Hospital and health system leaders are grappling with the balance between keeping patients safe and what to do when aging physicians continue to practice amid declining abilities, The Washington Post reported Oct. 12.
Nearly 47% of the active physician workforce is 55 or older, up from 38% in 2007, and in 2025, 22.4% of physicians are over 65. At older ages, reaction times slow, knowledge can become outdated and some can experience cognitive decline.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.
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.
“It’s becoming a bigger issue with each passing year,” clinical neuropsychologist Victor Del Bene,PhD, of the University of Alabama at Birmingham, told the Post.
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.
Mandatory retirement policies are almost nonexistent in the U.S. Instead, most systems and hospitals rely on physicians to retire on their own. However, 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, and most said they know of an impaired colleague, but have not acted because they assumed someone else would act, feared retaliation or believed nothing would happen.
This delay, however, leaves patients responsible for filing complaints about poor care, and by then, it can be too late to reduce harm, the Post reported.
To reduce liability and patient safety incidents, about 200 hospitals and systems have created late-career practitioner programs that mandate physicians 70 and older to be screened for cognitive and physical defects. Screenings are required before their 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. However, many physicians choose to retire rather than undergo evaluation.
“This [screening] really makes some doctors furious,” Thomas Gallagher, a University of Washington bioethicist and physician who studies healthcare quality and late-career medical practice, told the 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.
Some experts told the Post there could be a compromise. 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 arose, a hospital could chart reviews, observation or video review of procedures, as well as get feedback from coworkers and proctoring.
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