Advertisement

Assessing and Supporting Late Career Practitioners: Four Key Questions

Published:August 26, 2020DOI:https://doi.org/10.1016/j.jcjq.2020.07.001
      You are a hospital medical director who became concerned about a 75-year-old surgeon. Local quality leaders detected a string of unanticipated adverse outcomes and questioned whether aging had impaired the individual's performance. Colleagues had not intervened, hoping that the surgeon's self-awareness of limitations would suffice. The physician retired after a protracted and adversarial practice evaluation. You wonder whether a late career practitioners (LCP) program could identify similar practitioners earlier, avoid harm to patients, and perhaps safely extend LCPs’ careers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Powell DH
        • Whitla DK.
        Profiles in Cognitive Aging.
        Harvard University Press, Cambridge, MA1994
        • Eva KW.
        The aging physician: changes in cognitive processing and their impact on medical practice.
        Acad Med. 2002; 77: S1-S6
        • Choudhry NK
        • Fletcher RH
        • Soumerai SB
        Systematic review: the relationship between clinical experience and quality of health care.
        Ann Intern Med. 2005 Feb 15; 142: 260-273
        • Tsugawa Y
        • et al.
        Physician age and outcomes in elderly patients in hospital in the US: observational study.
        BMJ. 2017 May 26; (357:j1797)
        • Anderson BR
        • et al.
        Association of surgeon age and experience with congenital heart surgery outcomes.
        Circ Cardiovasc Qual Outcomes. 2017; 10e003533
        • Dellinger EP
        • Pellegrini CA
        • Gallagher TH
        The aging physician and the medical profession: a review.
        JAMA Surg. 2017 Oct 1; 152: 967-971
        • Federal Aviation Administration
        Modification of certain medical standards and procedures and duration of certain medical certificates.
        Fed Regist. 2008 Jul 24; 73 (Accessed Jul 29, 2020): 43059-43066
        • College of Physicians and Surgeons of Manitoba
        Annual Report. 2017.
        2020 (Accessed Jul 29)
      1. Medical Board of Australia, Expert Advisory Group on Revalidation. Final Report. Aug 2017. Accessed Jul 29, 2020.https://www.ranzcr.com/documents/4706-medical-board-report-final-report-of-the-expert-advisory-group-on-revalidation/file.

        • DesRoches CM
        • et al.
        Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues.
        JAMA. 2010 Jul 14; 304: 187-193
        • White AA
        • et al.
        Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences.
        BMJ Qual Saf. 2019; 28: 468-475
        • Cooney L
        • Balcezak T.
        Cognitive testing of older clinicians prior to recredentialing.
        JAMA. 2020 Jan 14; 323: 179-180
        • Katlic MR
        • Coleman J.
        The aging surgeon.
        Ann Surg. 2014; 260: 199-201
        • Teirstein PS.
        Boarded to death—why maintenance of certification is bad for doctors and patients.
        N Engl J Med. 2015 Jan 8; 372: 106-108
        • The Economist
        The Joys of Living to 100: How to Make the Most of Ageing Populations.
        Special Report. Jul 6, 2017; (Accessed Jul 29, 2020.)
        • Garrett KD
        • et al.
        Cognitive screening tools for late career physicians: a critical review.
        J Geriatr Psychiatry Neurol. Epub. 2020 May 18;
        • Davis DA
        • et al.
        Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
        JAMA. 2006 Sep 6; 296: 1094-1102
        • Ehrlinger J
        • et al.
        Why the unskilled are unaware: further explorations of (absent) self-insight among the incompetent.
        Organ Behav Hum Decis Process. 2008 Jan 1; 105: 98-121
        • Cooper WO
        • et al.
        Unsolicited patient complaints identify physicians with evidence of neurocognitive disorders.
        Am J Geriatr Psychiatry. 2018; 26: 927-936
        • Loch CH
        • et al.
        How BMW is defusing the demographic time bomb.
        Harv Bus Rev. 2010; 88: 99-102
        • Hodin MW
        Hoffman M. Snowbirds and water coolers: how aging populations can drive economic growth.
        SAIS Review of International Affairs. 2011; 31: 5-14
        • Sherwood R
        • Bismark M.
        The ageing surgeon: a qualitative study of expert opinions on assuring performance and supporting safe career transitions among older surgeons.
        BMJ Qual Safe. 2020; 29: 113-121
        • US Equal Employment Opportunity Commission
        Press Release: EEOC Sues Yale New Haven Hospital for Age and Disability Discrimination.
        Feb 11, 2020 (Accessed Jul 29, 2020)