André Jacques, MD, CCFP, FCFP Advisor to the President and CEO Quebec College of physicians. IPAC 2013 Queenstown, New Zealand

Transcription

1 André Jacques, MD, CCFP, FCFP Advisor to the President and CEO Quebec College of physicians IPAC 2013 Queenstown, New Zealand

2 POTENTIAL CONFLICT OF INTERESTS DISCLOSURE André Jacques declares: «I do not have any affiliation of financial interest of any nature in a business corporation, and I do not receive remuneration, royalties or research grants from a business corporation except»

3 DOCTORS REGISTERED AS ACTIVE 1600 Five-year age groups family physicians specialists Including 386 restrictive permits

4 DOCTORS REGISTERED AS ACTIVE 70 years old ,6% family physicians 8,4% specialists 322 family physicians 814 specialists

5 DOCTORS REGISTERED AS ACTIVE 80 years old Professional inspection visits Income levels (RAMQ - Health Insurance Organization of Québec ) No visit 53% Inactives 22% >5years 27% > $ 36% >20 000$ < $ 29% <5 years 20% <20 000$ 13% 0% 20% 40% 60% 0% 10% 20% 30% 40%

6 Number of physicians > 70 years old per year

7 How to find those physicians? Others 12% Random 2% Inquiry 29% n = 1918 visits Informations 20% Diploma > 35 years 20%

8 So, doctor when are you planning to retire? In three years if everything go well

9 Smile! «What gets measured gets attention» Anonymous

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11 Results per age groups n = % 80% 60% 40% 20% %

12 RESULTS OF CLINICAL TRAINING PROGRAMS OR TUTORIALS RECOMMENDED BY THE PIC FOR OLDER PHYSICIANS 22% 41% Retirement Success 45% Success Failure 9% Retirement Failure 69% N = 49 N = 90 14% years old > 70 years old

13 CONTINUING PROFESSIONAL DEVELOPMENT GOOD / INADEQUATE 100% 80% 60% % 20% 0%

14 CONTINUING PROFESSIONAL DEVELOPMENT AND LEVELS OF INTERVENTION N=904 1% N=258 11% 11% 24% 16% % % CPD satisfactory 62% P< 0,001 CPD not satisfactory Le Collège, Vol 49, #1, p14

15 CONTROLS Before and after 70 years old < 70 years old > 70 years old N = 1407 N = 516 Cancellation Level 3 Level 2 Level 1 Level 0 10% 12% 18% 51% 9% 0% 20% 40% 60% Cancellation Level 3 Level 2 Level 1 Level 0 31% 25% 11% 27% 6% 0% 10% 20% 30% 40%

16 MD 70 + still active PR = Peer review N/A 2% PR < 4 years 10% PR to come 7%? n = 1143 Unknown 81%

17 The Unkown WHO are they? WHAT are they doing? WHERE do they practice? Any CPD activities? Plan for the future Are they at risk of malpractice?

18 PROBLEMATICS In Québec, more than 2180 practising physicians have 65 years and over: 714 family physicians 1469 specialists There is an increasing number of physicians working beyond the age of 70 and 75 The literature shows that physicians performance declined beyond the age of 70

19 DISCUSSION Many physicians question their practice at the time of the announcement of a professional inspection visit Age becomes an important risk factor Our human resources do not allow us to assess them all There is a small pourcentage of success after a clinical training program for physicians beyond the age of 70

20 OUR MISSION IS TO PROTECT THE PUBLIC Questions??? Should we encourage these doctors to think about their future? Have a graceful exit, less traumatic and at the right time Should we encourage them to retire? To avoid a clinical training program doomed to failure To protect the public against the incomplete or inadequate practices

21 A new Program Two objectives Raise the level of awareness of those physicians on the potential decline in performance Evaluate the risk of malpractice through the answers to the questionnaire with a scoring sheet

22 A new Program Our plan Send a letter and a short inspection questionnaire, every two years, to every physician over 70 years of age unknown to us with hidden risk factors.

23 Short Questionnaire Scope of practice Volume of activities Practice outside initial medical training Support in the practice/professional isolation New patients Hospital practice Types of techniques CPD activities Future plans Level of satisfaction

24 SCORING SHEET Risk 1. Scope of practice A Open practice to any type of patients (e.g. walk-in, 0-99) 5 B Practice somewhat limited 3 C One field of practice (e.g. long term care, sports medicine, etc.) 1 2.Volume of activities A Active practice (4-5 days/week or a high volume of patients) 3 B Part-time practice (2-3 days/week) 2 C Schedule limited to less than 2 days/week 1 3. > 30% of the practice outside of the medical training A Yes 3 B No 1 4. Support in the practice A Solo office or lone specialist in the community 3 B University hospital Family medicine group Network clinic 1 5. New patients A Yes (walk-in, on-call, consultation) 3 B No (only known patients) 1

25 SCORING SHEET Risk 6. Hospital practice A No hospital practice 5 B Hospital practice with or without office practice 1 7. Locum only A Yes 5 B No 1 8. Types of techniques (emergency decisions, surgical or endoscopic procedures) A High risk 3 B Low risk 1 9. Continuing professional development (CPD) A Scarce medical education in the last 2 years 3 B Valid CPD plan Future plans A No intention to retire in the next year 3 B Precise plan to retire in less than a year 1 Score: 10 to 36

26 RESULTS Elementary, my dear Watson! «Watson, you see everything but you observe nothing» Sherlock Holmes

27 Risk scores based on scoring sheet Administrative practice 10,3% Doubt 7,2% n = 807 1,7%

28 Subjective risk assessment n = 807 Not at risk 73% Doubt 13% At Risk 14% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

29 Satisfied or bored? The great majority of physicians are satisfied with their practice. It s a nice end of practice. W 78 years old is preparing for the sub-specialty. Useful but should be done for all physicians. Practice is demanding. At the end of the day, I often have pain from head to toe. I must continue for my patients. I intend to keep up to date even after I retire. I delay retirement for fear of feeling useless.

30 Results of the program At the beginning of the program, 1248 physicians were over 70 and still active <10% were known by the College After 20 months : 187 retired (15%) 17 deceased (1%) 76 to come (6%) 968 physicians (78%) contacted: 126 (13% of contacted physicians) selected for peer review

31 Results of the program To date, of the 126 programmed peer review visits : 23 peer review visits were cancelled 23 peer review visits were made : 1 physician received a letter of satisfaction 8 received recommandations to improve their practice 5 received recommandations and will have a control visit 9 must do a retraining session or tutorial (39%) (N= 14%) The first cycle of the program will end this fall with an evaluation of the sensitivity and specificity of the questionnaire

32 PROFESSIONAL INSPECTION VISITS Cancellation reasons N = 23 4% 40% Death Irrelevant Retirement 56% 0% 10% 20% 30% 40% 50% 60%

33 Reflexions and actions Increase in the level of awareness from the physicians Better reflexion on their future Better understanding of those physicians at high risk Assess our results and actions Repeat this program every 2 years or 5 years?

34 Thank You! Questions?