Hospitals pilot policies to test older radiologists’ mental and physical fitness

Hospitals in recent years have begun screening older radiologists and other physicians to ensure they’re still mentally and physically fit for the job.

Nearly one-fourth of medical doctors with active licenses are over the age of 65. Previous research has shown that patients cared for by late-career physicians are more likely to experience worse clinical outcomes and file complaints about their care. 

Some healthcare institutions have aimed to address this problem by subjecting senior physicians to testing. Experts with the University of Washington School of Medicine sought to better understand these policies, sharing their findings in the Annals of Internal Medicine [1]. 

The study sample included 29 U.S. healthcare organizations with active late-career physician policies as of 2020. Andrew A. White, MD, and colleagues conducted interviews with 21 physician leaders across 18 institutions, unearthing commonalities and differences in such programs.

“Health systems have taken a risk because these policies create controversy and require buy-in from medical staff,” White, a general internist and professor at UW Medicine in Seattle, said in a Nov. 12 announcement. “Older physicians have to accept more oversight, which some might naturally resist.”

Policies commonly incorporated mandatory universal screening of physicians at a trigger age of around 70. They also often had a strategy of screening followed by an in-depth assessment of positive results and a commitment to patient safety as the stated motive. However, they varied “substantially” in the type of testing required, funding, processes after a positive screening result, and decision-making afterward. 

White and colleagues estimated that about 5% of U.S. healthcare organizations now have such policies. Among the study sample, about 12% to 14% of screened radiologists and other physicians were deemed unfit for the job. Seventy was the median screening age among institutions, with testing applied universally to any physician seeking new or renewed clinical privileges. Most (89%) required doctors to undergo a physical exam and neuropsychological exam (82%). A large portion (79%) also asked the examiner to offer a subjective judgment about the physician’s fitness to practice medicine. 

White and colleagues noted that most executives interviewed for the study said they believe these policies are effective at ensuring patient safety. They also highlighted the importance of gaining buy-in from physicians before implementing a screening program, rather than doing so in a top-down fashion. 

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

The study’s author noted that many policies appeared to be missing details about how radiologists and other physicians might appeal, if they disagree with the findings. 

“Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians’ buy-in was required for successful rollout,” the study authors wrote. 

Read more about the results, including potential limitations, at the link below. The study did not include healthcare organizations that tried and failed to implement late-career physician screening policies. 

In 2020, the Equal Employment Opportunity Commission accused Yale New Haven Hospital of discrimination for subjecting older physicians to such competency testing. Amid ongoing radiologist shortages, some have suggested luring these older docs out of retirement to work through imaging backlogs.