When the Doctor Needs a Checkup

In a Southern city, a 78-year-old surgical oncologist’s behavior in the operating room raised concerns among his colleagues. Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore, noted that during procedures, the surgeon appeared “hesitant, not sure of how to go on to the next step without being prompted” by his assistants.

The chief of surgery, worried about the doctor’s cognitive abilities, insisted on an evaluation before signing off on his credentials to practice surgery. Since the launch of Sinai’s screening program for surgeons aged 75 and older in 2015, around 30 surgeons from across the country have undergone a comprehensive two-day physical and cognitive assessment. Katlic recalled that this surgeon “did not come of his own accord,” but ultimately attended the evaluation.

The assessment revealed mild cognitive impairment, which can often precede dementia. The neuropsychologist’s report indicated that the surgeon’s difficulties were “likely to impact his ability to practice medicine as he is doing presently, e.g., conducting complex surgical procedures.” However, this did not necessitate his retirement; various accommodations allowed him to continue in other roles. “He retained a lifetime of knowledge that had not been impacted by cognitive changes,” Katlic explained. The hospital removed him from the operating room but permitted him to continue seeing patients in the clinic.

Such situations are likely to become more prevalent as the physician workforce in America ages rapidly. According to the American Medical Association, in 2005, over 11% of doctors seeing patients were 65 or older; by last year, this figure had risen to 22.4%, equating to nearly 203,000 older practitioners.

With physician shortages, particularly in rural areas and essential specialties like primary care, there is a reluctance to push out experienced doctors. However, researchers have documented a “gradual decline in physicians’ cognitive abilities” beginning in their mid-60s, as noted by Thomas Gallagher, an internist and bioethicist at the University of Washington.

As doctors age, reaction times may slow, and knowledge can become outdated. Cognitive scores can vary significantly; while some practitioners maintain their abilities, others may struggle. In response, a few health organizations have established late-career practitioner programs that mandate cognitive and physical screenings for older doctors.

UVA Health at the University of Virginia initiated its program in 2011, screening about 200 older practitioners. Only four cases resulted in significant changes to a doctor’s practice or privileges. Similarly, Stanford Health Care launched its late-career program the following year, with Penn Medicine at the University of Pennsylvania also implementing a testing program.

While the exact number of such programs is unclear, Gallagher estimates there could be as many as 200. However, given the U.S. has over 6,000 hospitals, those with late-career programs represent a “vast minority.” The number may have even decreased due to a federal lawsuit and the profession’s ongoing reluctance to assess older doctors’ abilities regularly.

Typically, late-career programs require evaluations for those aged 70 and older before renewing their privileges and credentials, with follow-up testing for those showing initial issues. Regular rescreening usually occurs every year or two. However, these efforts have often been unpopular among doctors, many of whom believe they can determine when it’s time to step down, a notion that has proven inaccurate.

Data from Hartford HealthCare’s late-career program revealed that 14.4% of the 160 practitioners aged 70 and older screened showed some degree of cognitive impairment. This aligns with findings from Yale New Haven Hospital, where 12.7% of the first 141 clinicians tested demonstrated cognitive deficits likely to impair their ability to practice independently.

Proponents of late-career screening argue that such programs can prevent harm to patients while guiding impaired doctors toward less demanding roles or retirement. Despite the initial enthusiasm, progress has stalled, with many organizations pausing or shutting down their programs due to legal concerns and discomfort with the regulatory nature of these evaluations.

As health systems await the outcome of federal court proceedings, most national medical organizations recommend only voluntary screening and peer reporting, which have proven ineffective. Physicians are often hesitant to voice concerns about their colleagues, and self-awareness regarding cognitive decline can be lacking.

In a recent commentary in The New England Journal of Medicine, Gallagher and his co-authors suggested procedural policies to promote fairness in late-career screening, emphasizing the need for confidentiality and safeguards, such as an appeals process. There are numerous accommodations for doctors needing different roles, such as adopting less demanding schedules or transitioning to teaching and mentoring.

However, many older doctors choose to retire rather than face mandatory evaluations. The future may involve programs that screen every practitioner regularly, though this could be inefficient and costly. Faster, reliable cognitive tests are reportedly in development, and changing the culture within healthcare organizations to encourage peer reporting is essential.

“If you see something, say something,” Orlando urged, highlighting the need for healthcare professionals to prioritize patient safety over protecting their colleagues. “We need to step back and say, ‘No, we’re about protecting our patients.’”

The New Old Age is produced through a partnership with The New York Times.

