Washington Association Medical Click toStaff edit Master title

Washington Association Medical Click toStaff edit Master title

Washington Association Medical Click toStaff edit Master title style Services Physician Aging and Physician Re-Entry More Challenges for MSPs April 24, 2019 Presented by Christine Cris Mobley, CPMSM, CPCS President, C Mobley & Associates, LLC Owner, Co-Founder, Edge-U-Cate, LLC Colorado Springs, CO In collaboration with Beth Korinek , Exec. Dir., CPEP Edge-U-Cate, LLC www.Edge-U-Cate.com

This presentation is proprietary and cannot be duplicated without Click to edit Master title style HAPPY 40th, WAMSS 2 www.Edge-U-Cate.com OBJECTIVES Click to edit Master title style Describe reasons why physicians are practicing longer and/or want to come back to practicing medicine Address policies that need to be in place to address these two scenarios Share resources available to assist organizations in assessing competency levels, internally and

externally Review some hypothetical case studies 3 www.Edge-U-Cate.com Then v Now Click to edit Master title style Physicians used to retire at 62, some waited till 65 Today: Working longer into 70s, 80s, 90s

More opportunities Financial Second families Good health (or maybe not) Physician shortages create opportunity Joy of work 4 www.Edge-U-Cate.com Its a Fact were all aging Click to edit Master title style Normal aging involves declines in processing speed, memory, executive function, motor control 5

www.Edge-U-Cate.com Click to edit Master title style We each age differentl y 6 www.Edge-U-Cate.com Physician workforce is aging Click to edit Master title style FSMB Study of Actively Licensed Physicians 2014 50% of actively licensed physicians are over 50 Boomers

Age 50 59 24% 216,643 physicians Age 60 69 20% 182,918 physicians Age 70 79 11% 99,554 physicians AMA Physician Characteristics and Distribution 2015 1 out of 4 physicians are older than 65 Total number of physicians over age 65 is 240,000 4 times the number in this age group in 1975 95,000 are still engaged in patient care 10,000 - 15,000 are actively practicing surgeons Some are in their 80s and 90s 7 www.Edge-U-Cate.com

Aging Surgeons Click to edit Master title style American College of Surgeons Statement on the Aging Surgeon Average age of practicing surgeon is rising 1/3 of practicing surgeons are over age 55 Baby Boomer physician workforce is aging along with aging population creating physician shortages (older means more 8 health care) www.Edge-U-Cate.com Factors associated with aging Click to edit Master title style Factors associated with aging that limit ability to

engage in analytical processes Decreased working memory and ability to store/process information Decreased processing speed limiting ability to complete complex tasks Increased difficulty to inhibit irrelevant information and inappropriate responses Tendency to be overly influenced by the order in which information is received Biased by personal experience Declining hearing and visual acuity Studies also show manual dexterity and visuospatial ability decreases with age AMA Council on Medical Education Report 5 9

www.Edge-U-Cate.com Assuring Safe and Effective Care for Patients by Senior/Late Career Physicians. April 2015 Looming physician shortage Click to edit Master title style March 2015 Demand for physicians continues to grow faster than supply Total physician demand is projected to grow by 17% By 2025, demand for physicians will exceed supply by a range of 46,000

to 90,000 In primary care, medical, and surgical specialties HIS Inc. The Complexities of Physician Supply and Demand: Projections from 2013 to 2025: Key Findings, March 2015 10 www.Edge-U-Cate.com The Dilemma Click to edit Master title style Older physicians bring incalculable insight and experience to the staff They are the most respected members of the clinical staff and often are department chairs They can be important sources of patient

revenue for the facility However, Age does impact cognition and clinical function Which can impact patient care and patient safety Many physicians are staying in practice longer Physicians may not recognize changes in their skills As doctors age, abilities about their age grow 11 www.Edge-U-Cate.com Making decisions to limit practice Click to edit Master title style Late career doctors tend to compensate for age:

See fewer patients Focus on patients with less acuity Spend more time with patients Stop doing lengthy surgeries Limit their work schedule (fewer days, shorter days) But some may not recognize their decline or make changes quickly enough 12 www.Edge-U-Cate.com ItsMaster

hardtitle style Click to edit Overall, physicians support the professional commitment to report impaired or incompetent colleagues; however, when faced with these situations, many do not Survey of 1,891 physicians Reasons for not reporting report. Someone else will take care of it Nothing will happen if I do report it Fear of retribution Physicians perceptions, preparedness for reporting, and experiences relating to impaired and incompetent colleagues. DesRoches, et al., JAMA. 2010;304(2):187-193 13

