Medical professionals working past the age of 70 are a small portion of the sector but apparently attract more than their fair share of complaints. Two older ophthalmologists sit down with Insight to discuss what keeps them going and the value they bring to the nation’s eye health system.
Dr Joe Reich won’t be back ice skating any time soon.
He used to be rather handy as a teen, but he could barely stand on the things during a recent visit to a Canadian ice rink with his grandchildren.
His golf isn’t what it once was either – “these are things that happen with ageing”.
But the Melbourne ophthalmologist, who is well into his 70s, had no qualms about heading into the surgical suite, until an accident on Christmas Eve resulted in a broken finger.
“This will allow me to transition earlier than I expected but at a time when my surgery was still at a high level,” he says.
He may be looking to hang up the surgical greens and focus a little more on the golfing variety, but he still plans to continue consulting and his refractive practice.
Sydney’s Dr Frank Martin, aged 83, is another ophthalmologist who has continued past the traditional age of retirement and who bolsters the country’s vulnerable health workforce.
He no longer operates but continues to consult and support colleagues.
They are just two among a small number of medical professionals still practising in Australia beyond the age of 70, and sometimes up towards 90.
The health and fitness of Australia’s older medical professionals and the sector in general has been brought into sharper focus after the Medical Board of Australia (MBA) announced in August 2024 it was considering health checks for those aged over 70.
The checks, which would include ophthalmologists, were one of three options put forward as part of a public consultation campaign in response to a rise of complaints and notifications involving the nation’s older health professionals.
Figures from the Australian Health Practitioner Regulation Agency (Ahpra) show those over 70 years old are 81% more likely to be the subject of a notification for any reason (not just impairment) than those under that age.
Notifications for doctors in the 70- 74-year age bracket have risen more than 130%, from 32 for every 1,000 doctors in 2015, to more than 74 per 1,000 in 2023. For medical practitioners aged 80 and over, notifications climbed by more than 180% between 2015 and 2023.
In comparison, notifications about doctors aged under 70 years increased 63% from 23.4 to 38.3 per 1,000 over the same period.
Those figures and the reaction of MBA suggest a big problem, but the reality is that the number of medical professionals still on the tools beyond 70 years in Australia is small, especially compared with other Aussies working beyond retirement age.
Ahpra’s statistics show that in 2023, there were 849,259 “practising registrants” across all medical disciplines in the health sector, with just 18,686 of them – 2.2% – aged 70 and over. In optometry, of the 6,503 practising registrants, just 90 (1.4%) were over 70.
And in ophthalmology, RANZCO figures show 114 professionals still practising over the age of 70, with 88 of those working fulltime. Just nine were aged over 80. With 1,092 practising ophthalmologists, according to MBA data, that’s 10% of the workforce over 70 and 0.8% over 80.
That compares with Australian Institute of Health and Welfare figures showing that in 2021, 15% of all Aussies were working beyond the age of 65.
Small those numbers might be, but both Dr Reich and Dr Martin believe the impact of more ophthalmologists far outweighs its few numerical parts.
And Dr Peter Sumich, president of the Australian Society of Ophthalmologists (ASO), believes that a health sector struggling with workforce issues simply “can’t afford to lose people”.
He says older professionals are involved in mentoring and training younger colleagues, they are taking leading roles in their profession and their experience is actually saving lives, not just eyesight.
Dr Reich works three days a week. He continued past retirement age because he was still confident of his abilities and issues with his surgical patients had been rare.
“I was getting plenty of referrals, and my colleagues were still asking me for advice and sending me difficult cases. I didn’t feel any need to stop.”
He acknowledges continuing past the age of 70 will not be possible for everyone, and not just ice skaters and golfers.
“Human physiology is such that we all vary, and some people are quite happy to retire early, particularly if they feel that they’re not quite as skilled as they were.
“And there’s the old 10,000-hour rule, which says the more you have practised something, the better you’re likely to be at it.”
Those 10,000 hours can help an experienced ophthalmologist pick up something that might be missed by a younger colleague. Even something potentially life-threatening.
