Aging U.S. doctors spark patient safety debate

Nearly one in four U.S. physicians with an active license is 65 or older. However, only a small number of hospitals assess whether their oldest doctors remain fit to practice.

The issue gained renewed attention on October 12 when The Washington Post reported that the aging physician workforce is raising patient safety concerns. Neuropsychologist Victor Del Bene told the paper that the problem intensifies each year, warning of a looming public health crisis.

Balancing Ageism and Competence

Neil Baum, MD, a professor of clinical urology at Tulane University, has cautioned against the opposite mistake. In his September column on ageism in medicine, Baum argued that age alone is an unreliable indicator of a doctor’s ability.

“The take-home message is that competence, not birthdays, should determine whether physicians continue practicing,” he wrote.

Both perspectives hold merit simultaneously. Research on hospital screening programs highlights the challenge of balancing these concerns.

Limited Screening Policies

Late-career practitioner policies are uncommon. A University of Washington team reviewed 29 hospital policies and interviewed 21 executives involved in their creation. They estimated such programs exist in fewer than 5 percent of U.S. hospitals.

Every policy used age as a trigger for screening, with a median starting age of 70. Most required a physical exam (89%) and a neuropsychological exam (82%). 79% asked the examiner for an overall judgment of fitness to practice. Early reports found 12 to 14% of screened physicians were deemed unfit.

“The vast majority of late-career physicians were found safe to continue to practice,” said lead author Andrew White, MD, a general internist and professor at the University of Washington School of Medicine. Policies developed with input from medical staff were better received than those imposed from above.

Fairness Challenges

Fairness remains a critical issue.

The authors recommend involving physicians early in policy design, screening all specialties starting at 70, using validated tests benchmarked against healthy, high-performing physicians rather than the general population over 70, clearly defining appeal rights, and exploring accommodations such as schedule changes, lower-risk patient assignments, or teaching roles before restricting privileges.

Beyond Hospital Screening

Hospital screening occurs when a physician seeks or renews clinical privileges. However, office-based physicians in independent groups may never encounter this checkpoint. This leaves the decision to partners and administrators, who often lack a formal process and have personal relationships with the physician in question.

Addressing Fairness in Screening Policies

Fairness is a significant concern in late-career physician screening policies. Fewer than one-fourth of the policies reviewed clearly defined standards for restricting privileges, appeal rights, or access to legal representation, according to a January analysis in the New England Journal of Medicine led by Daniel Kramer, MD, a cardiologist at Beth Israel Deaconess Medical Center, and Thomas Gallagher, MD, a professor of medicine and bioethicist at the University of Washington.