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Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences
  1. Andrew A White1,
  2. William M Sage2,3,
  3. Paulina H Osinska1,
  4. Monica J Salgaonkar1,
  5. Thomas H Gallagher4
  1. 1 Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
  3. 3 School of Law at the University of Texas at Austin, Austin, Texas, USA
  4. 4 Departments of Medicine and Bioethics, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Andrew A White, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; andwhite{at}


Background Unprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity.

Objective To describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development.

Design Thematic content analysis of interviews and focus groups.

Participants 40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from all US regions, surgical and non-surgical specialties, and both academic and non-academic institutions.

Results Stakeholders describe lax professional self-regulation of LCPs and believe this represents an important unsolved challenge. Patient safety and attention to physician well-being emerged as key organising principles for policy development. Stakeholders believe that healthcare institutions rather than state or certifying boards should lead implementation of policies related to LCPs, yet expressed concerns about resistance by physicians and the ability of institutions to address politically complex medical staff challenges. Respondents recommended a coaching and professional development framework, with environmental changes, to maximise safety and career longevity of physicians as they age.

Conclusions Key stakeholders express a desire for wider adoption of LCP standards, but foresee significant culture change and practical challenges ahead. Participants recommended that institutions lead this work, with support from regulatory stakeholders that endorse standards and create frameworks for policy adoption.

  • continuing education, continuing professional development
  • health policy
  • human error
  • management
  • qualitative research

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  • Contributors AAW, WMS and THG conceived of the study. AAW, MJS, THG and PHO obtained and analysed the data. All coauthors contributed to the drafting and revision of the manuscript.

  • Funding This study was funded by Greenwall Foundation (grant number: Making a Difference Program).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Washington Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.