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‘No evidence’ for older GP health checks: RACGP


Michelle Wisbey


16/10/2024 5:01:27 PM

The college says an AHPRA plan for mandatory checks on 70-year-old GPs diminishes experience and will lead to extra red tape and early retirements.

Older GP looking at a computer.
GPs over the age of 65 make up more than 15% of the full-time equivalent workforce in Australia.

The RACGP has railed against a plan from the health watchdog to introduce mandatory health checks for older GPs, saying the idea lacks evidence, detail, and an understanding of the profession.
 
In August, the Australian Health Practitioner Regulation Agency (AHPRA) revealed it is considering introducing health checks for doctors aged over 70.
 
It says this would be done to ‘safely extend the practice of late-career medical practitioners’.
 
In response, an RACGP submission into the proposal’s consultation has slammed the idea, saying the status quo should remain.
 
‘The statement does not present any evidence that health checks will reduce notifications against late-career doctors,’ the submission said.
 
‘This would be another regulatory burden unnecessarily imposed on the general practice profession without evidence to support effectiveness.’
 
According to AHPRA, its own complaints data shows that doctors aged over 70 are 81% more likely to be the subject of a notification for any reason than those under 70.
 
It says the rate of notifications about late-career doctors has almost doubled over the past eight years, rising to 69.5 complaints per 1000 in 2023.
 
But the RACGP submission points to specific concerns with this data.
 
‘No evidence is provided to demonstrate the effectiveness of mandatory health checks in reducing patient harms and notifications,’ it said.
 
‘It is unclear if notifications received by AHPRA were specifically related to the physical or cognitive decline of the doctor, or the age of the doctor, and could be avoided with a mandatory health check based on the doctor’s age.’
 
The RACGP submission also lays bare concerns over what impact these health checks would have on the GP workforce, saying ‘GPs will retire early rather than face increased administration and red tape to practice’.
 
That comes as, currently, GPs over the age of 65 make up more than 15% of the full-time equivalent workforce in Australia.
 
‘Late-career GPs are highly valued, bringing a wealth of knowledge, experience and mentorship,’ the submission said.
 
‘Additionally, late-career GPs often perform other leadership and voluntary roles within the profession.’
 
Associate Professor John Kramer is a GP who celebrated his 70th birthday last year and told newsGP that if he was forced to undergo a health check to continue working, he would ‘feel like I’ve been hit by a blunt instrument’.
 
‘I’d like to think that I’d have enough professionalism to have people able to tell me if I wasn’t up to scratch, and that’s something that all older doctors need to develop,’ he said.
 
‘But older GPs are in a really good position to mentor the younger ones, you can help them vent when they’ve had a bad day or they’ve spent a lot of time helping a patient and they’re ungrateful, you can cite a few cases and normalise the experience.
 
‘Keeping older GPs in the practice allows that sort of thing to happen, as long as the workload expected from them is adjusted because you can’t work like a young person.’
 
As part of its plan, AHPRA has put forward three different options it is considering implementing: keeping the status quo, introducing a ‘fitness to practise’ assessment for older doctors, or introducing general health checks with a GP for late-career doctors.
 
‘We’re looking for a way to keep late-career doctors in charge of their career,’ says Medical Board of Australia Chair Dr Anne Tonkin.
 
‘By having regular general health checks from age 70, late-career doctors and their treating practitioners will be able to make informed decisions about how they practise, and when they retire.’
 
But the RACGP submission reveals concerns that these checks will have the biggest impact on rural and regional patients and doctors, especially if doctors are required to be referred for specialist assessment.
 
One option put forward by AHPRA was a requirement for older GPs to see a specialist occupational and environmental physician for assessment, but with only 294 working in Australia, it says this is logistically challenging.
 
‘Doctors working in remote and rural areas may need to travel significant distances for specialist appointments,’ the RACGP said.
 
‘Many GPs are not salaried doctors, so they will be required to pay the cost of a specialist appointment, and potentially take time out of their practice, reducing their income, to attend the appointment.’
 
RACGP Vice President and Rural Chair Associate Professor Michael Clements said the logistics of this plan for those working regionally ‘are just silly’.
 
