Imagine that you are managing a group of radiologists, and your oldest employee is working part-time. Other employees share their concern that the quality of this employee’s reports is lacking, potentially due to “cognitive decline.” How do you proceed?

David Fessell, MD, University of Michigan Medical School in Ann Arbor, Mich., and Frank J. Lexa, MD, medical director of the American College of Radiology’s Radiology Leadership Institute, presented four different imaging leaders with this hypothetical situation, asking each one what they would do. All four answers were included in a recent article published by the Journal of the American College of Radiology.

Overall, each of the four respondents indicated that his first step would be to review the individual’s work.

Michael Recht, MD, New York University, detailed what he would do if a focused review confirmed the co-workers’ concerns.

“If the review confirmed that the reports were below our department’s standards of clinical excellence, I would then personally meet with the individual,” Recht said. “I would explain gently but firmly that although I, and the entire department, appreciated his previous contributions to our practice, he could not continue in his clinical role. I would, however, offer other options for the individual to remain a contributing member of our department.”

James Rawson, MD, Augusta University, also suggested finding a different employment opportunity for the radiologist.

“We would discuss the best way for my colleague to continue to contribute,” Rawson said. “This could lead to retraining, a change in clinical practice, or redirection of his time to other practice-building and quality improvement projects. We would reach a mutually beneficial solution.”

Kimberly Applegate, MD, Emory University, noted that recent performance would need to be compared with that of previous years to paint a clearer picture of the situation. Applegate also suggested a policy update that could help with future incidents.

“I would ensure that there is a retirement policy that includes annual review after 70 years of age and a performance and peer review committee,” Applegate said. “This committee or the quality officer could be tasked to review metrics and a sample of reports.”

Meanwhile, Mitchell Schnall, MD, University of Pennsylvania, was the only respondent who specifically mentioned suspending the radiology if evidence was found that patient care was being compromised.

“I would immediately ask the radiologist to suspend work (with pay) while we assess the situation further, likely with a focused professional practice evaluation (FPPE),” Schnall said.

Schnall added that if there was no clear-cut evidence of compromised care, he would still discuss the matter with the individual and ask if they believed their own skills were declining.