Hanging up the surgical cap: Assessing the competence of aging surgeons

Table 2 Late career practitioner policies adopted at health institutions

Program	Objectives	Candidates	Medical exam	Performance testing	Modification of privileges
Stanford Health Care[16,17]	To ensure high quality care for patients and protect them harm and identify health concerns of practitioners	74.5 years old and every 2 yr thereafter	Comprehensive history and physical examination including vision, hearing, neurological, and cognitive testing	Peer assessment by hospital staff of technical and procedural competencies, relative to Stanford expectations	Yes, if non-compliant or unsafe practice patterns
Aging Surgeon Program at Sinai Hospital, Baltimore, MD[43]	Designed to protect patients from unsafe surgeons and guard surgeons from arbitrary or unreliable methods of assessing competence or cognitive capacity. The program can identify potentially treatable or reversible disorders that, if properly treated, could restore or improve functional capacity	No mandatory age. Requested from surgeons, hospitals or licensing bodies of all surgical sub-specialties	Evaluation of general health, vision, hearing, neurocognition, visual-spatial and fine motor capability	None	No
Hartford Health Care[44]	To ensure patient safety and high-quality medical care	70 years old and above, and annually thereafter	Annual physical exam, vision, neurological testing and neuropsychological screening	OPPE. FPPE if needed, to identify patterns that may negatively impact quality and safety of care	Yes, discussion with department Chief ± Credentials Committee if deemed unable to safely exercise privileges
YNHH[21,45]	To protect patients from harm and safeguard fair physician assessment	70 years old and above	Ophthalmologic exam and 16 test neuropsychologic screening battery	None	Yes, MSRC suggestions based on screening results
Legacy Health, OR[46]	To assess physicians to ensure patient safety and physician wellness	70 years old and above, and every 2 yr thereafter	Physical capacity by occupational therapy and neuropsychological testing	Peer review assessment	Yes, determined by Credentials Committee, if health problems interfere with safe practice
Driscoll’s Children’s Hospital, Corpus Christi, TX[17]	To assure that patient safety and quality are adequately supported by carefully assessing the capabilities, competencies and health status of each practitioner	70 years old and above	Comprehensive examination addressing physical and mental capacity by a physician	Peer review assessment may be required. Must meet technical and procedural competencies	Yes, determined by Credentials committee, if practice unsafe or incompetent
University of Virginia Health System[17]	To assess each physician’s capacity to perform requested privileges	First assessment at age 70. Annual assessment after 75 years of age	Comprehensive examination addressing physical and mental capacity under the Physician Wellness Program	None	Yes, as determined by Department Chair
UC San Diego LCHS[47,48]	To detect any physical or mental health problems that may affect a physician’s ability to practice	70 years old and above. At request of hospital or medical group	History and physical exam. Cognitive and mental health screen	Dexterity tests for proceduralists/surgeons	No
Tahoe Forest Health System, CA[49]	To fairly and accurately evaluate physician performance and capabilities	70 years old and above. Required to partake in LCHS	See LCHS	See LCHS	Yes, after consultation with department Chair if adjustment is required

OPPE: Ongoing Professional Practice Evaluation; FPPE: Focused Professional Practice Evaluation; YNHH: Yale New Haven Hospital; MSRC: Medical Staff Review Committee; LCHS: Late Career Health Screening for Physicians and Healthcare Professionals.