Can Yale legally require cognitive exams of older doctors at its New Haven hospital? That question appears headed for trial after a federal judge’s ruling in a long-running dispute between Yale and the US Equal Employment Opportunity Commission (EEOC).
In February 2020, the EEOC filed a lawsuit against Yale New Haven Hospital (YNHH) over its policy requiring individuals aged 70 years or older seeking medical staff privileges to complete ophthalmologic and neuropsychological medical examinations.
The lawsuit arose after Irwin Nash, MD, a pathologist affiliated with YNHH at the time, filed a complaint with the EEOC. Although he passed the organization’s required testing, court documents allege that the late-career practitioner (LCP) policy subjected Nash and other employees to the “stigma of being singled out because of their age and to unlawful discrimination” under the Age Discrimination in Employment Act and the Americans with Disabilities Act.
Amid worsening provider shortages and an aging physician workforce, the EEOC lawsuit and subsequent ones continue to fuel questions about whether and how doctors’ capabilities should be evaluated as they age, and the risk that such assessments could prematurely push physicians out of the field.
An EEOC spokesperson told Medscape Medical News that the agency does not comment on ongoing litigation. A Yale hospital spokesperson said they have no further comment outside of the court proceedings.In a 2020 statement to The Connecticut Post, the hospital defended its policy as a patient-safety measure with safeguards to ensure fair treatment of physicians.
LCP Policies Vary
With nearly 1 in 4 active US physicians aged 65 years or older, according to survey data from the Association of American Medical Colleges, age-related cognitive screening policies could eventually affect a substantial portion of physicians.
While doctors often cite reasons other than money for wanting to practice into their later years, such as feeling they have more to contribute or considering medicine their passion, some may leave clinical practice early, well before age-based policies affect them.
But those who continue practicing into their seventies may face cognitive assessments as a condition of maintaining hospital privileges.
A September 2026 analysis in JAMA Health Forum identified about two dozen US health systems across 14 states that have implemented age-based screenings, typically beginning between 70 and 75 years. The analysis found that most health systems do not publicly disclose their cognitive screening methods, though some use validated tools, such as the Montreal Cognitive Assessment or MicroCog.
A 2024 study in the Annals of Internal Medicine reviewed the LCP policies of 29 healthcare organizations and found that program success varied, frequently because of provider pushback and concerns about assessment accuracy. About 80% of the programs required reassessment every 2 years, with nearly 90% requiring a physical examination and roughly 83% requiring a neuropsychological examination.
But without standardized age-related testing across the workforce, physicians may be reluctant to participate.
James Ellison, MD, MPH, a geriatric psychiatrist and co-director of the Comprehensive Alzheimer’s Center at the Vickie & Jack Farber Institute for Neuroscience at Jefferson Health in Philadelphia, told Medscape Medical News that some doctors may even choose to retire early rather than submit to mandatory age-based testing, “particularly if they view the process as intrusive, stigmatizing, or potentially unfair.”
The Annals of Internal Medicine study noted this outcome, with one health organization reporting that more than 25% of physicians eligible for the assessment resigned before screening. Seven LCP policies also did not specify a recommended course of action when a physician tested below expectations, possibly adding to physician uncertainty about how the testing could impact their livelihoods.
‘We Can’t Assess Ourselves’
According to EEOC’s lawsuit, YNHH had applied its LCP policy to 145 individuals as of April 2019. The majority passed, but 14 were classified as “borderline deficient,” 1 as “deficient,” and 7 as “failed.” Court records said five clinicians refused testing, resigned, or changed status, and one individual was ultimately identified as needing a “discussion regarding modifying his duties to simple coverage because of his findings.”
Mark Katlic, MD, director of the Aging Surgeon Program at LifeBridge Health System in Baltimore, supports age-based screening to identify potential problems before they become larger issues. The Aging Surgeon Program provides comprehensive, 2-day evaluations of late-career surgeons, who are often referred by other hospitals to assess their abilities.
He told Medscape Medical News that the program is separate from LifeBridge’s broader LCP policy, which requires all practitioners, including advanced practice providers, seeking renewal of hospital privileges to undergo physical, eye, and neuropsychological examinations beginning at age 75. Doctors can have a provider of their choosing complete all but the neuropsychological assessment, which LifeBridge coordinates, said Katlic.
Although he admits age-based assessments may have rare drawbacks and that more regulations can make doctors feel like “cogs in a wheel,” he still believes they are currently the best alternative to “pick up those few individuals who might represent a risk to patient safety.”
“You’re not hiring or firing based upon that screening evaluation; it’s just providing additional data upon which a rational decision can be made,” said Katlic, who will undergo the assessment himself next spring when he turns 75. “The reality is we can’t assess ourselves, and it would be unfair to have mandatory retirement based on age, because there’s enormous variability in deterioration among individuals.”
Screening Best Practices
Ellison said employers should question what cognitive screening results can actually tell them about a clinician’s abilities. “A low screening score may be a reason to look more closely,” he agreed. “It is not, by itself, proof that a physician is practicing unsafely.”
In an October 2026 paper in The American Journal of Geriatric Psychiatry, Ellison and co-authors proposed a “stepwise whole-career quality assurance program,” not just one focused late in practice, since concerns about performance, health, or well-being can arise at any age. This approach would avoid what he calls the “pre-emptive justice” associated with age-triggered testing, which “risks treating a marker of possible vulnerability as though it were evidence of professional wrongdoing.”
Still, “if there is an immediate, credible patient-safety concern, the hospital must act promptly to protect patients while arranging a fair evaluation,” he said.
For less critical assessment findings, Ellison favors an individualized response. Next steps may include observing a physician’s clinical performance or addressing vision, hearing, or sleep difficulties. Workplace accommodations, changes to workload or scope of practice, or help transitioning to retirement may also be warranted.
“But the key question remains how the physician is functioning in the work they actually do,” he said. “What we still need is stronger evidence connecting [assessment] findings to independent measures of clinical performance and patient outcomes.”
Both Ellison and Katlic said they would welcome national standards for physician assessment. State medical boards could fill that role and, in the process, cover more physicians than hospital-based LCP policies.
The American Medical Association has adopted nine guiding principles for assessing physician competence throughout their careers, including evidence-based standards, supportive remediation practices, and a recommendation that “age alone should not be a precipitating factor.”
Whatever the approach, Ellison said, assessments should be confidential, set clear standards tailored to a physician’s specialty and scope of practice, and allow physicians to respond to and appeal findings.
As for the Yale case, the October 23 ruling paves the way for a trial, unless parties reach an agreement beforehand.
US District Judge Kari A. Dooley said in her decision: “[T]here is no genuine dispute among the experts that the single greatest indicator of cognitive decline is age and that cognitive decline is often difficult to detect. This is, unfortunately, where the agreement ends.”
The sources cited in this article had no relevant disclosures.
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