1. 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

2. 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… »

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

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

5. January 2010 & 2011 DOCTORS REGISTERED AS ACTIVE
≽ 70 years old
physicians ≽ 70 y.o.
physicians ≽ 70 y.o.
physicians ≽ 75 y.o.
physicians ≽ 75 y.o.

6. 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

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

8. 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

9. 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

10. PROFESSIONAL INSPECTION VISITS
Cancellation reasons
N = 304

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

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

13. RESULTS PER DECADE
From 2001 to 2010

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

15. DOCTORS REGISTERED AS ACTIVE
≽ 80 years old

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

17. CONTINUING PROFESSIONAL DEVELOPMENT AND LEVELS OF INTERVENTION1 2 3
CPD satisfactory
N=904 1 2 3
CPD not satisfactory
N=258
P< 0,001
Le Collège, Vol 49, #1, p14

18. CONTINUING PROFESSIONAL DEVELOPMENT
GOOD / INADEQUATE

19. 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

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

21. 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

22. « Feedback create change »
Anonymous

23. 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

24. Thank You !
Questions ?