Editor's note: This popular story from the Daily Briefing's archives was republished on June 30, 2023.

As the physician workforces ages, there are growing concerns about potential physical and mental decline among older doctors. Writing in the New York Times, Sandeep Jauhar, a cardiologist in New York, explains why he thinks age-based competency tests may be necessary to ensure older doctors are not significantly impaired and protect patients from potential harm.

How an aging physician workforce could impact care

According to Jauhar, the physician workforce, much like the general U.S. population, is growing older, and many baby boomer doctors are choosing to continue practicing medicine even as they pass retirement age. A survey from 2020 also found that almost a third of licensed physicians in the United States were ages 60 and older—up from 25% a decade ago.

With high levels of burnout and turnover among the health care workforce, the trend of older doctors staying in the workforce "isn't entirely unwelcome," Jauhar writes. However, "aging inevitably brings physical and mental decline, which can affect physician performance and put patients at risk," Jauhur writes.

In a recent study published in JAMA Neurology, researchers found that one in five adults over the age of 65 may have cognitive impairment that cannot be attributed to normal age-related changes. This problem also worsens the older people get, with estimates suggesting that roughly 40% of Americans have measurable cognitive impairment.

Although "growing older can also bring great benefits, including the accrual of experience and judgment" and "[c]hronology isn't everything" when it comes to competency, aging has been "highly correlated with physical and mental decline," Jauhar writes, making it important to address the issue of an older workforce.

Should older physicians face mandatory competency tests?

Currently, certain occupations have mandatory requirement ages for their workers. For example, air traffic controllers must retire at 56, and airline pilots can no longer fly commercial flights when they turn 65.

However, Jauhar writes that having a mandatory requirement age for physicians "would be a crude and unfair solution." Instead, he advocates for periodic competency assessments that would be given to physicians every two to three years after they reach a certain age, such as 65 or 70.

"These competency exams would gauge rudimentary mental and physical capacities for practicing medicine," Jauhar writes. "They might include, for example, neuropsychiatric testing to help in the detection of low-level cognitive impairment, as well as vision testing."

These assessments would also need to be validated for transparency and fairness and take into consideration the requirements of an individual physician's specialty, which could range from simple office visits to complex surgery.

And if an assessment suggested a physician had significant impairment, "transitional strategies such as cutting back on workload, avoiding invasive procedures and using assistants and aids" could be implemented first before mandatory retirement is necessary, Jauhar writes.

So far, there has been no data published on the number of hospitals that require competency assessments for their older doctors, but it is likely to be relatively low, with perhaps a few dozen hospitals at best. Last year, the American Medical Association published guidelines for age-based screenings among physicians, but stopped short of making them mandatory.

As of now, there are several obstacles to implementing these requirements more broadly. Aside from resistance among physicians, there has also been legal pushback. For example, the Equal Employment Opportunity Commission (EEOC) is currently suing a hospital in Connecticut over its cognitive and vision testing requirements for older employees. According to EEOC, these requirements violate federal anti-discrimination law.

In general, Jauhar says that age-based competency testing should not be limited to physicians. Instead, these tests "should also be extended to other professions in which age-related impairment can result in serious harm to others, such as law, accounting and even politics," he writes. "It would be neither fair nor proper for doctors to be singled out for such evaluations."

As the U.S. physician workforce continues to age, "it's just a matter of time before outside agencies impose mandatory retirement or some other crudely designed bureaucratic solution," Jauhar writes. To avoid this, hospitals be proactive and enact their own "thoughtful and nuanced programs of competency assessment" to benefit both "patients and doctors alike." (Jauhar, New York Times, 11/28)