A growing number of doctors today are working beyond traditional retirement age, and their patients may "start to wonder whether [their] doctor is still competent," Jonathan Maltz, a 70-year-old family physician, writes in a Washington Post perspective. Maltz offers six "red flags" that signal that a doctor may be ready to retire.

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Cognitive decline among older physicians is a 'valid concern'

According to the American Academy of Family Physicians, the average physician retirement age is 65, but Maltz writes today it's not uncommon for doctors to keep practicing past that age. In fact, he notes the number of physicians over age 65 who are still actively practicing medicine quadrupled between 1975 and 2013.

As more doctors choose work past the traditional retirement age, patients may "start to wonder whether [their] doctor is still competent and up to date on the best practices or whether it's time to end what is likely a trusted relationship and go find someone new," Maltz writes, adding that it's a "valid concern."

But he notes that assessing physician competence can be hard, especially if the physician is in denial about his or her cognitive decline. Some hospitals have established mandatory testing for doctors over 70 to assess their cognition, motor skills, balance, reaction time, and health, but according to Maltz, none of these tests have been scientifically validated.

6 signs that your doctor should 'call it quits'

Still, Maltz suggests there are six signs that could signal it's time for a physician to stop practicing medicine:

1. The physician confuses a patient he or she has been seeing for years with another patient or forgets who the patient is entirely;
2. The physician is unusually dismissive or impatient;
3. The physician responds to patients' questions with confusing or convoluted answers;
4. The physician forgets to complete a task he or she was expected to do, such as ordering a test, researching a question, or calling a patient;
5. The physician refers patients to a specialist or other medical professional for every ailment; and
6. The physician is shaky when handling instruments or has difficulty hearing or seeing things clearly.

Maltz offers these "red flags" with that caveat that these symptoms are not always signs of lesser competence andthat not all doctors experience detrimental cognitive decline in their 60s and 70s. Maltz still practices part time at a small walk-in clinic at age 70.

But whether or not a patient's doctor is showing some of these signs, he writes, "Ultimately, it's important to follow your gut." He continues, "If you don't feel comfortable or confident in your doctor, find a new one, regardless of how old or young your current doctor is. It really should be that simple" (Maltz, Washington Post, 3/21).

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