When Are Doctors Too Old to Practice? Physicians Who Bully and What to Do; and Monkeypox Mutates

October 06, 2022

When Are Doctors Too Old to Practice?

More than half of practicing physicians are older than 60, raising the question: Can a person be too old to practice?

Few age limits exist for physicians in the private sector, but some observers favor regular age-related assessment testing by more institutions. Some 57% of physicians in a recent Medscape survey were 60 or older; 17% were 50 to 59; and 12% were 40 to 49.

Hard to generalize: "If you look at a group of 80-year-olds, there will be much more variability than within a group of 40-year-olds," said Mark Katlic, chief of surgery at LifeBridge Health System in the US, who has studied the subject.

Age discrimination? Frank Stockdale, an 86-year-old practicing oncologist affiliated with Stanford University Health, opposes age-related assessment testing. "It's age discrimination," he said, adding: "Physicians receive assessments throughout their careers as part of the accreditation process — there's no need to change that as physicians reach a certain age."

Physicians Who Bully, and What to Do

Temper tantrums, bullying, and abusive behavior by physicians are so common they have a name: disruptive physician behavior.

Some 41% of more than 1500 respondents to a Medscape survey said they observed inappropriate behavior in the workplace in 2022, an increase from 35% in 2021, according Medscape's report, Physicians Behaving Badly: Stress and Hardship Trigger Misconduct. But 38% said they had not seen misbehavior, and instances of bad behavior declined significantly over the past 5 years.

Still, tension, stress, dangerous conditions during COVID-19, burnout, and other problems have made many physicians tired, frustrated, depressed, and more reactive to situations around them, the survey showed.

Root causes: More than half of physicians cited personal arrogance as one of the leading reasons physicians behave inappropriately. Physicians also blamed personal problems outside of work, a social shift in accepting more casual behavior, and job-related stress for bad behavior.

What may help: Coaching, teaching better interpersonal skills that medical school often doesn't address, and interventions may alleviate inappropriate behavior.

Race plays a role: Racist language was the third most commonly observed bad behavior cited in the Medscape survey, behind only bullying of staff and mocking or disparagement of patients.

Monkeypox Mutates

Researchers have identified mutations in the monkeypox genome, and scientists are monitoring them to see what they mean, Nature reported.

Crystal Gigante, a microbiologist at the CDC, and her colleagues found deletions and rearrangements in a handful of monkeypox genomes collected in the United States, according to a report that was posted on the preprint server bioRxiv, which has not undergone peer review.

Monkeypox is a DNA virus that evolves more slowly than RNA viruses such as the SARS-CoV-2 coronavirus. But it does change over time, and the more the virus is transmitted among humans, the more opportunities it will have to mutate.

Time to worry? Scientists aren't alarmed but are monitoring the changes to understand why they have appeared and what they might mean for the global monkeypox outbreak.

Incomplete data: Researchers have not yet characterized the function of many genes in the monkeypox virus's large genome, so it’s difficult to predict how its behavior will change.

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