‘For the level of detail and the complexity of the assessment, it just seems too hard to implement,’ he told newsGP.
 
‘We recommend GPs have health checks with a GP that knows them, because certainly a part of being a good clinician is having a GP look after you.
 
‘If we lose experienced people because of a poorly thought-out policy from the practice, then we lose a richness and an experience to the whole practice, not just to that individual doctor and patient.’
 
Associate Professor Clements said the life experience and knowledge older GPs bring to the profession, to the consulting room, and to younger doctors is ‘invaluable’.
 
‘We certainly do know there are conditions that could occur when we age, both physical and in terms of concentration and cognition, but then we also get more experienced and skilled as we practice and as we see things,’ he said.
 
‘If there was going to be an attempt to reduce the complaints, then we need to delve deeper into the kinds of complaints that they’re receiving, and we need to understand that better to find out ways of addressing that.
 
‘It’s a little bit scary, and we need to think about the problems that it will cause before we think that it’s going to solve all of the complaint concerns.’
 
Moving forward, Associate Professor Kramer suggested that a health check would be tied to the current fitness to drive test for 75-year-old patients.
 
‘If you can drive a car, one of the things you’re supposed to be screened for his dementia, so if you could pass a driving license medical, then you’re probably okay,’ he said.
 
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A.Prof Harold James Jacobs   17/10/2024 10:35:00 AM

So where is the evidence for protecting our patients from elderly GP's with failing health and failing standards? Or is this further evidence of the RACGP protecting membership interests at any cost? Is there evidence that drivers medicals do any good? As a GP over 70, I have no problem with having a regular GP and allowing that doctor to report on my health annually. The Jeavons paradox would suggest that while us elderly GP's continue there is no incentive for new graduates to consider GP as a career.


Dr Maureen Anne Fitzsimon   17/10/2024 11:21:45 AM

If the health check is tied to the 75 year old fitness to drive test, why is it to be implemented at age 70?


Dr Philip Soffer   17/10/2024 11:47:27 AM

I'm 75 in February. I work with 30 minute appointments. A substantial proportion of my patients have their file endorsed "... does not want to see Dr xxx" or "Dr xxx does not want to see ...". They are often patients with difficult personalities and/or with complex, time consuming requirements. They do not satisfy the 10 minute or 15 minute medicine model. A retired doctor friend of mine referred to such patients as his "A team".
An older GP usually does not have the same pressing financial responsibilities that a younger doctor has (HEX, mortgage etc) . I can afford to work at a more sedate pace. Some of my most satisfying and useful achievements in medicine have been, as an older GP, getting to know and to help some of these troubled souls who would perhaps otherwise fall through the gaps.


Dr Madoc Schlencker   17/10/2024 12:34:28 PM

Next they will be telling and enforcing the correct way to defecate!
I am a youngish Doctor, but I am completely over this micromanaging / lack of trust / robotisation of the workforce. The real enemy here is the heavy foot of governance, Lack of acceptance of ANY risk, an overly litigious legal system and insurance system that drives a provision of bureaucrats over coal face workforce. With the decreasing numbers of Doctors on the coal face, patients are not accessing timely care, and are literally dying because of it. But don't worry! Our health care systems are legally protected! Every layer of bureaucracy we add, every piece of red tape, we add another straw to the camels back, and the feeling of oppression grows. Our society is struggling under this burden, and it is partly the reason we see such high levels of escapism and drug abuse, and mental health concerns.
We need to train and trust our professionals again, and stop or reduce the heavy foot of governance!


Dr Edward Thomas Wu   17/10/2024 12:50:42 PM

I am glad we are talking sense which is sorely lacking in the bureaucracies.


Dr Mark Warwick Simcoe-Fitzmaurice   17/10/2024 1:58:43 PM

"the rate of notifications about late-career doctors has almost doubled over the past eight years"
As 1/3 of doctors say they will retire in the next 5 years, it is quite likely that the absolute number of GPs over 70 has also almost doubled in the last 8 years. In other words this so called data must be qualified before it can show anything at all.


Dr Vladimir Bosanac   17/10/2024 2:11:53 PM

What a stupid idea by the bureaucracy in AHPRA (one of many including annual CPD requirement).....as if they have nothing else to do?!?
Yet another RED TAPE for doctors but I am sure the registration fee will increase.
Would same rule be applied for other professions in the society?


