- The U.S. and other nations lack standardized nationwide cognitive screening frameworks for aging doctors.
- About 25 U.S. health systems independently screen older clinicians, according to public records.
- Experts urged patient-safety protections while ensuring screening programs were fair to physicians.
Policies addressing cognitive decline in aging physicians were uncommon in the U.S. and similar countries, a comparative policy analysis showed.
Unlike safety-critical fields in other industries, healthcare has historically relied on self-regulation and peer review rather than proactive cognitive screening, though some hospital systems screen physicians independently, reported Nathan Stall, MD, PhD, of the University of Toronto, and co-authors.
No Group of Seven (G7) country has established a standardized, nationwide framework to directly evaluate the cognitive health of aging physicians, the researchers stated. In contrast, mandatory retirement is required for most judges, commercial pilots, and air traffic controllers across all G7 countries, they said in JAMA Health Forum.
"Physicians take great pride in the knowledge and skills they acquire over their career, and self-regulatory models will remain important components of physician oversight," Stall and colleagues observed.
"However, the public expects and the high standards of medical professionalism require more nuanced protective measures to account for the complex and individualized nature of cognitive aging," they wrote.
Some institutions, like the Yale New Haven Hospital in Connecticut, implemented their own age-based cognitive screening programs, the researchers noted. Between 2016 and 2019, Yale New Haven implemented a screening strategy as part of recredentialing of clinicians ages 70 or older.
In 2020, a study of 141 of these physicians suggested that 13% had cognitive deficits that were likely to impair their ability to practice medicine independently and the hospital was sued by the Equal Employment Opportunity Commission on the basis of age and disability discrimination. The case was argued in federal court in August 2026.
Two things stood out in the Yale New Haven study, said Thomas Gallagher, MD, of the University of Washington in Seattle, who wasn't involved in the research. "One was the proportion of screened physicians who had cognitive impairment that was noteworthy," he told MedPage Today.
"It also struck me that none of those physicians were on the radar screen of the medical staff leadership in any other way," Gallagher pointed out.
"This is why screening is such an important thing to do," he emphasized. "But professional societies like the American College of Surgeons or the American Medical Association have stopped short of recommending mandatory screening because I think a lot of physicians have concerns about the fairness of these programs."
In a recent New England Journal of Medicine paper, Gallagher and colleagues highlighted that patient safety should be prioritized in screening programs for late-career clinicians. "The patient's interests should be first, but that doesn't mean we should ignore the interests and the needs of physicians," Gallagher said. "Taking steps to ensure that programs are fair to physicians can increase their buy-in and acceptance."
About 24% of active physicians are ages 65 or older, according to the AAMC. To analyze regulatory frameworks addressing cognitive decline in aging physicians in the U.S. and other G7 countries, Stall and colleagues assessed 342 policy documents, government reports, scholarly works, and other official federal or jurisdictional documents.
Approximately 25 U.S. health systems in 14 states had publicly available age-based cognitive screening policies for clinicians ages 70 to 75, including academic hospitals and clinics in Arkansas, California, Connecticut, Kentucky, Maryland, Michigan, Nebraska, New Hampshire, New Jersey, Oregon, Pennsylvania, Texas, Utah, and Virginia, the researchers found.
Of these, only five -- three in California (University of California San Diego, Tahoe Forest Health System, and Los Robles Regional Medical Center), one in Connecticut (Hartford HealthCare), and one in Utah (Intermountain Health) -- specified validated screening instruments like the Montreal Cognitive Assessment or MicroCog as part of age-based assessments.
Continuing medical education (CME) credits were required in 46 states for physician license renewals; Indiana, Montana, New York, and South Dakota were exceptions. License renewal was compulsory in all states and applications required self-disclosure of impairments that may affect clinical performance.
The analysis had several limitations, the researchers acknowledged. It relied on publicly available policies which may have led to internal institutional guidelines being omitted. Physicians are not a homogeneous group and cognitive demands vary by specialty, they added.
"One of the things you learn as you talk with organizations that have developed late-career practitioner programs is that when they launch the programs, there's often a preemptive wave of retirements," Gallagher noted.
"I've asked medical directors whether they think that's a good outcome or a bad outcome. If physicians retire rather than going through a screening program -- if it's a physician who was really starting to struggle to practice safely -- then retirement is a good thing," he said. "But if it's a physician who could have continued to practice safely but was worried about whether the testing was going to be fair, if they're retiring when they really could keep practicing, that's a bad outcome."
Disclosures
Stall had no conflicts of interest. One co-author received research funds from the Alzheimer Society of Canada.
Gallagher reported grant funds from the Greenwall Foundation to the University of Washington.
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