The Medical Board of Australia is seeking clinical advice on how to implement mandatory cognitive fitness-to-practice checks for doctors over the age of 70.

In its Professional Performance Framework released in November 2017 the Board proposed to require all medical practitioners to have peer review and health checks at the age of 70 and three yearly thereafter.

The Board says cognitive testing is needed for older doctors because the evidence for age-related risk of poor performance is strong and cognitive decline must be identified and addressed to keep patients safe.

“Doctors tend to retire later than many other professionals and often wish to continue to make important professional contributions as they age,” it says in a Request for Proposal released on 14 September.

“Respecting and supporting this, the Board believes it is time to also assure their continuing ability to provide safe clinical care by requiring peer review and health checks.”

To help with implementation planning, the Board is seeking “evidence-based comprehensive clinical advice to guide the development of a framework to support accessible and affordable health checks for doctors aged 70 years and older.”

It says recommendations should be practical to implement and cover questions such as:

• What are the components of a practical and effective health check for doctors aged 70 years and older, including physical and cognitive checks? (but not detailed neurocognitive testing)
• Who should conduct these checks, including what are the relevant qualifications and experience?
• When is cognitive screening indicated and what validated cognitive screening tools should be used.

The Medical Board says it expects targeted screening to identify doctors who have markers of poor performance, for whom “practical, proportionate and supportive” interventions will be to be made to keep patients safe, where needed.

“The Board will collaborate with stakeholders to ensure that there is support available for individual medical practitioners with age-related health issues that pose risks to patient safety.”

Support and remediation interventions for cognitively impaired doctors will be developed via partnerships led by specialist medical colleges, medical educators, employers, insurers under the guidance of the Medical Board.

“The Board expects that the vast majority of doctors with identified risk factors will demonstrate their ability to provide safe care to patients and will remain in active clinical practice,” its proposal states.

Older doctors will be required to show they have undertaken the required checks but will not have to reveal the results unless they indicate the practitioner poses a serious risk to the public.

“Most action to address identified health issues and return medical practitioners to safe practice when this is possible will be conducted at arms-length from the Board,” it says.