OR, there but for the grace www.Edge-U-Cate.com of God, Forced Retirement? Click to edit Master title style Airline pilots age 65 Age 45: First class medical certificate renewed every 6 months Air traffic controllers age 56 (exceptions to 61) AMA and others do not support a specific age cut-off for retirement from practice Some practice groups do have mandatory retirement policies Anesthesia Service Medical Group (ASMG) 240 anesthesiologists; San Diego County Must leave the group at 70th birthday Southern California Permanente Medical Group

www.Edge-U-Cate.com Must resign partnership at age 65 COMPETENCY EVALUATIONClick to edit Master title style Decisions, Decisions To mandate or not to mandate To test or not to test Need for policies Hospitals need to put patient safety ahead of physician autonomy 15 www.Edge-U-Cate.com

Age-based screening Click to edit Master title style Decide age (65, 70, 72, 75) Decide frequency (annually, every 2 years) Decide elements Cognitive function screen Physical exam By qualified, impartial evaluator Evaluator should know physicians specialty Chart review Observation in practice (FPPE) Peer evaluation Other

16 www.Edge-U-Cate.com Stanford Late Career Click toPractitioner edit Master Policy title style Purpose of Screening Provide high quality care/protect patients from harm Identify issues that may be pertinent to health and clinical practice Support medical staff Apply criteria objectively, confidentially 17

www.Edge-U-Cate.com Stanford Late Career Practitioner Click to edit Master Policy title style Elements of Screening For those renewing privileges age 75 or older Different age requirements for new privileges applicants Includes Peer assessment by 3 peers Comprehensive physical examination Cognitive screen* *DROPPED from screen

18 www.Edge-U-Cate.com Stanford policy under fire Click to edit Master title style The rest of the story Several doctors refused to take the cognitive test Questioned its validity in physician population Administration formed a committee Set aside cognitive testing Instituted a more robust peer-review process Medical staff voted to keep the policy (53% to 47%) Stanford faculty senate (all faculty, not just doctors) voted to reject the policy (20 to 9)

www.Edge-U-Cate.com Hospital decided to 19 keep the policy What happens if they dont pass? Click to edit Master title style Physicians who do not pass the screen may be Referred for more comprehensive evaluation Required to complete remediation Required to limit privileges Asked to retire Depending on the severity of the concerns identified in the screen 20 www.Edge-U-Cate.com

Case Study: Shaky surgeon Click to edit Master title style 68 year-old orthopedic surgeon Hospital suspended due to slight tremor PHP identified possible progressive disease Referred for competence assessment 21 www.Edge-U-Cate.com Case Study: Shaky

surgeon Click to edit Master title style 22 www.Edge-U-Cate.com Case Study: Confident clinician Click to edit Master title style 76 year-old internist Hospital referred due to several index cases and malpractice suits Physician did not think there was any reason to retire

Very confident in his skills and abilities I dont know why Im going through this Referred for competence assessment 23 www.Edge-U-Cate.com Case Confident clinician Click toStudy: edit Master title style

24 www.Edge-U-Cate.com Physician Aging Policy Click to edit Master title style Develop one now if you dont have one And before you might need one Suggested content: Addressing any age requirements Credentialing and privileging Consider one year reappointments over certain age Address any testing/assessment and what kind mental, physical Required for all

Required or only if 25 there are concerns www.Edge-U-Cate.com Physician Aging Policy Contd Click to edit Master title style How it will be conducted internal is the expertise there external organizations like CPEP (see resource list) any costs and who will pay Consequences if physician refuses Frequency may vary according to age, specialty Medical staff acceptance of policy, board approval Other??? 26

www.Edge-U-Cate.com Reasons for Policy Click to edit Master title style 1. Patient Safety! 2. Protection for physician who may not know his limitations or skills are compromised 3. Protect the organization from incompetent physicians due to aging. 27 www.Edge-U-Cate.com AMA Report on Senior/Late Career Click to edit Master title style

