Practice Enhancement Division Québec College of Physicians André Jacques, M.D. Practice Enhancement Division Québec College of Physicians CPE Fall meeting November 2011 San Diego

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… »

April 2011 DOCTORS REGISTERED AS ACTIVE Five-year age groups Including 386 restrictive permits

April 2011 DOCTORS REGISTERED AS ACTIVE ≽ 70 years old 3,6% family physicians 8,4% specialists

January 2010 & 2011 DOCTORS REGISTERED AS ACTIVE ≽ 70 years old 2010 - 1058 physicians ≽ 70 y.o. 2011 - 1097 physicians ≽ 70 y.o. 2010 - 444 physicians ≽ 75 y.o. 2011 - 453 physicians ≽ 75 y.o.

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

« What gets measured gets attention » Smile… ! « What gets measured gets attention » Anonymous

DATA FROM INDIVIDUAL PEER REVIEWS From 2001 to 2010 N = 1618 16 different full-time physician inspectors over the last 10 years ~ 165 peer reviews/year ~ 70 with experts/year (43%) Data from the province billing administration

PROFESSIONAL INSPECTION COMMITTEE PROGRAMS From 2001 to 2010 ADMINISTRATION 733 INQUIRIES 885 Diploma > 35+ 325 Inquiry Division 476 Work in office only 89 Reporting 290 Methadone 67 Executive Committee 63 Restrictive permit 65 Physicians in difficulty program 26 Witness group 32 Changing practice fields 12 Failure at licence exam Committee on Revision 16 Substitute doctor 44 Specialized Medical Centre 2 Migratory doctor 19 Continuing Professional Development Atypical profile 60 Cancelled visits 304

PROFESSIONAL INSPECTION VISITS Cancellation reasons N = 304

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

LEVEL OF DECISIONS AFTER A PEER REVIEW Cancellation Quality of practice NOT satisfactory Quality of practice Satifactory

RESULTS PER DECADE From 2001 to 2010

From 2001 to 2010 N = 1068 N = 338 N = 207 N = 309

DOCTORS REGISTERED AS ACTIVE ≽ 80 years old

CONTROLS Before and after 70 years old N = 1407 N = 516

CONTINUING PROFESSIONAL DEVELOPMENT AND LEVELS OF INTERVENTION 1 2 3 CPD satisfactory N=904 1 2 3 CPD not satisfactory N=258 P< 0,001 Le Collège, Vol 49, #1, p14

CONTINUING PROFESSIONAL DEVELOPMENT GOOD / INADEQUATE

RESULTS OF CLINICAL TRAINING PROGRAMS OR TUTORIALS RECOMMENDED BY THE PIC FOR OLDER PHYSICIANS Success Retirement Success Failure Retirement Failure N = 49 N = 90 65-69 years old > 70 years old

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

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

« Feedback create change » Anonymous

OUR MISSION IS TO PROTECT THE PUBLIC Reflection ??? !!! 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

Thank You ! Questions ?