Synergy - March/April 2014 - 10

industry feature

The Aging Physician:
Balancing Safety, Respect, and Compliance
By Jonathan H. Burroughs, MD, MBA, FACHE, FACPE; James B. Hogan, Esquire; Jennifer H. Richter, Esquire
Quiz on page 11; Worksheet on page 30

he aging physician is a difficult issue
for the medical staff to address on
many levels. The medical staff's core
values of autonomy and advocacy create
both respect for an individual to make
professional judgments and an unwillingness
to make determinations that may threaten
the physician's identity as an independent
professional. Although these attitudes are
slowly eroding with the growing number of
employed physicians, the medical staff has
been reluctant to cede authority regarding
the assessment of competence and conduct
to human resources (HR), even though the
employer has an obvious legal interest.

The potential conflict between HR
and the medical executive committee
regarding the evaluation and management
of performance issues should always be
negotiated in advance and memorialized
in both hospital and medical staff policies
and procedures. The medical staff bylaws
should clearly articulate the relationship
between the approach of the organized
medical staff and any relevant employment
contracts. For instance, many bylaws
indicate that when "there is conflict
between the bylaws and an employment
contract, the contract shall prevail." In
addition, relevant HR policies/procedures
need to address the relationship between
the hospital and medical staff's approach
when there is overlap, such as in the
area of professional conduct, potential
impairment, and the like. Many healthcare
organizations encourage the medical
staff to implement peer review through
a focused professional performance
evaluation when concerns are raised
regarding the exercise of current clinical
privileges. However, once that assessment
and analysis is complete, management
is permitted to utilize the terms of the
employment agreement to exercise any
progressive discipline necessary.
10

SYNERGY MARCH/APRIL 2014

Many medical staffs are finally addressing
the aging process as a distinct form of
potential impairment, as it requires
sensitivity and respect for both the
practitioner and relevant laws. There is
excellent data that when a physician (or
any professional) reaches their 60s and
70s, there is a significant and progressive
decline in cognitive and physical skills. For
instance, in 1994, Harvard psychologist
and researcher Dr. Douglas Powell
published his landmark and controversial
work, "Profiles in Cognitive Aging," in
which he compared more than 1,000
physicians and 600 non-physicians
from ages 25-92. He found that overall,
physicians scored higher in cognitive
functioning from ages 25-55, but that
thereafter, there was a consistent and more
precipitous decline with increasing age in
the areas of cognitive function (as measured
by the Micro-Cog assessment tool),
inductive reasoning, verbal memory, and
overall reasoning, and the overall scores of
the two comparative groups began to
equalize with increasing age.
Interestingly, most physicians
successfully modulate their practice
appropriately with age. Most
medical staffs have a significant
number of physicians
entering their 60s and
a much lower number
entering their 70s. This
corresponds to a
time when most
physicians find
the rigors of
night call,

managing critically ill or injured patients,
long work weeks, and sleep deprivation
taxing. In response, they modify their
practice to allow shorter work weeks in the

Synergy - March/April 2014

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