Physicians Physicians should be allowed to remain in practice as long as patient safety is not endangered Remediation should be a supportive, on-going, proactive process Self-regulation is important aspect of medical professionalism Helping colleagues recognize declining skills is an important part of self-regulation Physicians MUST develop guidelines/standards for monitoring and assessing competency Formal guidelines on the timing and type of testing may be appropriate AMA Council of Medical Education Report 5 2015: Assuring Safe and Effective Care for Patients by Senior/Late Career Physicians 28

www.Edge-U-Cate.com Aging Physician Resources and Click to edit Master title style References CPEP/Center for Personalized Education for Physicians (Denver and Raleigh) assessment, re-entry, and education for physicians and other health care professionals; (303) 5773232 or email [email protected] PACE/Physician Assessment and Clinical Education Program (San Diego); (619-543-6770) Healthleadersmedia.com Stanford University29 Hospitalwww.Edge-U-Cate.com

aging Aging Physician Resources and Click to edit Master title style References Childrens Hospital and Medical Center Late Career Practitioner Policy http://childrensomaha.org/uploads/public/documents/workfiles/th epulse/LateCareer.pdf Assuring Safe and Effective Care for Patients by Senior/Late Career Physicians AMA Council of Medical Education Report 5 2015 Assessing Late Career Practitioners: Policies and Procedures for Agebased Screening A Guideline from California Public Protection and Physician Health 2015 List of Health and Assessment Programs (some with aging physician evaluations)

Federation of State Physician Health Programs http://www.fsphp.org/state-programs 30 www.Edge-U-Cate.com Federation of State Medical Boards PHYSICIAN RE-ENTRY Click to edit Master title style 31 www.Edge-U-Cate.com Physician Re-Entry Click to edit Master title style Reentry A return to clinical practice in the discipline in which one has been trained or certified following an extended period of

clinical inactivity not resulting from discipline or impairment AMA - State Medical Licensure Requirements and Statistics 2011 Key Points Returning to the same specialty They Left practice voluntarily for an extended period of time Not due to disciplinary action As opposed to: Retraining new specialty requiring new knowledge and skills Remedial training addressing gaps in knowledge, skills or other core competencies 32 www.Edge-U-Cate.com What do you think?

Click to edit Master title style Anesthesiologist retires at 62; 5 years later decides his finances werent what he thought Surgeon in a fulltime administrative position for 6 years; wants to rejoin his practice group at your facility A small hospital desperately needs pediatric coverage; internist on staff was boarded in IM/Peds 20 years ago; he is willing to sit for his pediatric boards OB/GYN left practice for 10 years raising children; she wants to resume practice A family physician in outpatient practice for 10 years; new practice requires him to provide inpatient care Orthopedic surgeon out of practice for 2 years following a car accident; ready to resume limited practice 33 www.Edge-U-Cate.com

Common reentry situations Click to edit Master title style Returning to practice after an absence to: Raise children or care for family member 30% Pursue other career options (medical administrator, non-clinical career) 20% Recover from an illness 30% Retire 10% Other 10% Physicians Reentering Clinical Practice: Characteristics and Clinical Abilities; E.S. Grace et. al.; JCEHP 31 (1):49 - 55 , 2011

34 www.Edge-U-Cate.com Preparation to return to practice Click to edit Master title style AMA Survey: Respondents reentered practice Activities completed to prepare for return to practice*: Live CME

22% Online CME 16% Shadowing a physician 11% Formal reentry program 3.1% Mini-residency 2.2% Other 16% *37% reported they had prepared before reentering medicine 35 www.Edge-U-Cate.com 2/3rds did not report any preparation

to return to PHYSICIAN RE-ENTRY Click to edit Master title style Hospitals have responsibility to ensure these physicians are competent and practice safely 36 www.Edge-U-Cate.com U.S. faces shortage of physicians Click to edit Master title style

At the same time: 78% of hospital executives report physician shortages 83% of hospital leaders are extremely concerned or somewhat concerned about clinical staff vacancies AMR Healthcare: Clinical Workforce Survey 2013 37 www.Edge-U-Cate.com AAMC Report on Physician Supply and Demand Click to edit Master title style

March 2015 Demand for physicians continues to grow faster than supply Total physician demand is projected to grow by 17% By 2025, demand for physicians will exceed supply by a range of 46,000 to 90,000 . In primary care, medical, and surgical HIS Inc. The Complexities of Physician Supply and Demand: Projections from 2013 to 2025: specialties Key Findings, March 2015 This shortage must be addressed now.

