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

2. 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 »

3. Plan
Demographics
Screening
Peer-reviews
Remediation
Outcomes

4. Plan Active physicians in Canada January 2016 : 83 159
Active physicians in Quebec
January 2017:

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

6. 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

7. Inescapable slope peer reviews 2007-2016
canceled

8. 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 Melbourne, Australia

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

10. 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

11. 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

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

13. 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

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

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

16. 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

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

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

19. Peer-reviews results before and after 70 yo 2007-20163
≥ 70 yo
< 70 yo
N = 1050
p < 0,001
N = 676

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

21. 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

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

23. 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

24. MD < 70 yo (2007-2016) 3 2 1 N = 604 N = 446 other programs3
other programs
Inquiry division
p = 0.2
N = 604
N = 446
March 2017

25. MD > 70 yo (2007-2016) 3 2 1 N = 116 N = 560 Inquiry division3
Inquiry division
Other programs
p =
N = 560
N = 116
March 2017