“Recently I saw a patient with a bulgy eye that could have had any number of diagnoses, and when I referred it on to somebody who knows that area, I said, ‘I think this patient has a lymphoma’, and he came back with a biopsy and said, ‘you’re right’. Now that’s from having seen a few of these over a career.”
He believes that those who step away from surgery can still diagnose and treat eye disease.
“If you’re doing general ophthalmology there are many other fields that do not require surgery, and probably the largest of those is glaucoma,” says Dr Reich. “And then there’s macular degeneration issues, and many of the sort of incidents that can creep up on people that do not require an operation.”
Dr Martin stopped surgery four years ago, at 79, but that barely dented his workload. His “part-time”, four-days-a-week schedule includes private work in a Macqaurie St practice and a role as a visiting medical officer at Children’s Hospital Westmead.
On top of that, he, like Dr Reich, has other medical management roles, ophthalmic clinics and is busy with community organisations.
He made the choice to put down the scalpel because “I decided that I’d like to go out on top while I was still doing good surgery”.
When he made that announcement, his scrub nurse started to cry and others urged him to change his mind, but “I said, no, I’d much rather have this discussion than a discussion saying, ‘hey, when are you going to stop?’”
That collective scrutiny and discussion, within a team of professional colleagues, is key to supporting older practitioners but also ensuring they remain fit to practise.
“Working in a group, you’re being constantly peer-reviewed, because we see each other’s patients, and we work together,” says Dr Martin. “It is the same as when I work in a clinic at the Children’s Hospital; I have registrars, fellows of other ophthalmologists working with me, and so I feel that at the moment, the quality of my work is still fine to keep doing it.”
Dr Reich agrees: “I get people from my own practice who spend time with me, I’ve always felt very open to that.”
ASO president Dr Sumich believes that’s a feature of work within the ophthalmic discipline that helps to ensure practitioners are up to speed, fit to practise and the public is safe, no matter what age the specialist is.
“What we have with RANZCO is a practice visit component of our CPD where a colleague comes and visits for a day and spends time with the professional, and both write a report for the CPD,” he says.
“I would suggest that should become more of a feature for people over 70, which takes care of their abilities and their cognitive abilities, and also how up to date they are. That’s far more valuable than a health check.”
Self-audits are also important, and keeping up to date on complication rates, as ophthalmologists continue to assess their own skills, their ages and the potential impacts on patients.
“As a professional, it’s on you to present yourself as healthy enough to do your job,” says Dr Sumich. “So health-wise, I don’t think there’s any difference between a 70-year-old and a 50-year-old.”
Dr Reich agrees: “I’m not so full of myself to think that I’m the only surgeon in town.
“I think that’s one of the problems that you can have as a doctor. And you’ve got to be aware that there are times when you have to look at slowing down or stopping.”
That’s why both work hard to keep up to date with advances in technology and treatment, through conferences and CPD, but also by rubbing shoulders and sharing knowledge with younger colleagues.
It’s also what keeps them mindful about how they communicate with a variety of patients and colleagues.
Dr Sumich believes it’s that failure to communicate and a clash of generational cultures – rather than a failure in ability or standards – that may be to blame for the rise in complaints against older medical professionals.
“As younger doctors, I suspect we’re a little bit more patient in dealing with patients who are difficult and patients who need to be smoothed over and maybe get an explanation,” he says.
“I strongly suspect that as you get older, you just become a little bit grumpier, and what could have been smoothed over ends up as a complaint.”
Dr Martin disagrees.
“My personal experience has been that there are just as many younger grumpy practitioners,” he says. “I know for fact that in my many years of practice I have never been grumpy or rude to a patient.”
He says his ability to communicate “comes naturally; just as I communicate with my grandchildren, my children, others in the community, I can communicate with patients young and old”.
Both he and Dr Reich are surprised that older professionals are pulling in more complaints, and both report to having received none personally.
