Aging Doctors Lack Standard Cognitive Screening Policies
A study finds no G7 country has a nationwide framework to evaluate aging physicians' cognitive health, though about 25 U.S.
No G7 country has a standardized, nationwide framework to directly evaluate the cognitive health of aging physicians. This finding comes from a comparative policy analysis published in JAMA Health Forum, which examined regulatory approaches in the United States and other major industrialized nations.
Researchers led by Nathan Stall, MD, PhD, of the University of Toronto, reported that healthcare has historically relied on self-regulation and peer review rather than proactive cognitive screening. This stands in contrast to other safety-critical fields like commercial aviation, where mandatory retirement ages are common across all G7 nations. The study assessed 342 policy documents, government reports, and scholarly works.
Patchwork of U.S. Screening Programs
Approximately 25 U.S. Health systems across 14 states have publicly available age-based cognitive screening policies for clinicians, typically starting between ages 70 and 75. These systems are located in Arkansas, California, Connecticut, Kentucky, Maryland, Michigan, Nebraska, New Hampshire, New Jersey, Oregon, Pennsylvania, Texas, Utah, and Virginia. However, the study found that only five of these institutions specified the use of validated screening instruments.
The following health systems named specific cognitive assessment tools as part of their age-based screening:
The Yale New Haven Case Study
Some institutions, like Yale New Haven Hospital in Connecticut, have implemented their own programs. Between 2016 and 2019, the hospital began screening clinicians aged 70 or older as part of recredentialing. A subsequent 2020 study of 141 of these physicians suggested that 13% had cognitive deficits likely to impair their ability to practice independently.
Thomas Gallagher, MD, of the University of Washington in Seattle, commented on the findings to MedPage Today. "One was the proportion of screened physicians who had cognitive impairment that was noteworthy," he said. "It also struck me that none of those physicians were on the radar screen of the medical staff leadership in any other way." The hospital was later sued by the Equal Employment Opportunity Commission for age and disability discrimination, with the case argued in federal court in August 2026.
Balancing Safety and Fairness
Experts stress that patient safety must be prioritized while ensuring screening programs are fair to physicians. In a recent New England Journal of Medicine paper, Gallagher and colleagues highlighted this balance. The patient's interests should be first, but that doesn't mean we should ignore the interests and the needs of physicians, Gallagher said. He noted that professional societies like the American College of Surgeons or the American Medical Association have stopped short of recommending mandatory screening due to physician concerns about fairness.
Gallagher also observed a common trend when organizations launch such programs. There's often a preemptive wave of retirements, he noted. He explained that retirement is a good outcome if a physician was struggling to practice safely, but a bad outcome if a capable physician retires due to fears about unfair testing.
Current Regulatory Landscape
The study noted that about 24% of active U.S. Physicians are aged 65 or older. For license renewal, continuing medical education credits are required in 46 states, with Indiana, Montana, New York, and South Dakota as exceptions. All states require physicians to self-disclose impairments that may affect clinical performance on their license applications. The researchers acknowledged limitations, including that their analysis relied on publicly available policies and may have missed internal institutional guidelines.
Stall and colleagues concluded that while self-regulation remains important, the public expects more nuanced protective measures to account for the complex nature of cognitive aging.
