News

Competency screening of older doctors roils Stanford faculty

Policy aimed at protecting patients called discriminatory

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."

Comments

12 people like this
Posted by Virgil Bierschwale
a resident of Stanford
on May 15, 2015 at 10:43 am

It would seem that we are making this mistake in all occupations.

When you get rid of the people that understand the “Why” of Wax On / Wax Off, you get rid of the knowledge, wisdom, and experience that they have accumulated over decades and replace their expertise with those that have never “fought the battles that they have fought”.


5 people like this
Posted by Sylvia
a resident of Midtown
on May 15, 2015 at 11:47 am

Speaking as someone in their 70s I think I have the right to say that having doctors past 75 screened seems worth while. Screening seems to imply implicitly that, should they pass the screening tests, they can continue to have admitting privileges. How is this discrimination? Looks like patient protection to me.


31 people like this
Posted by issues
a resident of Community Center
on May 15, 2015 at 12:20 pm

My guess is that there are multiple unstated (financial) concerns behind this rule. Malpractice insurance for doctors over 75–particularly surgeons–is exorbitantly high, presumably because statistically doctors in this age group have a higher proportion of malpractice lawsuits. Also, academic physicians in this age group are overwhelmingly full professors, whose salaries are considerably higher than those of equally (or sometimes more) competent assistant and associate professors.


2 people like this
Posted by Hulkamania
a resident of Duveneck/St. Francis
on May 15, 2015 at 12:39 pm

Hulkamania is a registered user.

"... in four states... ...and sheriffs at 70."

Too bad Arizona doesn't have this law.


7 people like this
Posted by Me
a resident of Adobe-Meadow
on May 15, 2015 at 4:48 pm

Screening for competency past 70 is a safe thing to do especially in medicine. We will all get old and our brains won't be functioning as if we were in our 20s.

Now what was I talking about?


14 people like this
Posted by Long Time Resident
a resident of Old Palo Alto
on May 15, 2015 at 5:26 pm

How about monthly or bi-monthly drug and alcohol testing for ALL doctors?
It wouldn't be a huge inconvenience since they work near facilities.


12 people like this
Posted by Rating
a resident of Another Palo Alto neighborhood
on May 16, 2015 at 4:32 pm

How about an arrogance test for all doctors? Seems to me sometimes the older ones are happily more likely to let experience and judgment overrule the hierarchical nonsense from medical school. On the other hand, it often seems like the younger ones are more willing to think of patients as partners. An age-blind test for arrogance would at least save patients time and money having to sit through useless visits.


6 people like this
Posted by me
a resident of Stanford
on May 16, 2015 at 5:45 pm

It should be clear. Every doctor at Stanford Medical Center undergoes evaluation for competency to practice medicine every two years. All must pass this evaluation if they are to practice at Stanford. This is true if the doctor is 40, 45, 55 60 or 75. This will remain so. Were there deficiencies, these must be corrected to continue to practice. The measure approved by the Faculty Senate related to special additional testing for which the sole reason was age, not complaints or any evidence of a lack of ability. The point being, if there is a superior additional method to evaluate a physician’s competence, why should its use be restricted to one age of physician? It should be applied to all aged physicians whether 40, 45,55, 60 or 75. The Senate resolution was very simple. The Senate recommended that the two year evaluations be rigorous for all physicians no matter what their age.


4 people like this
Posted by dennis
a resident of Fairmeadow
on May 16, 2015 at 7:05 pm

My daughter's life was saved by the correct surgery by a twenty-six year old doctor at Stanford after her regular pediatrician, who was in his seventies, failed to correctly diagnose her life threatening sleep apnea at the time. Like older drivers, Physicians should be reviewed periodically, and the idea that they have more experience and should have more knowledge is nothing but a lode of crap, because it is the younger doctors that have and keep up with the latest developments in medicine.


8 people like this
Posted by Rating
a resident of Another Palo Alto neighborhood
on May 16, 2015 at 7:53 pm

@dennis,
I'm glad to hear your daughter got the appropriate care after it was missed by her primary, and hope she is doing well.

But you cannot exactly generalize your single experience to all physicians. THAT is nothing but a lode [sic - but very funny mistake] of crap... The doctors I've known who were the most up to date on medical literature have been the most experienced older doctors. I'm not saying all older doctors are experienced, I'm just telling you my experience with doctors I've known, and the most knowledgeable and up to date haven't been the youngest.

Our child was saved on delivery by an older doctor who wasn't even our doctor, the younger one had dismissed some important history and wasn't even around. You can't draw generalizations from that, the only information that was useful was who to recommend to others who needed same kind of doctor.


