UW Medicine study highlights patient safety risks with late-career doctors

A new study led by UW Medicine researchers finds that nearly one-fourth of U.S. physicians with active licenses are aged 65 or older, raising concerns about patient safety and prompting some health systems to adopt policies assessing their fitness to practice.

While these policies are still uncommon—implemented by fewer than 5% of hospitals in the country—they yield promising results, according to the study published Nov. 5 in the Annals of Internal Medicine.

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

The analysis examined 29 policies and included interviews with 21 hospital executives who oversaw their design and rollout.

Dr. White reported that, despite initial concerns, the hospital executives overwhelmingly believe the screening policies effectively safeguard patients and organizational integrity.

Preliminary reports show that 12-14% of older physicians screened under these policies were deemed unfit to practice.

Of the policies reviewed, all required age-based screenings, typically beginning around age 70, and applied to physicians renewing or seeking clinical privileges.

Nearly all policies (89%) mandated a physical exam, and the majority (79%) asked for a general fitness judgment from the examiner. Furthermore, 82% of these policies required a neuropsychological assessment.

The study found that policies with robust support from medical staff and leadership were more favorably received than those implemented from the top down without input.

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

However, some areas for improvement remain. White noted that many policies lack clear descriptions of the appeals process, which could leave late-career physicians uncertain about their rights if they disagree with an assessment outcome.

“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.”

White suggested that hospitals could improve by framing the policies as supportive rather than punitive.

“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 process,” he said.

The study highlights the growing need for systems to balance patient safety with respect for the contributions and autonomy of senior physicians as they continue their careers.

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