Dr Eric John Drinkwater   17/10/2024 3:46:48 PM

Too late for some ... AHPRA has increasingly interfered for so long in the well-being of GPs and the actual viability of primary health care, has abused the privileges conferred by Government Legislation, has failed to deal sternly with weaponised complaints, and employs some at the coal face who are clearly on the fringes of personality dysfunction to "counsel", bully and emotionally harass GPs.

I for one am retiring soon, for my own sanity and safety despite 40+ years service to the community failing to adequately provide financially for my retirement.

I do not envy those entering General Practice, I fear for the long term survival of the profession and the well being of those who will be in the death throes find decade of gold standard primary health care in Australia.

I am not surprised less than 20% of medical graduates are interested in becoming a GP. I am not surprised there are more GP training positions than candidates wanting training. #justaGP


Prof John Marley   17/10/2024 3:52:36 PM

AHPRA analysis is fatally flawed by using a continuous variable, age, as a dichotomous variable using an arbitrary cut point. Using percentages is utterly misleading. They show the number of notifications in 2023 per 1000 for under 70 to be 38.33 and for over 70 to be 69.5, a difference of 31.7, it also shows that if the rate per 1000 is 69.5 it is remarkably low in that 930.5 out of 1000 had no notifications. The only doctors for whom the outcome of notification was suspension are in the under 70 group. This is like mass medicating a whole population, a tiny number of whom have an unproven illness, with a medication for which there are no clinical trials.
This is sure to exacerbate the rural and remote staffing crisis, many docs working there would like to retire but can't because there's nobody to replace them.


Dr Thomas Hilliar   17/10/2024 5:25:16 PM

The RACGP should take a reality check and get their board of directors a mandatory check.
In 2yrs of being a registrar I worked at 4 practices.
3 had GPs in their 70's.
1 fell asleep regularly (once a week) in consults. The other prescribed meds for kids at 1/10 of the therapeutic dose. The other one had mild - mod dementia.
It was absolutely disgraceful. As a registrar it was scary.
Having said that, my wife's uncle & aunt are GPs in their 80's. They read AFP every month. We regularly talk together about running GP businesses, about the latest changes in medicine & they are better than many colleagues I have known over the years at other practices at their craft.

The RACGP are being a bunch of old men railing against Drivers license medicals, or are old aviators trying to fly until they die.
Cars crash fast & planes explodes when the above fail to be regulated.
Neglected patients slowly die, often decades earlier. Some of the worst GPs I've ever seen probably had MMSE of 18-24


Dr Merelie Jean Hall   17/10/2024 6:10:50 PM

Are the increasing notifications to APHRA serious mistakes health practitioners (of any age) have made, or practitioners saying "no" to inappropriate requests? Getting older does reduce one's tolerance for B***shit. As does taking on the "problem-solver" role in the practice, as older doctors often do.


Dr Patrick Denis Byrnes   18/10/2024 7:57:51 AM

Re Prof Jacob’s reply: 2 good EBM re evidence and one emotive RACGP question. Then Two comments that are off topic. Having a regular GP general health check up which I also do is totally different from the APHRA fitness to practice requirement. The reason we have a shortage of GPs is not old GPs clogging up the system but only 13% on new graduates seeing GP as a great career
Sorry Harry but you need to rethink
Pat Byrnes


Dr David Alan Wallace   19/10/2024 4:56:52 PM

What a crazy notion this is.
Sometimes I think it's AHPRA that needs the MMSE.


Dr Christopher St John Kear   22/10/2024 8:57:13 PM

I've had enough of AHPRA. I'm 64, a GP, and I'm retiring next year. I've had my own experiences of AHPRA'S systems, and they're exactly what you'd expect from a bureaucratic, unaccountable organisation with an empire building strategy, and an infinite supply of money (us). They are judge, jury, and executioner, and all of them allowed to hide behind complete anonymity.
The whole AHPRA system needs shutting down, and replacing with something more accountable and transparent.
Their mission statement is a far cry from their behaviour.
I have no faith in them whatsoever.