As outlined in the Norwegian Act relating to medical practitioners (of 1980), doctors practising in Norway loose their authorization automatically at age 75, but have the possibility of applying for a continued license. Such a regulation is rather unique from an international point of view. We have investigated doctors' attitude towards this regulation.
The article is based on two postal questionnaire surveys; one sent to 1400 practising doctors in 2006 and one sent to 900 retired doctors in 2007.
69% (969/1400) of the practising and 92 % (829/900) of the retired doctors responded. 80 % (772/969) of the practising and 34 % (284/829) of the retired doctors agreed with the requirement to apply for an extended licence at age 75. 25 % (97/389) of the respondents over 74 years had retained their license at the time of the investigation.
Most doctors under age 70 accept automatic discontinuation of authorization at age 75, but support of the regulation decreases with increasing age.
Viral respiratory infections (VRIs) are a common reason for ambulatory visits, and 35% are treated with an antibiotic. Antibiotic use for VRIs is not recommended, and it promotes antibiotic resistance. Effective patient-physician communication is critical to address this problem. Recognizing the importance of physician communication skills, licensure examinations were reformed in the United States and Canada to evaluate these skills.
To assess whether physician clinical and communication skills, as measured by the Canadian clinical skills examination (CSE), predict antibiotic prescribing for VRI in ambulatory care.
A total of 442 Quebec general practitioners and pediatricians who wrote the CSE in 1993-1996 were followed from 1993 to 2007, and their 159,456 VRI visits were identified from physician claims.
The outcome was an antibiotic prescription from a study physician dispensed within 7 days of the VRI visit. Multivariate logistic regression analyses were used to estimate the association between antibiotic prescribing for VRI and CSE score, adjusting for physician, patient, and encounter characteristics.
Better clinical and communication skills were associated with a reduction in the risk of antibiotic prescribing, but only for female physicians. Every 1-standard deviation increase in CSE score was associated with a 19% reduction in the risk of antibiotic prescribing (risk ratio, 0.81; 95% confidence interval, 0.68-0.97). Better clinical skills were associated with an even greater reduction in risk among female physicians with higher workloads (risk ratio, 0.48; 95% confidence interval, 0.29-0.79).
Physician clinical and communication skills are important determinants of antibiotic prescribing for VRI and should be targeted by future interventions.
The Clinician Assessment for Practice Program (CAPP), a program of the College of Physicians and Surgeons of Nova Scotia (CPSNS), assesses the readiness for family practice of international medical graduates (IMGs) who have trained and practiced abroad with no formal Canadian residency training.CAPP has three parts. Part A, a therapeutics exam and an objective structured clinical examination, assesses practice readiness. Part B is a 12-month mentorship in which the CAPP physician is in active practice under a defined license and is mentored by an established family physician. The mentor provides teaching, supervision, guidance, and regular performance assessment. Each CAPP physician negotiates an individualized continuing medical education plan. An on-site assessment of each CAPP physician's practice is conducted by an external assessor who provides feedback to the CAPP physician and his or her mentor. Multisource feedback is administered at 10 months, using questionnaires from patients and colleagues. After 12 months, all assessment data are reviewed by the CPSNS to determine whether to continue the defined license. Part C, run by the registration department (not CAPP), may last three additional years until full licensure is obtained. To date, 148 IMGs have been assessed, 35 have been deemed eligible for a defined license, and 27 have entered family practice, virtually all in small or medium-sized communities in Nova Scotia. The program has been well received by participants and their communities. The mentorship, particularly valuable in assisting IMGs to integrate into their communities, has proven to be the defining feature of CAPP.
Clinical competence is a determinant of the quality of care delivered, and may be associated with use of health care resources by primary care physicians. Clinical competence is assumed to be assessed by licensing examinations, yet there is a paucity of information on whether scores achieved predict subsequent practice.
To determine if licensing examination scores were associated with selected aspects of quality of care and resource use in initial primary care practice.
Prospective cohort study of recently licensed family physicians, followed up for the first 18 months of practice.
The Quebec health care system.
A total of 614 family physicians who passed the licensing examination between 1991 and 1993 and entered fee-for-service practice in Quebec.
All patients seen by physicians were identified by the universal health insurance board and all health services provided to these patients were retrieved for the 18 months prior to (baseline) and after (follow-up) the physicians' entry into practice. Medical service and prescription claims files were used to measure rates of resource use (specialty consultation, symptom-relief prescribing compared with disease-specific prescribing) and quality of care (inappropriate prescribing, mammography screening). Baseline data were used to adjust for differences in practice population.
Study physicians saw a total of 1116389 patients, of whom 113535 (10.2%) were elderly and 83391 (7.5%) were women aged 50 to 69 years. Physicians with higher licensing examination scores referred more of their patients for consultation (3.8/1000 patients per SD increase in score; 95% confidence interval [CI], 1.2-7.0; P = .005), prescribed to elderly patients fewer inappropriate medications (-2.7/1000 patients per SD increase in score; 95% CI, -4.8 to -0.7; P=.009) and more disease-specific medications relative to symptom-relief medications (3.9/1000 patients per SD increase in score; 95% CI, 0.3 to 7.4; P= .03), and referred more women aged 50 to 69 years (6.6/1000 patients per SD increase in score; 95% CI, 1.2-11.9; P = .02) for mammography screening. If patients of physicians with the lowest scores had experienced the same rates of consultation, prescribing, and screening as patients of physicians with the highest scores, an additional 3027 patients would have been referred, 179 fewer elderly patients would have been prescribed symptom-relief medication, 912 more elderly patients would have been prescribed disease-specific medication, 189 fewer patients would have received inappropriate medication, and 121 more women would have received mammography screening.
Licensing examination scores are significant predictors of consultation, prescribing, and mammography screening rates in initial primary care practice.