1 / 23

Objectives

Slip Slidin’ Away: Practice Change and Implications for Physician Performance Elizabeth S. Grace, M.D. Medical Director, CPEP The Coalition for Physician Enhancement Fall 2013 Meeting Fort Worth, Texas. Objectives.

cassie
Download Presentation

Objectives

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Slip Slidin’ Away:Practice Change and Implications for Physician PerformanceElizabeth S. Grace, M.D.Medical Director, CPEP The Coalition for Physician Enhancement Fall 2013 MeetingFort Worth, Texas

  2. Objectives • Discuss findings of research pertaining to predictors of physician performance on competence assessment, including practice to training match • Provide case studies • Consider what might potentially lead to practice drift • Discuss challenges for assessment programs when assessing such physicians

  3. IM to Pain Management • Male physician in his 60’s • IM training • ER work then IM with pain management • 2.5 year suspension for rx’ing then probation • Returned to practice but off medicare and insurance panels • Assumed a practice that was 50% pain 50% IM • No formal training

  4. Background • Independent, not-for-profit organization • Founded in 1990 • Located in Denver, Colorado • Post-licensure competence assessment and educational remediation • Referrals from licensing boards, hospitals, medical groups

  5. Background • Experience: > 1300 assessments > 60 medical and surgical specialties • Physicians, PAs, NPs, Podiatrists • Research project: outcome data • Predictors of performance/risk factors for poor performance

  6. Predictors of Physician Performance on Competence Assessment Elizabeth S. Grace, MD Medical Director, CPEP Denver, Colorado Elizabeth F. Wenghofer, PhD Associate Professor, Laurentian University Sudbury, Ontario Elizabeth J. Korinek, MPH CEO, CPEP Denver, Colorado Accepted for publication: Academic Medicine

  7. Study Purpose: To identify factors associated with physician performance in a comprehensive competence assessment • Retrospective analysis • 683 physicians assessed at CPEP • Evaluated as either safe or unsafe to practice • Multivariate logistic regression to determine factors predictive of unsafe assessment outcome

  8. Variables: Personal Characteristics • Age • Gender • Board certification • Specialty (general practice vs. other)

  9. Variables: Practice Context • Solo practice • Rural practice • Current practice status • Scope of practice match with training

  10. Variables: Referral Information • Previous or current discipline by medical licensing body (board) • Source of referral (hospital, licensing body)

  11. Characteristics of Participants • Male – 84% • Mean age 53 years old (range 32 to 84) • Average time in practice 18 years • Family physicians/General practitioners – 29% • Board certified – 65%

  12. Characteristics of Participants • Solo practice – 59% • Board action – 42% • Scope of practice not match training – 3.2%

  13. Findings • More likely to have unsafe outcome • For each year of increasing age • General practitioner (did not complete full residency) • In solo practice • Current or previous licensure action • Less likely to have unsafe outcome • Board-certified • Practice scope matches training Regression model accounted for 26% of variation

  14. Findings • Some factors not significant: • Gender • Years in practice • Degree (MD versus DO) • Rural practice • Significant on univariate but not multivariate analysis • Medical School (LCME versus IMG) • Current practice • DEA revocation • Referral source

  15. Significant Predictors “Unsafe” Outcome Multivariate Logistic Regression

  16. Conclusions • Confirmed previous associations: age, board-certification, solo practice • Highlighted new unrecognized factors: practice drift - practicing outside scope of training

  17. Conclusions • Discordance between training and practice specialty is important! • Consider models that conceptualize physician performance as a complex construct Combination of effects of personal characteristics, practice context and disciplinary history rather than simply a reflection of credentials and training

  18. Case Study: General Practice • 66 year-old male • Trained in and practiced general surgery • Shares office with spouse (FP) • Stopped surgery 9 years ago • Over the years, did some general practice • Now practicing only general practice • Complaint received by the board about billing

  19. Case Study: Addiction Medicine • 68 year-old male physician with long history of substance abuse • Trained and worked in EM • 2010 decided to specialize in addiction medicine for patients with chronic pain • No formal training, pursued self-study since completed residency

  20. Case Study: Cosmetic Surgery • 40 year-old male physician • Trained in internal medicine • Worked as a hospitalist for a few years • Opened cosmetic surgery practice • Training by manufacturer, observation, preceptorship

  21. What may lead to practice drift? • Rural practice • Practice circumstances and licensure history • Personal history and personal interests • Practice difficulties • Financial motivators?

  22. Challenges for Assessors • Isn’t everyone trained to be a general practitioner? • “But I am not a (fill in the blank) specialist!” • Complex hybrid practices encompassing several disciplines

  23. esgrace@cpepdoc.orgwww.cpepdoc.org303-577-3232 Questions?

More Related