By Greg Freeman
Executive Summary
Older physicians may experience cognitive and physical declines that threaten patient safety. Few hospitals and health systems have programs to address this risk.
- The few organizations with policies are inconsistent in how they address the problem.
- Most of them start testing physicians after age 70 years.
- Payment for the examination costs is consistent.
Research indicates that some older physicians may pose a threat to patient safety, but only a small number of healthcare organizations are developing strategies to require screening and additional actions to address these concerns. Policies are inconsistent among those organizations.
A recent study led by Andrew A. White, MD, an internist at the University of Washington School of Medicine in Seattle, assessed policies for late-career physicians — identified as those practicing after age 65 years. White and his colleagues found that few institutions address the patient safety risk of older physicians and that it is unrealistic to expect their colleagues to speak up with concerns. White estimates that only about 5% of U.S. hospitals have any program addressing late-career physicians. Those that do tend to start screening physician clinical and cognitive performance at about 70 years of age and link that screening to recredentialing, his research found. The testing usually involves a neurocognitive test, a peer review, and a physical exam.
In White’s research, he and his colleagues looked at 29 U.S. hospitals with late-career physician programs. None had specific instructions on how the exam results should affect physicians’ request for new or renewed hospital privileges, and only seven policies specified how those results would be communicated to the physician before a decision was made about credentialing.
Four of the healthcare organizations shared the exam results with the physician only if there was a concern. Four organizations paid for the physical exam, and five split the cost with the doctor, with others paying through health insurance.
Of the 29 programs, 16 required that a trained neuropsychologist conduct the assessment, with nine paying for the cognitive exam. Seven policies specified no potential actions to take if the exam findings were problematic. The full study report is available online at https://bit.ly/4g7dVyV.
Uncommon But Needed
Late-career programs are relatively uncommon and fairly new, but they are necessary because previous research has shown that about 12% to 14% of older physicians were found to be not safe to practice because of age-related concerns, White says. Those physicians had not come to the attention of patient safety officers, risk managers, and medical directors by any other means, he says.
“So, screening for them is a really reasonable thing to do,” he says. “It finds this minority of physicians who we need to help have a dignified exit from practice, and then it assures the majority that they’re safe to practice and they can go on with their career with confidence.”
The concept is met with resistance by many of the physicians involved, but White says the leaders who implemented the policies told him they thought the programs were successful at improving patient safety.
“They said that after an adequate period of communication and socializing these policies, they could really get their medical staff on board. Not that it was easy by any means,” White says. “It was a lot of work, a lot of investment to get people to buy into that change, but once it was implemented, they felt they were functioning pretty well.”
Most late-career physicians can be swayed that this was the right thing for them and their patients, White says.
“It’s natural for any person to resist changes or new possible restrictions,” he says. “But we know that physicians don’t reliably report themselves or their colleagues if their clinical performance is gradually slipping.”
In addition to the physical and neurocognitive exams, most of the programs had some sort of augmented peer review that went deeper than a traditional peer review by including things like a 360 review with nurses, more patient comments, and more case reviews, White says.
“Those were common features, but the language around how the organization approached the results was pretty different from site to site, and some of the ones that were more established had more sophisticated language about things like how they were going to handle the results and how they protected confidentiality,” he says. “Across the board, there were still opportunities to refine the policy language, to really reassure physicians that the programs are going to be fair to them, and that the aim is to support physicians to practice as long as they safely can.”
Programs should emphasize that the goal is not punitive but rather to show equal concern for the well-being of the late-career practitioners as with patient safety, White says.
White notes that the future of these sorts of programs is in limbo because the Equal Employment Opportunity Commission (EEOC) filed a lawsuit three years ago against Yale University Hospital, one of the centers that has a robust late-career practitioner screening program and which has provided the most reliable data on their success. The EEOC alleges age discrimination because the hospital only requires physicians older than 70 years of age to be screened rather than all physicians.
“Much to their credit, Yale has defended their position, saying this is actually a valid program,” White says. “They’re offering a strong justification for why this should be legal, but I think, until that’s resolved, and it has sat in discovery and pre-trial motions for three years, it’s pretty unlikely that hospitals are going to create new programs.”
Source
- Andrew A. White, MD, University of Washington School of Medicine, Seattle. Email: [email protected].
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Research indicates that some older physicians may pose a threat to patient safety, but only a small number of healthcare organizations are developing strategies to require screening and additional actions to address these concerns. Policies are inconsistent among those organizations.
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