PEM Physicians' Perceptions of Colleagues' Clinical Competencies over Four Age Categories

Background: The US physician workforce is aging, prompting concerns regarding clinical performance of senior physicians. Pediatric Emergency Medicine (PEM) is a high acuity, multitasking, diagnostically complex and procedurally demanding pediatric specialty. The impact of aging on clinical competence in PEM has not been previously examined; our aim was to assess peer ratings of the clinical competency of four age groups of PEM physician colleagues using an electronic survey instrument

Methods: We invited all 478 PEM physicians who were members of the AAP Section on Emergency Medicine survey study list-serve in June 2020 to participate anonymously. The survey was designed by the investigators with iterative input from institutional colleagues. Respondents were asked to rate, using a 5-point Likert scale, the average competency of four age categories of PEM physicians in performing 9 clinical tasks. Additional items included concerns about de-identified colleague’s clinical competence, preferences for age of physician managing a hypothetical critically ill child family member of the respondent, self-ratings of clinical competencies, late career transition plans and impact of COVID-19 on personal practice pattern. This analysis focuses on respondents’ rating of colleagues’ clinical competencies and age preference for physician managing a child relative. Our study was exempted from IRB review.

Results: We received 256 survey responses; 24 failed to answer at least one question central to our hypotheses and were excluded, leaving 232 for analysis (adjusted response rate of 48.9%). Most respondents were 36-49 years old (yo) (34.9%) or 50-64 yo (47.0%), with 45.8% female and 40.9 % male.
The majority of respondents (53%) reported some concern about a colleague’s competence. A lower percentage of the senior PEM physician age group (≥ 65 yo) was rated as very good or excellent for critical care-related competencies when compared to mid-career physicians (36-49 yo or 50-64 yo ) (Table). The performance ratings for effective communication to hostile or anxious families and delivery of bad news found the senior group rated better than the youngest group (≤ 35 yo). Among the 129 of 224 (57.6%) respondents who ranked an age category for a colleague managing a critically ill child relative, almost all indicated preference for a 36-49 yo (69%), followed by a 50-64 yo (27.9%) colleague (Figure).

Conclusion: In this exploratory study, PEM physicians’ perceptions of their peers’ clinical competencies demonstrated significant differences by peer age group. For competence domains posing procedural and multitasking challenges, PEM physicians ≥ 65 yo were generally perceived as less competent than those aged 36-64 yo. However, for those practice domains that required considerable “clinical wisdom” such as demanding communication skills, senior PEM physicians were perceived as performing as well if not better than younger peers. Further study of age-related PEM competencies with more objective measures may be warranted.