Late career physicians The Quebec perspective Marc Billard, MD Practice Enhancement Division Collège des médecins du Québec CPE 2017 Spring meeting, Forth Worth, Texas

No conflict of interest I am a full-time employee at the Collège des médecins du Québec. My sole interest is to promote our mission Une médecine de qualité au service du public « Quality medicine at the service of the public »

Plan Demographics Screening Peer-reviews Remediation Outcomes

Plan Active physicians in Canada January 2016 : 83 159 Active physicians in Quebec January 2017: 20 686

Distribution Active physicians 2016 vs peer reviews 2007-2016 39 % Mean Age 64 yo Mean Age 50 yo 6.5%

Four possible levels of intervention following an inspection visit Remediation prescription, limitation, retirement Non satisfactory quality of practice Level 2 Level 1 Level 0 Level 3 Level 2 Recommendations + Control visit Satisfactory quality of practice Level 1 Recommendations Level 0 No action, Satisfaction letter

Inescapable slope peer reviews 2007-2016 canceled

Questionnaire 70/2 Program 2012 Questionnaire 70/2 Program Briefly describe your medical practice Summary of your clinical activities and number of patients Do you practice outside your initial medical training? Do you practice alone or with medical colleagues? How many patients, on average, do you examine every week? List each place of practice Do you do: Locum, On-call duty, Diagnostics or therapeutics interventions? Do you participate in an approved CPD Program? Did you change your practice in the last 2 years ? Are you satisfied with your actual practice? In the Questionnaire, there are open-ended questions on the physician’s practice. September 2016 IPAC 2016 - Melbourne, Australia

Results of the 70/2 Program: Scores 2012-2017* No clinical activities * Results as of 2017-02-28

A B C Results of the 70/2 Program: letter grade 2012-2017* Peer-review any score Peer-review if score ≥ 24 A B C Peer-review if score ≥ 26 * Results as of 2017-02-28

Results of the 70/2 Program 2012-2017* Number % Questionnaires sent 2 409 Questionnaires reviewed 2 291 95% Practice not judged at risk 1 795 78% Selected for peer review 496 22% Peer reviews cancelled 152 31% Peer reviews to be done 344 69% Peer reviews done 217 63% Peer reviews to come 127 37% * Results as of 2017-02-28

Gender and Country of MD graduation Female Male Canada or US Outside Canada or US

Variety and intensity of practice No clinical practice One field Limited fields All kinds of patients < 2 days/week 2-3 days/week ≥ 4 days/week

Isolation n = 2291 Group practice Solo practice Establishment practice Office practice only

High-risk interventions and retirement project Low-risk interventions High-risk interventions Retirement in the next year No short-term project

High-risk interventions and retirement project Only 60% are now inactive Low-risk interventions High-risk interventions Retirement in the next year No short-term project 24% are now inactive

Results of the 70/2 Program 2012-2017* (n = 217 peer reviews) 3 Positive predictive value of the questionnaire = 63% * Results as of 2017-02-28

Based on 1 215 peer-reviews (first visit only)

Peer-reviews results before and after 70 yo 2007-2016 3 ≥ 70 yo < 70 yo N = 1050 p < 0,001 N = 676

Remediation results before and after 70 yo 2007-2016 p < 0,0001 N = 156

Huge investment supported by the medical community 6.5% of our active physicians 39% of our peer-reviews Almost 50% of our remediation resources Nearly 400 physicians retired in relation with the process in the last 10 years

Why retire so late ? Passion, mission, vocation Patient pressure, peer pressure No other significant interest No retiring planning Money incentive Poor self-evaluation

What can we do? Increase awareness of all physicians to late career pitfalls Size-down, narrow the field of practice Enhance planning for the end of the career Workshop “Planning for retirement” Give age limit ahead of time Unsustainable legally

MD < 70 yo (2007-2016) 3 2 1 N = 604 N = 446 other programs 3 other programs Inquiry division p = 0.2 N = 604 N = 446 March 2017

MD > 70 yo (2007-2016) 3 2 1 N = 116 N = 560 Inquiry division 3 Inquiry division Other programs p = 0.0001 N = 560 N = 116 March 2017