Hospital policies emerge to screen older doctors’ fitness

Nearly one-fourth of U.S. physicians with active licenses are 65 or older. Patients who receive care from such late-career docs have worse clinical outcomes and are more likely to file care-related complaints. 

Some healthcare systems have begun to implement policies to assess the cognitive and physical health and practice performance of these caregivers. Today the policies are nascent, thought to represent less than 5% of U.S. hospitals. But early adopters are reporting encouraging results, according to an analysis led by researchers at UW Medicine in Seattle. 

“Health systems have taken a risk because these policies create controversy and require buy-in from medical staff. Older physicians have to accept more oversight, which some might naturally resist,” said Dr. Andrew White, a general internist and professor at the University of Washington School of Medicine. 

White is lead author of the analysis, which describes common features and potential omissions of 29 policies, and includes context from interviews with 21 hospital executives who oversaw the policies’ design and implementation. The paper appeared Nov. 5 in the Annals of Internal Medicine.  

By and large, White said, the hospital executives think these screening policies are effective at protecting patients’ safety and that of their organizations, too. Initial reports published (1, 2) indicate that 12-14% of screened older physicians were deemed unfit for practice.

“The vast majority of late-career physicians were found safe to continue to practice, and they were able to finish the process with a sense of assurance and confidence,” White said.

Of the 29 policies examined, all required an age-based screening assessment, with a median age of 70 years, and were applied to all physicians seeking new or renewed clinical privileges.

Nearly all (89%) policies required the late-career doctor to undergo a physical exam, and most (79%) asked that examiner to offer a global subjective judgment about the doctor’s fitness to practice. Most (82%) policies required a neuropsychological exam, as well.

Policies were less in sync about the actions that would ensue when these assessments raised concerns.

In terms of policies’ rollout, those for which medical leaders cultivated buy-in from medical staffs were better-received than those that simply announced the initiative in a top-down fashion.

“The common initial reaction before launch was a lot of physician concern and, in some cases, resistance. Medical leaders had to spend a lot of time building legitimacy for the policies,” White said.

Even so, the policies’ language tend to heavily prioritize institutional discretion and give much less consideration to the concerns of the late-career physicians who are suddenly subject to new scrutiny, he added.

“Part of what we observed was missing was explicit descriptions of the appeals process that physicians might have if they didn't agree with either the assessment or the response to a concerning test finding. In that respect, (the policies) have an opportunity to better describe how they are fair.”

The physicians who must accommodate this new screening could be better reassured that the process isn't intended to be punitive, White added.

“Hospitals could better frame the issue as a way to ensure the physicians’ wellness and effectiveness, and affirm that the doctors have a voice in the in the process.”