38 www.Edge-U-Cate.com What are your physician shortages? Click to edit Master title style (audience) What are you doing about it? Recruitment New physicians Some of those who have left area, retired, other

Locums Contract Transfers Increase use of PAs, APNs High probability that physician shortage is why physicians are 39 practicing longer and some are lured www.Edge-U-Cate.com Re-Entry Policy/Plan Click to edit Master title style Do you have one? Do you need one? Most likely Set the parameters to assure all are

treated fairly and consistently Medical Staff input and approval Use external resources if needed Educate medical staff about your policies 40 www.Edge-U-Cate.com Things you want to know Click to edit Master title style Why did she/he leave practice If at another facility, what were his/her scope of privileges Are all expirables up to date (license, DEA, malpractice, etc) What was practitioner doing while not

practicing, if that is the case (may have been in non-acute care setting) What has the practitioner done to ready him or herself for re-entry (formal training, CME, other) Have they kept up 41 www.Edge-U-Cate.com with changes in Things your organization has to Click to editknow Master title style What capabilities does facility have for allowing re-entry for bringing them up to date with current operations Are there any special state license considerations for re-entry check

state statutes! Will they be assisted by anyone else (PA, APN) and how will they be supervised (not by re-entry dr) Are there any re-entry guidelines 42 www.Edge-U-Cate.com from their professional association Perfect Scenario for PreClick to edit Master title style Application More than likely, each case will be different Consider mandatory interview to determine if they qualify to apply (dept chair, CMO, Chief of Staff) May require additional references, background checks, training

Create a specific plan for each individual given their whereabouts Develop a specific FPPE process based on situation 43 www.Edge-U-Cate.com Remember.Patient Safety #1!!! Click to edit Master title style PATIENT SAFETY #1 44 www.Edge-U-Cate.com

Case Familytitle Obligations ClickStudy: to edit Master style 45 Pediatrician Left practice to raise young children (out 4 years) Recently passed boards Returning to part-time practice

www.Edge-U-Cate.com Case Study: Family Obligations Click to edit Master title style Pediatrician Stay at Home Mom 46 www.Edge-U-Cate.com Case Helping Hand Click to Study: edit Master

title style 64 year-old Family Physician Left practice in good standing 2.5 years ago Now wants to help out Recruited by small hospital to oversee PAs 2 weekends/month Seeking license in state where hospital is located 47 www.Edge-U-Cate.com CasetoStudy: Helping Click

edit Master title Hands style Family Physician Returning to Practice 48 www.Edge-U-Cate.com In Summary Click to edit Master title style 49 www.Edge-U-Cate.com Questions, Comments Please Click to edit Master title style

50 www.Edge-U-Cate.com Click to edit Master title style for the pleasure of speaking to you today! 51 www.Edge-U-Cate.com Planning a break from practice Click to edit Master title style If someone on your staff is thinking about taking a break, it helps to plan ahead Resources

The Physician Reentry Inventory http://physician-reentry.org/wp-content/uploads/AAPR eentryInventory.pdf From the Physician Reentry into the Workforce Project What Employers Need to Know 2015 http://physician-reentry.org/wp-content/uploads/Physi cianReentryEmployers2015.pdf 52 www.Edge-U-Cate.com Additional Re-Entry Resources Click to edit Master title style CPEP/Center for Personalized Education for Physicians (Denver and Raleigh) assessment, re-entry, and education for physicians and other health care professionals; (303) 577-3232 or email

[email protected] AMA Physician Reentry http://www.ama-assn.org/ama/pub/education-career s/finding-position/physician-reentry.page Physician Reentry into the Workforce Project www.physicianreentry.org ACOG Reentry Statement and Resources http://www.acog.org/Resources-And-Publications/Co mmittee-Opinions/Committee-on-Patient-Safety-andQuality-Improvement/Re-entering-the-Practice-of-Ob stetrics-and-Gynecology 53 www.Edge-U-Cate.com Re-Entry Programs Click to edit Master

title style Physician Reentry into the Workforce Project http://physician-reentry.org/program-profile s/reentry-program-links/ AMA website page on Physician Reentry http://www.ama-assn.org/ama/pub/educatio n-careers/finding-position/physician-reentry. page 54 www.Edge-U-Cate.com

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