South SFV Today

As the physician workforce in the United States ages, health care organizations face increasing pressure to manage potential risks linked to cognitive and physical decline among late-career physicians (LCPs), typically those aged 65 and older. A recent paper published in the Annals of Internal Medicine by Michelle Mello, a professor at Stanford Law School and Stanford University School of Medicine, examines policies some hospitals have implemented to screen aging physicians. The paper offers recommendations for improving fairness, effectiveness, and physician acceptance of these programs.

The study titled "Ensuring Safe Practice by Late Career Physicians: Institutional Policies and Implementation Experiences" reviews approaches from 29 U.S. health care institutions that generally mandate screening assessments once physicians reach around age 70. While older physicians contribute valuable clinical experience, they are at increased risk for cognitive and sensory decline as well as diminished adherence to standards of care. Evidence suggests that patients treated by LCPs may experience worse outcomes and are more likely to file complaints.

Screening assessments vary by institution but often include physical exams, neuropsychological testing, and peer feedback. Although all institutions aim to ensure patient safety, inconsistencies exist in handling screening results and procedural safeguards for physicians. Some institutions have structured appeals processes with confidentiality guidelines; however, many rely on internal discretion which can affect transparency and fairness.

“Little is known about the LCP policies in use today and there have been controversies surrounding some of them, including allegations of age discrimination,” said Mello. She co-authored the paper with medical doctors and public health scholars from various universities including Harvard Medical School. “We reviewed a range of LCP policies to better understand how hospitals can balance patient safety protection with physicians’ own interests.”

The authors recommend a standardized approach to LCP screening that includes clear guidelines for interpreting test results along with steps for appealing decisions. They suggest reframing these programs as supportive rather than punitive measures targeting age. By presenting screenings as proactive steps for maintaining high-quality patient care, acceptance can be fostered while reducing discrimination concerns.

The study emphasizes building physician support through early dialogue. Successful programs often involve physicians in policy design and explain how assessments protect patient safety—an approach that builds trust and reduces resistance which might otherwise lead to premature retirements among LCPs feeling targeted by age-specific policies.

Practical challenges faced by Health Care Organizations (HCOs) include logistical issues arranging assessments or concerns over current tools' predictive accuracy. Not all institutions have access to specialized neuropsychological tests or struggle financially implementing large-scale screenings; resource sharing across institutions could address these challenges promoting fairness consistently.

“We hope these findings will serve as a valuable guide for institutions seeking to implement effective and equitable LCP screening programs,” Mello stated.

This article was initially published by Stanford Law School.