Health systems are facing a late-career physician dilemma: An aging workforce raises patient safety concerns, yet shortages and early retirements among mid-career physicians mean late-career physicians are needed more than ever.
The physician workforce has faced an aging problem for decades. Nearly 47% of the active physician workforce is 55 or older, up from 38% in 2007, and in 2025, 22.4% of physicians were over 65. The share of physicians 65 or older doubled, from about 11% in 2005 to 22.4% in 2025.
With age, reaction times slow, knowledge can become outdated and some people can experience cognitive decline. Mild cognitive impairment increases with age, going from 8.4% in adults 65 to 69, up to 25.3% in adults 80 to 84, according to the American Academy of Neurology. However, systems do not want to push experienced physicians out of patient care.
Hospitals and systems are trying to balance safety and keeping experienced physicians.
1. Most systems and hospitals rely on physicians to decide when to retire, but most physicians do not recognize when it’s time. An American College of Surgeons statement said physicians do not reliably recognize when it’s time to step back, and colleagues often fail to report issues. A survey found 69% of physicians reported being prepared to effectively deal with impaired colleagues in their practice. Among those who knew of an impaired or incompetent colleague and didn’t report it, common reasons were assuming someone else would act, fearing retaliation or believing nothing would happen. This delay leaves patients responsible for filing complaints about poor care, and by then, it can be too late to reduce harm.
2. Some research links older physicians with poorer patient outcomes. A 2005 review of 62 studies found increased physician age or years in practice was associated with poorer performance in some or all measures, including higher patient mortality. A 2023 study that analyzed more than 2.6 million emergency department visits found patients aged 65 to 89 who were treated by physicians under 40 had lower seven-day mortality than those treated by older physicians.
Studies from Yale New Haven Hospital and Hartford (Conn.) Healthcare found 12.7% to 14.4% of physicians over 70 who were screened showed some degree of cognitive impairment.
3. To catch cognitive decline and possibly prevent patient harm, about 200 hospitals require screenings for physicians 70 and older. Screenings are required before physicians’ privileges and credentials are renewed on a yearly or two-year basis. Depending on the results, physicians may see a change in job responsibilities or how they practice. Proponents of the screenings say the programs could prevent patient harm and allow physicians to take on less demanding assignments or more easily transition to teaching, mentoring and consulting.
4. But many physicians choose to retire rather than undergo evaluation.
“This [screening] really makes some doctors furious,” Thomas Gallagher, MD, a University of Washington bioethicist and physician who studies healthcare quality and late-career medical practice, told The Washington Post. “It comes from the sense of stigma and maybe even humiliation around feeling like you’re being labeled as no longer an effective clinician because of your age.”
A trial over Yale New Haven (Conn.) Hospital’s policy of cognitive testing for physicians over age 70 began Aug. 27. The federal Equal Employment Opportunity Commission sued the hospital in 2020 over cognitive testing for older staff members, claiming the policy is age discrimination.
5. This dilemma comes as more mid-career physicians are retiring early. Research suggests mid-career surgeons are more likely to leave clinical practice than those with more than 15 years or less than nine years of experience. Among 224,629 surgeons, 15,753 left clinical practice over a median of eight years.
Physicians are also leaving clinical practice earlier. A May American Medical Association study of clinically inactive physicians found that administrative burdens and stress were prime motivators for leaving medicine. Among 971 clinically inactive physicians surveyed, 11% reported never entering clinical practice after completing residency, 53.7% have stopped practicing and 35.3% worked fewer than 20 hours per week.
6. Small shifts in retirement age could strain physician supply. The AMA study estimated that if the average retirement age dropped by two years, the projected physician supply would fall in 2036 by about 40,000.
Across 35 specialties, the Health Resources and Services Administration’s National Center for Health Workforce Analysis projected a shortage of 141,160 full-time equivalent physicians by 2038.
7. Some organizations are pushing for a middle path. The American College of Surgeons endorsed a whole-of-career assessment for surgeons of every age. It would combine clinical outcomes, physical and mental health assessment and standardized cognitive measures. If issues arise, a hospital could conduct chart reviews, observe or video review procedures, as well as get feedback from coworkers or assign a proctor.
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