Consider seniors and the role they might play in ACP

Let's start with a multiple-choice question: Which of the following groups is not currently represented within ACP by an interest group, council, task force, or committee?

A. Students

B. Residents and fellows

C. Early-career physicians

D. Our incredibly talented senior physicians, who may or may not be considering retirement but intend to continue their membership in the College, just as they have for decades, and have an enormous amount to offer.

Right. D.

The College, of course, values highly its senior members, many of whom anchor important functions at the chapter and national levels. But here I ask: Might we do more? Would it, for example, be beneficial to have a Council of Senior Members, and if so, what might such a group provide not only for the members of that Council but also for the College? (I find the second part of that question particularly interesting because there is evidence that seniors can provide something for an organization such as ours that other age-based groups cannot. More on that shortly.)

First we should determine whether senior members are indeed underrepresented in College activities. This is currently under study. Consistent with the College's approach to issues such as this, data first, plans later. But there is no harm in speculating that we will find issues that would benefit from attention. Anecdotally, I have been approached by a number of senior members bringing concerns about this issue to my attention. If such underrepresentation proves to be the case, then we need to ask why the College has not yet capitalized on this important pool of talent in a systematic way.

There are several explanations. One reason, of course, is that opportunities to serve and become involved with the College are finite, particularly at the national level. There are more members who wish to become engaged than there are positions that need to be filled, and the College is appropriately concerned that gender, race, and sexual orientation are represented within our organizational structure.

Senior members, as a demographic group, are not typically mentioned as the College strives for diversity and parity. Another reason may be that we do not have that many members over age 70 (my definition of “senior,” and you know where that comes from). Preliminary data indicate more than 12% of College members are over 70, although some in this group may not be well, and others may not be interested in increasing their involvement with the College. But, still, why has there been so little attention paid to our senior members relative to other groups? It would be helpful if we examined whether we are subtly and unintentionally biased when it comes to providing programs and opportunities for our senior members. And, if so, from where does this bias arise?

The answers are several, but I am concerned that the College may be caught up in the same misperceptions as other institutions and organizations in our society, perhaps more so since so much of clinical medicine focuses on problems related to aging, both physical and mental. But there is more to this. As a society—perhaps also ACP as a “society”—we fail to appreciate that in many ways senior members can contribute more, not less.

Yes, the older brain is slower. Seniors may have difficulty recalling names and may be more susceptible to those “tip of the tongue” moments. However, healthy seniors have a greater capacity for wisdom, and not just conventional wisdom, but wisdom that is born of experience. Perhaps Oliver Wendell Holmes said it best: “The young man knows the rules but the old man knows the exceptions.” When it comes to tasks that require judgment, dialectic thinking, consensus building, and leadership are where seniors can make special contributions.

How can we relate this to the College, particularly as we begin to examine this issue more formally now than we have in the past? It is too early to talk about actual plans or pilots. But I would like to stimulate a conversation at the chapter level and at the national level. Let's think about this together. Suppose we decided that more should be done. What might that “more” look like? Here are my initial ideas:

• Senior members would be represented on important College policy committees and within the strategic planning process, just as other demographic groups are now.
• The College would have a Council of Senior Members just as it has a Council of Student Members and a Council of Early Career Physicians. Imagine how valuable such an advisory council would be.
• Data show that as a demographic group seniors are more charitable than other age-based groups. Perhaps we should develop philanthropic opportunities for our senior members, with goals and programmatic targets such as expanding the College's program for funding scholarships for the Internal Medicine Meetings.
• We also might provide special programs or even tracks at Internal Medicine Meetings, complete with name badge ribbons, geared to senior members on topics such as retirement, late-age creativity, exercise, and volunteerism. This is speculative, and like the other ideas requires more thought and study. But it's interesting, isn't it? A senior track at our Internal Medicine Meeting? I'd go.

These are just preliminary ideas for how the College might underscore its commitment to its senior members while deriving the benefit that only senior members can provide. I, for one, suggest we move quickly. None of us are getting any younger. I'm reminded of an interview with the comedian George Burns, who was still performing at age 97. Mr. Burns was asked how he was adapting to his advanced age. He replied, “I now ask for my applause in advance, just in case.”

It is an honor to serve as your President and share my ideas with you. Please let me hear from you.