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‘No evidence’ for older GP health checks: RACGP
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.
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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AHPRA Australian Health Practitioner Regulation Agency GP workforce late-career GPs Medical Board of Australia
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