UC San Diego PACE outlines how physician assessments and remediation work; board probes recidivism and scope

UC San Diego's PACE program described to the Medical Board of California on Aug. 20 how it conducts clinical competence assessments, fitness-for-duty evaluations and remedial education for referred physicians.

PACE director of administration Peter Bull told the board the program uses a hybrid assessment model that combines remote review of records with one-to-two-day on-site evaluation in San Diego. Assessments are framed against the ACGME/ABMS six core competencies — patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice — and may include chart-stimulated recall, standardized patient encounters and multidisciplinary case conferences, Bull said.

Bull described PACE's four-category rating scale. Category 1 indicates performance consistent with safe practice; category 2 indicates minor, non-safety-relevant deficits; category 3 identifies broad-based deficiencies warranting remediation and supervision; and category 4 denotes practitioners judged unsafe at the time of evaluation, some of whom may not be suitable for reassessment without substantial retraining.

Bull said about two-thirds of physicians referred to PACE fall into categories 1 or 2, roughly 20% in category 3, and about 10% in category 4. He added that the program has reassessed physicians when remediation pathways were plausible, while some physicians with health-related impairments may not be candidates for reassessment.

PACE staff also reviewed programs that follow an assessment: longitudinal physician enhancement programs (monthly chart review and mentoring, quarterly reports to the referring entity), behavioral courses addressing communication, professionalism and disruptive behavior, plus a PACE-plus coaching option (seven coaching sessions over several months with behavioral assessments and accountability planning).

Board members asked how PACE measures recidivism and whether allied health professionals can participate. Bull said recidivism calculations reflect participants who returned for the same PACE course more than once. He confirmed the program assesses physician assistants and podiatrists in some circumstances and accepts some allied professionals for select CME/remediation activities, but most regulatory referrals come for physicians.

Why it matters: Board members repeatedly asked how PACE's findings are translated into enforceable conditions and how the board should rely on the program when approvals, probationary terms, or public letters of reprimand follow. PACE staff said the board retains responsibility for implementation and that the program's recommendations are commonly incorporated into probationary or settlement terms when the board or an attorney general filing asks for them.

Lede takeaway: PACE aims to combine objective testing with clinical judgment to recommend remediation or monitoring; the board sought clarity about how program recommendations should be embedded in licensing or disciplinary orders to ensure public protection.

Nut graf: The PACE presentation clarified the range of assessments and remedial options available to regulators reviewing physician competence. Board members pressed for more detail on how to operationalize PACE findings in enforcement orders, how to handle clinicians close to the safety threshold, and how outcomes are tracked over time.

Ending: PACE staff urged referring bodies to consider structured, documented supervision and to evaluate defendants' medical and procedural competence longitudinally before restoration of full privileges. The board signaled continued interest in guidance on integrating PACE recommendations into enforceable terms.

Speakers quoted (whitelist): Peter Bull, director of administration, UC San Diego PACE program; Dr. Felix Yip, Medical Board member.

Topics: physician assessment; remediation; professional conduct

Actions: none formalized at this meeting