CMPA Perspective March 2016

How to practise safely and maintain competence
The following tips may be helpful for physicians as they age:
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Consider your own health issues and the possibility of
cognitive decline. Strive to maintain a healthy lifestyle
through good diet and exercise. 5
Carefully consider the concerns of family members,
treating physicians, colleagues, friends, and patients
regarding your own health and practice. Seek timely
assistance and support for issues and problems.
Where appropriate, consider narrowing or limiting the
scope of your practice or work, shortening your work
hours or week, and decreasing the workload based on
the time demands, your stamina, and fatigue levels. 4
Take appropriate time with cases requiring rapid
cognitive processing, when necessary. Plan for
longer appointments for patients with complex
medical problems. 5
Avoid, where possible, practising in isolation and work in
collaboration with other providers.
Be familiar with any relevant College competency review
programs, and hospital guidelines and policies regarding
screening to maintain competency and proficient
performance in practice.
Consider self-assessment programs such as those
offered by the Royal College of Physicians and Surgeons
of Canada 13 to assess your knowledge and practice to
further enhance your competence.
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Document patient care in medical records. A
physician’s thought process is demonstrated through
good documentation.
Consider your approach to retirement so you can
continue to meet the needs of your patients and your
own personal goals.
If you are in an administrative position, collaborate
with all members of your department to support
aging physicians.
If you encounter a colleague or another doctor who
appears to be having difficulties possibly due to
advancing age, it is advisable to talk with the doctor
directly and privately. An open and honest discussion,
carried out with empathy, is usually well-received. If it
is not, speak to another colleague or physician leader
for guidance and support. Furthermore, be familiar with
the legislation and College policies on reporting in your
province or territory in case you conclude you have a
legal duty or ethical responsibility to report a physician’s
health decline possibly due to advanced age. 14
If you feel you are being discriminated against based on
your age, consider contacting the CMPA for advice.
In many cases, doctors can successfully modify their
medical practice to accommodate changes as they age and
continue to meet their patients’ needs.
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Keep up to date with clinical standards, and meet
requirements for continuing medical education and
professional development.
Additional reading at www.cmpa-acpm.ca
▪ ▪ “Physician health: Putting yourself first”
▪ ▪ “Winding down your practice”
▪ ▪ “Reporting another physician”
1. Drag LL, Bieliauskas LA, Langenecker SA, Greenfield LJ. Cognitive functioning, retirement
status, and age: results from the Cognitive Changes and Retirement among Senior Surgeons
study. J Am Coll Surg 2010;211(3):303-7.
2. Davis DA, Mazmanian PE, Fordis M. Accuracy of physician self-assessment compared with
observed measures of competence. JAMA 2006 Sep 6;296(9):1094-102.
3. Peterson RC. Mild Cognitive Impairment. N Engl J Med. 2011;364(23): 2227-234.
4. American Medical Association. Competency and Retirement: Evaluating the Senior Physician.
AMA Wire [Internet]. 2015 June 23 [cited 2015 Nov 2]. Available from: http://www.ama-assn.
org/ama/ama-wire/post/competency-retirement-evaluating-senior-physician.
5. Lee L, Weston W. The Aging Physician. Can Fam Physician [Internet]. 2012 [cited 2015 Nov
2];58(1):17-18. Available from. http://www.cfp.ca/content/58/1/17.full.
6. Choudhry NK., Fletcher RH, Soumerai SB. Systematic Review: The Relationship between
Clinical Experience and Quality of Health Care. Ann Intern Med [Internet]. 2005 [cited 2015
Nov 2];142( 4):260-74. Available from: http://annals.org/article.aspx?articleid=718215.
7. Donaldson LJ, Panesar SS, McAvoy PA, Scarrott DM. Identification of poor performance
in a national medical workforce over 11 years: an observational study. BMJ Qual Saf 2014
Feb;23(2):147-52.
8. Collier R. Diagnosing the Aging Physician. CMAJ [Internet]. 2008 [cited 2015
Nov 2];178( 9):1121-123. Available from: http://www.cmaj.ca/content/178/9/1121.
full?ijkey=93ec04862c1862cbf333b253bb42abcf780cb25f&keytype2=tf_ipsecsha.
9. Annual Report 2014 [Internet]. Winnipeg (MB); College of Physicians and Surgeons of
Manitoba;[cited 2016 Jan 21]. Available from: http://cpsm.mb.ca/cjj39alckF30a/wp-content/
uploads/CPSMAnnRep2014.pdf.
10. Selection for Assessment [Internet]. Toronto (ON); College of Physicians and Surgeons of
Ontario, Peer Assessment section; [cited 2016 Jan 21]. Available from: http://www.cpso.on.ca/
CPSO-Members/Peer-Assessment/Selection-for-Assessment.
11. Nouveau Programme 60 Ans. Le Collège [Internet]. 2015 [cited 2015 Nov 10];55(1): 21.
Available from : http://www.cmq.org/publications-pdf/p-5-2015-01-01-fr-hiver-2015.pdf.
12. Canadian Medical Association. Number of Active Physicians by Age, Sex and Province/
Territory, Canada, 2015. CMA Masterfile. 2015. Available from: https://www.cma.ca/Assets/
assets-library/document/en/advocacy/04AgeSexPrv.pdf.
13. Self-Assessment Programs (SAPs) [Internet]. Ottawa (ON): Royal College of Physicians and
Surgeons of Canada, About Us section; 2010[cited 2016 Jan 21]. Available from: http://www.
royalcollege.ca/portal/page/portal/rc/members/cpd/cpd_accreditation/self_assessment_
programs.
14. Canadian Medical Protective Association. Reporting another physician. Dec. 2010. [Internet].
[cited 2016 Jan 21] Available from: https://www.cmpa-acpm.ca/en/physician-wellness1/-/
asset_publisher/la3xaaAQQE06/content/reporting-another-physician.
12 cmpa perspective | march 2016