'Too Old to Practice? Screening Older Physicians Gains Ground'

 Aging is known to reduce cognitive and physical capacities and may affect professional performance, including that of physicians. This topic was addressed in 2022 in Medscape’s Portuguese edition.

The article “ Too Old to Practice Medicine?” by Mônica Tarantino noted that, “unlike many other professions, there is no age limit for practicing medicine.” It cited an international standard that recommended mandatory retirement for airline pilots based on age.

In contrast, “the only restriction on professional practice in the medical field is the mandatory retirement imposed on medical professors who teach at public universities, starting at 75 years of age.”

A Medscape survey cited in the article showed that most physicians were against age-based limitations, although one third of respondents agreed with periodic assessments of cognitive abilities.

Physicians do not always report or recognize their own limitations, and such concerns are rarely communicated to human resources departments. So what can be done? Even in the US, few programs have been designed to assess the limitations and protect the professional performance of older physicians.

An analysis of these programs was recently published in The New England Journal of Medicine, which found that many policies designed to screen late-career physicians for cognitive impairment lack basic procedural fairness and legal protection.

The analysis highlighted the lack of clear standards defining physicians’ rights, appeal processes, and access to legal representation. Therefore, the authors proposed recommendations to help protect patients while treating physicians fairly.

Main Recommendations

Five recommendations are proposed to improve fairness and make these policies more acceptable to older physicians:

1. Early engagement: Hospital leaders should clearly explain the necessity of mandatory screening, seek feedback from physicians on policy design, and genuinely consider their suggestions.
2. Universal application: All physicians should be screened starting at age 70, an age that reasonably reflects the current evidence.
3. Best tests: Screening should use validated tests that can reliably predict clinical performance. An individual’s results should be compared with those of healthy, high-performing physicians rather than those of the general population aged more than 70 years. Physicians should receive the results of the assessment confidentially, with clear explanations and guidance on opportunities for improvement.
4. Clear processes: Programs should clearly explain how concerning results lead to further evaluation and which scores may result in restrictions. Physicians should have clear rights to appeal, including the option to request additional assessments and seek legal representation.
5. Significant adaptations: Before restricting physician work, hospitals and healthcare organizations should explore less restrictive options, such as adjusting schedules, shifting patients to lower-risk cases, or transitioning to teaching roles.

Implications

The study’s lead author , Daniel B. Kramer, MD , MPH, Section Head of Electrophysiology and Digital Health, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, and Associate Professor of Medicine, Harvard Medical School, Boston, attributed the delay in implementing screening policies, in part, to the traditionally autonomous nature of medical practice in private settings. Recently, physicians have increasingly become employees of hospitals and healthcare organizations. Therefore, it is understandable that older physicians may resist the perceived loss of autonomy.

In Brazil, older physicians are allowed to continue practicing and are valued for their experience, provided they maintain competence. Oversight is largely complaint-driven, with Regional Medical Councils responsible for evaluation when concerns arise.

It is worth reflecting on these recommendations to help protect older physicians and their patients.

https://www.medscape.com/viewarticle/too-old-practice-screening-older-physicians-gains-ground-2026a10008ib