A longitudinal study of performance of physicians' office practices: data from the Peer Assessment Program in...

The College of Physicians and Surgeons of Ontario has conducted a Peer Assessment Program since 1980. All physicians who turn 70 years of age in a given year are automatically selected for assessment, and the program assesses a random selection of physicians within specific practice and specialty areas. Each assessor--a physician who practices in the same area of medicine as the physician undergoing assessment--reviews the physical facilities, the system of record keeping and the content of approximately 20-30 medical records, and the quality of care provided, as determined by the medical record content and discussions with the physician. The assessed physician is then assigned a grade. In 1998, program records for 109 nonspecialist physicians who had undergone two assessments more than 10 years apart (first assessment, 1981 to 1987; second, 1991 to 1997) were examined to determine possible changes in performance.

The mean time between assessments was 12.2 years. Seventy (64.2%) of the 109 physicians showed a decline in grade, whereas 35 (32.1%) received the same grade, and only 4 (3.7%) had an improvement in grade.

This report is consistent with previous observations that performance changes with age. In contrast to previous studies, this report is based on longitudinal rather than cross-sectional data.