Policies assuring safe practice by late-career physicians vary widely among health care organizations

Policies assuring safe practice by late-career physicians vary widely among health care organizations

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00829

URL goes live when the embargo lifts   

A mixed-methods study found that variations in policies developed to assure safe practice by late-career physicians (LCPs) makes it difficult for these programs to reach their full potential. Interviews conducted with health care organization leaders responsible for implementing such programs revealed varying levels of successes and frustrations. This study is important because it highlights the need for better physician acceptance and improved program rigor to meet policy objectives. The findings are published in Annals of Internal Medicine.

LCPs, or physicians working beyond age 65 to 75 years, may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. However, little is known about the content or implementation of these policies.

Researchers from the University of Washington School of Medicine studied LCP policies at 29 health care organizations and interviewed 21 physicians in charge of those policies to characterize key program features and physician perspectives. LCP policies were assessed for rationale and process for adoption, whom the policy covers, assessment methods, actions taken on assessment results, confidentiality and procedural fairness protections, and who executes policy components. The researchers found that the LCP policies at all health care organizations applied to 100 percent of physicians seeking new or renewed clinical privileges and required an age-based screening assessment, with a median starting age of 70 years. Of those, 79.3% required reassessment every two years, and almost all required a physical examination (89.7%) and/or a neuropsychological examination (82.8%). Potential follow-up actions varied widely after a concerning LCP assessment, and 7 policies did not include potential actions after a concerning finding. Many organization leaders cited patient safety as the primary reason for LCP policy implementation and said the top challenges when implementing LCP programs included pushback from physicians, logistical difficulties with program rollout and doubts about predictive accuracy of the assessments. Outcomes data across LCP programs was limited, but the respondents noted the primary effect of the programs was voluntary retirements, with one organization reporting that over a quarter of physicians eligible for the assessment resigned before getting screened.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Andrew A. White, MD, please email [email protected].