2 people like this
Posted by Merry
a resident of Palo Alto Hills
on May 18, 2015 at 12:38 pm

Is there a problem? Or are we fix in'
What ain't broke?


5 people like this
Posted by PA doctor
a resident of Stanford
on May 18, 2015 at 8:56 pm

The plan makes no sense. Only 30 of the 1800 doctors at Stanford are over 75 and this group is NOT disproportionately represented with medical errors. Nationally, tThe greatest risk for making mistakes is in younger age groups, particularly in those impaired by alcohol and drugs. In the airline industry, all pilots have health exams every 6 months. I would be in favor of ALL doctors being examined every few years for vision problems, hearing loss, tremors, and cognition. And, of course, all should be required to maintain board certification by repeat testing of medical knowledge. Currently, in the US, older physicians are exempt from this obligation but Stanford could make it mandatory.


1 person likes this
Posted by David
a resident of Another Palo Alto neighborhood
on May 18, 2015 at 11:41 pm

[Post removed.]


Like this comment
Posted by Fred
a resident of Stanford
on May 25, 2015 at 10:12 am

Sylvia, the point is missed, 70 year olds, like all doctors at Stanford are screened and evaluated now and will continue to be so. This resolution did not do away with evaluation of 70 year old doctors - merely asked that the evaluation be rigorous and equal for all doctors.


7 people like this
Posted by Permanent Scars
a resident of Atherton
on May 25, 2015 at 1:04 pm

[Post removed.]


1 person likes this
Posted by Middle aged guy
a resident of Old Palo Alto
on May 25, 2015 at 3:05 pm

75 is past the outer edge for any professional to still be on top of their game. Which is to say that one is taking a risk by hiring a doctor, lawyer, etc. that old.


13 people like this
Posted by Permanent Scars
a resident of Atherton
on May 25, 2015 at 6:05 pm

Since my days as a Stanford student, I have been injured by young inexperienced doctors in the STANFORD Health Center and Stanford Hospital. Their hospitalists do not keep the patient apprised of test results, and the young docs rarely even stick their head in the door of your room. I have never been injured by a doctor over 45, but I recently transferred all of my care to El Camino Hospital because the doctors and in-patient care are so much better and more attentive. The bills are also WAAAAY lower, in spite of improved quality and better food.


1 person likes this
Posted by Common Sense
a resident of Downtown North
on Jun 19, 2015 at 2:04 pm

The state asks people over a certain age to get screened to drive a car, but physcians are up in arms if Stanford asks for a similar screening before they operate on an individual. Standord is merely attempting to protect patients by insuring the doctor has the physical and mental capabilities to perform his or her requested privileges. This does not mean if they can no longer can physically operate that they cannot provide their wisdom and advice. Unfortunately for patients there are physicians that cannot self identify the limitations that have crept up on them from aging. It is sad that prominent physicians have been quoted that there is no evidence that age effects the care provided by physicians. Lets use common sense as everyone gets older they lose there mental and physical capabilities, some faster than others. Basically what they are saying is do not screen me because my ego is more important than patient care. If they cared about patients they would willingly be screened.


5 people like this
Posted by Stanford Hospital is the Pits
a resident of Another Palo Alto neighborhood
on Jun 24, 2015 at 1:23 pm

When my daughter had a tumor removed, a YOUNG resident was allowed to do the suturing and he messed that up badly, causing infection and excessive scarring.

When, years later, my daughter had to have a bone marrow biopsy, a YOUNG resident bike the needle off in her thigh bone. Once he cleaned up that mess, he had todo it over on the other leg. As a result, she suffered more pain and fear than were necessary.

Both times, these young doctors were very inexperienced, it had no supervision. Inexcusable!


4 people like this
Posted by AlexDeLarge
a resident of Midtown
on Jun 24, 2015 at 1:35 pm

Two of my uncle's are 82 & 84 and are still working MD's, not on me though...


6 people like this
Posted by Stanford is the Pits
a resident of Another Palo Alto neighborhood
on Jun 24, 2015 at 1:36 pm

When my mother had a hip replacement there, she suffered a post-surgical side effect that caused her severe abdominal pain. Her surgeon, age 40, refused to comein on a Sunday afternoon. The nurse tried calling three other young doctors who were "supposed" to be on call. They refused to come in as well.

The nurse told us she felt pretty certain my mom had avowed obstruction, but she was not legally able to diagnose or treat. There was not a gastroenterologist on duty in the hospital at all, and the arthritis surgeons were too busy to attend to a patient in pain.

So, finally, the nurse tried a gastroenterologist who was not on call, but knowing this condition could e serious, gave him a call.

This doc was in his 60s at least. He told us this could be a life-threatening situation, prescribed IV medication, and STUCK around to make sure she improved before leaving. Ta-da! He saved her life!


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