“I think one of the issues we have is a lot of doctors tend to work alone,” says Dr Reich, “and without that scrutiny are sometimes reliant upon their receptionist or their practice nurse to tell them they’re not at the standard that you once were, or what the patients expect.
“The advantage in working in a group is that you get the immediate feedback.”
Communication was not part of training for older medical professionals, he says.
“And that’s one of the real risks, is that you can still be practising 50 years after you’re trained, and still practising in a manner that you were originally taught. And that might mean not communicating well with patients, and not actually practising as you should,” Dr Reich says.
“There’s no doubt that the younger generation, even in their medical school, have been taught communication skills.”
Attitudes towards doctors had changed over time, as well.
“I think there have been doctors in the past who had a great degree of self-importance,” he says. “And arrogance, where the doctor knew what was best for you.”
He felt that there could be more training, especially for older medical professionals, to help them communicate better with patients.
Dr Sumich said the ASO had touched on communication in previous events and conferences, including video sessions on how to deal with difficult patients, but there could always be more training and support.
While he was less enamoured with the idea of health checks for older professionals, and felt organisations like ASO and RANZCO had the tools in place to ensure the fitness of older professionals and the safety of the public, Dr Reich and Dr Martin offered a collective shrug of the shoulders.
People their age were used to health checks in order to keep driving their vehicles. It was “not unreasonable” to expect similar testing for ageing medical professionals.
“I’ve got no problem with it,” says Dr Martin. “I’d be very happy to go to my general practitioner, just like when I renew my driver’s licence.
“People over a certain age are taking certain medications,” says Dr Reich. “There’s probably very few people over the age of 70 who aren’t on antihypertensive or cholesterol-lowering drugs. And there are more serious conditions, which probably the patient needs to know about.”
But like Dr Sumich, he wonders if a health check would be focused on the right things. He mentions Portuguese football star Cristiano Ronaldo; at 40 he remains one of the world’s best and is still scoring goals at the highest level.
“If you take your 40-year-old footballer and you gave him a health check, he’s probably going to be in fabulous health, right?
“But ask him whether he passes the football as quickly or his reactions are as quick as they were when he was 10 years younger and you can understand that a health check may not pick up the things, in surgery, for example, which is where it’s most critical, and also in consulting.
“You need to have a check on what a person’s skills are like in terms of handling the procedure that they’re doing, and are they still doing it as well as they did, or are they doing it better and whether they are competent in maintaining up-to-date diagnosis and care of patients with complex disease,” he says.
Both are happy to offer that reassurance of their remaining prowess; if not for the patients then at least for a health sector with a vulnerable and stretched workforce. One that, as Dr Sumich points out, can’t afford to lose ophthalmologists.
He believes there are fewer issues in ophthalmology, where the challenge is more about distribution of that workforce and resources in the regions and remote parts of the country.
But Dr Martin believes a problem does exist.
“We have a shortage, especially in paediatric, ophthalmology and strabismus management surgery, and we need every person who’s capable of delivering service to be available and continue to work.”
That vulnerability was highlighted in the RANZCO publication Vision for Australian Eye Healthcare to 2030 and Beyond, which said the ophthalmology workforce was “struggling to meet the nation’s needs”.
“Adult and paediatric public ophthalmology services across Australia are under-resourced to meet the needs of the population they serve, with increasingly long waitlists to access outpatient and inpatient (elective surgery) services,” the report said.
“A national shortage of specialist ophthalmologists in Australia is inevitable. To avert this crisis, Australia needs an immediate and steady increase in the overall number of training positions in ophthalmology nationally.”
The irony is that the report highlighted a number of reasons for the growing pressure on the ophthalmology sector, including “the ageing of Australia’s growing population”.
But as Dr Sumich points out, the nation and its health workforce “can’t afford to lose people”.
And until there are enough trainees coming through to meet the sector’s workforce challenges, it will continue to rely on this ageing population of medical professionals.
Older medical professionals are still making a meaningful contribution to the health of their patients and communities.
Even if they are not what they once were on the ice rink and putting green.
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