In a Southern city, a 78-year-old surgical oncologist’s behavior in the operating room raised concerns among his colleagues. Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore, noted that during procedures, the surgeon appeared “hesitant, not sure of how to go on to the next step without being prompted” by his assistants.

The chief of surgery, worried about the doctor’s cognitive abilities, insisted on an evaluation before signing off on his credentials to practice surgery. Since the launch of Sinai’s screening program for surgeons aged 75 and older in 2015, around 30 surgeons from across the country have undergone a comprehensive two-day physical and cognitive assessment. Katlic recalled that this surgeon “did not come of his own accord,” but ultimately attended the evaluation.

The assessment revealed mild cognitive impairment, which can often precede dementia. The neuropsychologist’s report indicated that the surgeon’s difficulties were “likely to impact his ability to practice medicine as he is doing presently, e.g., conducting complex surgical procedures.” However, this did not necessitate his retirement; various accommodations allowed him to continue in other roles. “He retained a lifetime of knowledge that had not been impacted by cognitive changes,” Katlic explained. The hospital removed him from the operating room but permitted him to continue seeing patients in the clinic.

Such situations are likely to become more prevalent as the physician workforce in America ages rapidly. According to the American Medical Association, in 2005, over 11% of doctors seeing patients were 65 or older; by last year, this figure had risen to 22.4%, equating to nearly 203,000 older practitioners.

With physician shortages, particularly in rural areas and essential specialties like primary care, there is a reluctance to push out experienced doctors. However, researchers have documented a “gradual decline in physicians’ cognitive abilities” beginning in their mid-60s, as noted by Thomas Gallagher, an internist and bioethicist at the University of Washington.

As doctors age, reaction times may slow, and knowledge can become outdated. Cognitive scores can vary significantly; while some practitioners maintain their abilities, others may struggle. In response, a few health organizations have established late-career practitioner programs that mandate cognitive and physical screenings for older doctors.

UVA Health at the University of Virginia initiated its program in 2011, screening about 200 older practitioners. Only four cases resulted in significant changes to a doctor’s practice or privileges. Similarly, Stanford Health Care launched its late-career program the following year, with Penn Medicine at the University of Pennsylvania also implementing a testing program.

While the exact number of such programs is unclear, Gallagher estimates there could be as many as 200. However, given the U.S. has over 6,000 hospitals, those with late-career programs represent a “vast minority.” The number may have even decreased due to a federal lawsuit and the profession’s ongoing reluctance to assess older doctors’ abilities regularly.

Typically, late-career programs require evaluations for those aged 70 and older before renewing their privileges and credentials, with follow-up testing for those showing initial issues. Regular rescreening usually occurs every year or two. However, these efforts have often been unpopular among doctors, many of whom believe they can determine when it’s time to step down, a notion that has proven inaccurate.

Data from Hartford HealthCare’s late-career program revealed that 14.4% of the 160 practitioners aged 70 and older screened showed some degree of cognitive impairment. This aligns with findings from Yale New Haven Hospital, where 12.7% of the first 141 clinicians tested demonstrated cognitive deficits likely to impair their ability to practice independently.

Proponents of late-career screening argue that such programs can prevent harm to patients while guiding impaired doctors toward less demanding roles or retirement. Despite the initial enthusiasm, progress has stalled, with many organizations pausing or shutting down their programs due to legal concerns and discomfort with the regulatory nature of these evaluations.

As health systems await the outcome of federal court proceedings, most national medical organizations recommend only voluntary screening and peer reporting, which have proven ineffective. Physicians are often hesitant to voice concerns about their colleagues, and self-awareness regarding cognitive decline can be lacking.

In a recent commentary in The New England Journal of Medicine, Gallagher and his co-authors suggested procedural policies to promote fairness in late-career screening, emphasizing the need for confidentiality and safeguards, such as an appeals process. There are numerous accommodations for doctors needing different roles, such as adopting less demanding schedules or transitioning to teaching and mentoring.

However, many older doctors choose to retire rather than face mandatory evaluations. The future may involve programs that screen every practitioner regularly, though this could be inefficient and costly. Faster, reliable cognitive tests are reportedly in development, and changing the culture within healthcare organizations to encourage peer reporting is essential.

“If you see something, say something,” Orlando urged, highlighting the need for healthcare professionals to prioritize patient safety over protecting their colleagues. “We need to step back and say, ‘No, we’re about protecting our patients.’”

The New Old Age is produced through a partnership with The New York Times.