A policy requiring doctors 75 and older to undergo special screening in order to keep their privileges at Stanford University's two hospitals was criticized in a vote by faculty leaders Thursday.
The two-year-old rule mandating evaluations for "late-career practitioners" has so upset and polarized professors that Thursday's vote a non-binding resolution by the university's Faculty Senate -- was taken by secret ballot.
Leaders of the hospitals' medical staffs said the screening is meant solely to protect patients from mistakes that could become more likely as physicians age. Doctors sometimes fail to recognize that conditions like tremors or impaired vision can affect their care of patients, they said.
But opponents charged that -- in the absence of high-quality data showing that older doctors are more error-prone than younger ones -- the rule amounts to age discrimination. Any competency screening for physicians should be applied regardless of age, they said.
After an hour's debate, the elected members of the Faculty Senate voted 20 to 9, with 2 abstentions, in favor of a resolution recommending to the university's leadership that it advise the hospitals "that age discrimination in competency testing of Stanford faculty end and that patients be safeguarded by a process that is the same for all faculty age groups."
Thursday's vote does nothing to change Stanford Medical Center's "Late Career Practitioner Policy," enacted in September 2012.
But the Faculty Senate "does have a lot of moral authority," said biology professor Robert D. Simoni, who sponsored Thursday's resolution. Simoni read aloud several letters of support from professors who were not present at the meeting, including one from engineering professor Bernard Roth, who wrote, "Ageism is as pernicious as sexism and racism."
When the screening policy was adopted on 2012, Stanford Medical Center leaders said they hoped other medical centers would follow suit as a way to "optimize the effectiveness of physicians to care for their patients."
The policy requires a health screening every two years as well as a "peer assessment" of clinical skills for doctors 75 and older.
Philip Pizzo, who was dean of the medical school at the time, said, "Most physicians have known at least one colleague who practiced beyond the time when he or she was most effective, and many of us have struggled with how to best handle that to protect patients as well as the reputation and self-esteem of the physician.
"For this reason it is important, from the point of view of both patient safety and physician well-being, to establish a process by which late-career physicians' performance and capacities can be fairly and accurately evaluated."
But the policy though affecting just a few dozen of the nearly 2,000 faculty and community physicians with Stanford hospital privileges -- was controversial from the start.
An ad hoc committee was appointed to review and tweak the policy, which was then put to a vote by the medical staff. It was approved by a vote of 53 percent to 47 percent with nearly 1,000 doctors voting by far the largest turnout for a medical staff vote in history, according to Ann Weinacker, former chief of staff at Stanford Health Care.
Weinacker and Norman Rizk, the current chief medical officer of Stanford Health Care, defended the screening policy during Thursday's debate.
Weinacker said its logic is akin to medical standards recommending colonoscopy screening for people over a certain age. Although "there's no clear (age) cutoff at which there's a decline (of physician competence), it is unfortunately inevitable when we get older," she said.
Stanford chose the age of 75. Duke University mandates that doctors retire from clinical practice at age 70, she said. Screening policies for older doctors also have been adopted by the University of Virginia and in the 20 hospitals run by the University of Pittsburgh, she said.
Weinacker also pointed to mandatory retirements in other professions including airline pilots at 65, FBI agents at 57, air traffic controllers at 56 and, in four states, various judges and sheriffs at 70.
Rizk said the screening policy was "not done in any way to be discriminatory," noting that it was strongly backed by department chairs, most of whom are in their 60s and will soon be subject to the policy themselves.
"There's been a tremendous amount of soul searching around this because of the gravity of the situation," he said. "We tried to proceed in a pragmatic fashion that honors everybody's contributions and is mindful of risk."
Medical school Dean Lloyd Minor argued that it was inappropriate for the Faculty Senate to insert itself into policies governing patient care, which should be the purview of the medical staff. That viewpoint was echoed by Pizzo, the former dean, in a letter read from him by Professor of Medicine Marcia Stefanick.
"It is important to underscore that the medical staff is required by State of California statute to operate independently," Pizzo wrote. "The delegated authority of the medical staff must be respected."