You can't force older surgeons into retirement, but it's important to find out if they can still operate safely. Here at Stanford Health Care (SHC), the medical staff implemented a Late Career Practitioner Policy, which uses focused physical exams and robust peer reviews to screen physicians. Our goal was to stay out in front of the aging physician issue with a policy that's evidence-based, practical and as respectful as possible. Here are its key elements.

• Application. After turning 75, all physicians practicing at SHC must undergo physicial exams and peer reviews every 2 years. Age 75 was chosen somewhat arbitrarily, but the choice was guided by data that show the rate of decline of cognitive functions starts gradually as early as age 35 or 40 until about age 70 or 75, when deterioration begins to increase at a faster pace. This policy does not violate the Age Discrimination in Employment Act, which protects workers 40 years of age and older from being denied employment due to advancing age, as physicians practicing at SHC are not hospital employees.
• Peer reviews. Our policy initially included a cognitive screen, but we critically reexamined that element when some physicians voiced significant objections. Because there were no data in the literature to support (or refute, for that matter) the use of cognitive screening to gauge a physician's ability to practice safely, we dropped that requirement. Instead we increased the number of peer reviews from 3 to 10, an approach that does have support in the literature, which demonstrates that peer review is an accurate and fair way to determine if physicians are practicing safely and effectively. We ask the chief of surgery for names of 10 peers who are in a position to honestly and fairly judge a physician's ability to practice and include them in the peer review process.
• Physical assessments. Physical exams are performed by individuals' primary care physicians, and focus on determining whether surgeons have the physical skills needed to perform the procedures for which they're privileged.
• Respect. The screenings are intended to uncover possible problems; they're not used as pass/fail assessments. For example, a surgeon who needs to be on her feet for hours during a busy day of surgery might have a physical ailment that impairs her ability to operate. Instead of looking for ways to get rid of her, we'll think of ways to accommodate her needs. That's the respect piece of our policy. Not everyone sees it that way — some feel threatened by the process — but our goal is to help physicians practice as long as possible in a safe way. Although some disagree with the policy, the majority of our medical staff offered their support when it was put to a vote.

Before it's too late

Reaching a certain age does not mean a surgeon is impaired, and our program is designed to identify opportunities to help aging physicians maintain the respect and admiration they deserve, not force them to retire. Sadly, I'm aware of a nationally known physician at another institution who became severely demented. His colleagues covered for him for a long time instead of addressing the issue. Instead of remembering him as the incredibly accomplished physician he was, he's talked about as a physician who practiced longer than he should have. That's ultimately the type of scenario our policy is designed to avoid. OSM