5 serious diseases that could force doctors into early retirement

After years of medical education and training, you want to be able to practice to your full capacity. Unfortunately, certain conditions may leave you unable to do so, thus, putting your medical career at risk. The 2011 Federation of State Medical Board’s (FSMB’s) “Policy on Physician Impairment” offers important guidance to state-level medical and osteopathic boards on identifying physician impairment and best practices on how to effectively assist impaired licensees for optimal health outcomes and patient care. 

“It is important to draw a distinction between ‘impairment’ and ‘illness,’” wrote the FSMB. “The diagnosis of an illness does not equate with impairment...Impairment is a functional classification.”

Impairment refers to the inability of the licensee to practice medicine with reasonable safety and skill. It can be due to substance-related disorders, mental illness, or physical disorders.

The FSMB goes on to note that the majority of “physicians who become ill are able to function effectively even during the earlier stages of their illness due to their training and dedication. For most, this is the time of referral to a state [physician health program (PHPs)]. Even if illness progresses to cause impairment, treatment usually results in remission and restoration of function. PHPs are then in a position to monitor clinical stability and continuing progress in recovery.”

Nevertheless, there are certain illnesses from which a physician may never recover. These medical disorders may cause impairments that could negatively impact cognitive, motor, or perceptive skills and, consequently, patient quality of care.

Here are five serious health conditions that could result in the inability to practice medicine.

Stroke

The ineffable nature of the brain makes the effect of stroke incredibly nuanced, with varying degrees of resulting disability—from none to profound. Depending on the type of stroke and severity, a physician may have extreme difficulty or may be unable to communicate with patients, conduct physical exams, or perform routine or minor surgical procedures. For instance, a stroke to the cerebrum may result in difficulty with speech, movement, vision, regulation of emotions, and cognition. Likewise, a cerebellar stroke could cause an inability to walk, coordination problems, dizziness, and nausea/vomiting. Furthermore, a stroke at the level of the brain stem could cause potentially irreversible vision problems, circulatory or respiratory problems, and in some cases, even paralysis. 

Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that causes gradual paralysis, which often results in death secondary to respiratory failure within 3 to 5 years. Importantly, onset of ALS usually occurs between 55 and 75 years of age—a time when most physicians are likely enjoying their “golden years” in medicine.

In most patients, initial symptoms of ALS can manifest in the hand or arm, affecting simple tasks such as buttoning a shirt, turning a key, or writing. This is known as limb-onset ALS. For physicians, these initial symptoms may interfere with common tasks like taking patient notes, writing prescriptions, taking vital signs, and the like. 

Where limb-onset ALS affects the arms or legs, bulbar-onset ALS—a less common form of the disease—affects speech or swallowing. Patients may develop a strained, strangled vocal quality, eventually leading to loss of speech. This barrier in communication could adversely affect the health of the patient-doctor relationship.

Eventually, muscle weakness and atrophy spread to other body parts, regardless of where the disease started. People with ALS often have problems moving, dysphagia, dysarthria, and breathing difficulty—the latter of which can lead to respiratory arrest and open the door to pneumonia and ventilator dependence.

Unfortunately, the clinical endpoint for patients with ALS involves the inability to stand/walk, use the hands or arms, or rise from/lie down in bed. In those with ALS, higher mental processes—including reasoning, memory, comprehension, and problem solving—remain intact. Thus, patients—especially ones with medical training—realize their condition, which can lead to additional adverse effects, including anxiety and depression.

Alzheimer disease

Most people develop Alzheimer disease (AD) after the age of 60 years. However, the brain changes that lead to AD can take 10 or more years to manifest. During this time, the affected person may be symptom-free. A physician, for example, might still be able to practice medicine with little impact on patient quality of care. Mild AD, however, could result in some impairment of daily functioning. 

Common symptoms of mild AD— such as wandering, getting lost, trouble handling money, repeating questions, taking longer to complete tasks, and demonstration of personality and behavior changes—could impact a physician’s ability to effectively practice medicine. For instance, a physician may be unable to continue running the financial aspects of their practice due to cognitive deficits, or may be unable to recall a patient’s medical history, diagnosis, or treatment. Memory impairment is, after all, one of the earliest signs of disease, and unfortunately—perhaps more than most other professions—the practice of medicine is rooted in memory. 

Parkinson disease

For physicians who rely on their hands to practice—namely, surgeons and specialists who perform routine procedures—a diagnosis of Parkinson disease (PD) may be practice-ending. Surgical and non-surgical practitioners alike require steady hands to perform both complex surgical procedures and routine diagnostic screenings. Because tremors are a hallmark of PD, a physician would no longer be able to perform these career-defining medical functions.  

Although most people with PD also eventually experience dementia, cognitive dysfunction does not initially define the disease. In a study published in Neurology, researchers, in part, examined motor and nonmotor symptoms in participants with PD who were divided into 4 age groups: < 50 years, 50-59 years, 60-69 years, and ≥ 70 years. Except for rigidity, severe motor and nonmotor PD symptoms were worse in the oldest age group, including bradykinesia, resting tremor, and postural instability. Furthermore, symmetrical disease, as well as autonomic, olfactory, and cognitive dysfunction, were highest in the oldest sample of patients, suggesting widespread degeneration. 

Multiple sclerosis

Multiple sclerosis (MS) is an enigmatic disease with a highly variable presentation. Experts hypothesize that it may be an autoimmune disease, with the body primed to attack the myelin sheaths that encase nerves. Most affected individuals have mild forms of the disease, but severe MS can make it hard to write, speak, or walk—all symptoms that can impair a physician’s ability to practice. 

The first symptoms of MS usually occur when a person is between 20 and 40 years old and include blurred vision, double vision, red-green distortion, or blindness in one eye. Most people with MS experience muscle weakness in the extremities and disturbances in balance/coordination. In severe cases, paralysis can result.

First, do no harm

Physicians should keep in mind that despite any impairment, they have an ethical obligation to keep patients from harm. No matter how hard it may be, a physician with an impairment that results in the unsafe or unskilled practice of medicine must report these concerns to the appropriate authorities, including superiors, hospital administrators, or proper licensing personnel. In the end, you must know yourself and have a clear picture of any physical manifestations of illness that may affect your ability to practice medicine. 

Although many of these conditions may render a physician incapable of practicing at full capacity, there are other job prospects for a physician who has retired from treating patients. Such options include teaching, consulting, and healthcare administration.