The challenge of competency assessment of the late-career practitioner

Just as the general population of the United States is aging, so, too, is the population of active physicians. Training to become a physician and practice medicine is an arduous process. The competition to gain admission to medical school is fierce, the price tag of medical education is high, and waiting to learn about matching to a residency program is stressful. No wonder that physicians equate their profession with their identity. This sentiment, along with other factors, has resulted in many physicians continuing to practice well beyond the average retirement age. While each individual ages differently, there is evidence that the aging of physicians and length of time since medical school and residency is associated with deficiencies in history-taking, physical examination, record-keeping, and the ability to problem-solve. For late-career surgeons performing complex surgical procedures, there is a higher mortality rate for patients. Unlike other professions that have a mandatory retirement age, medicine does not. Health systems are grappling with how to fairly assess the competence of late-career practitioners. This article will explore that challenge from different perspectives, identify best practices, and describe how a risk manager can facilitate stakeholder discussion focused on implementing a competency-assessment process that is fair and effective.