due date,” he says.
But he warns dermatologists not to count on colleagues flagging any changes in behaviour, since approaching someone to express their concern can be difficult and seen as intrusive.
Testing cognitive and other abilities has sometimes been suggested as an alternative to a mandatory age for retirement.
Queensland GP Dr David King, who has done assessments for AHPRA, says testing brings “problems with validity, accuracy and reliability”.
“But we do know from evidence that elder GPs, although they’re more experienced, can get a bit behind with new knowledge. I’m getting towards that stage where I’m struggling to keep up with new technology and change.”
The pace of change in general practice increased during the pandemic, with telehealth and e-prescribing two areas that challenged older GPs.
“A number of people are notified who are in their 70s, some even into their 80s. Some decide to retire before we can actually get to visit them because they realise they’re no longer up to it. There are many reasons: with many of them, their record-keeping is an issue, or they’re one-finger typists and they’ve tried to have dual systems with written notes and someone else transcribing.
“And just because they occasionally get a report about incidents in older people doesn’t mean that all older people shouldn’t be working. You’ve got to be really careful about the unintended consequences,” Dr King says.
There are, however, ways to plan for a smooth transition into retirement.
“I’d recommend older practitioners who want to keep their feet in the pool should join a group practice,” Professor Gebauer says. “Then you can get collegial support and advice and mentorship, and you can turf out the stuff that you really don’t want to do.
“You shouldn’t work on your own.”
This article has been updated to include additional quotes.