Screening physicians for cognitive impairment remains rare in U.S.

While nearly one-quarter of U.S. physicians are 65 or older, a new study found that policies to root out cognitive decline among those doctors remain rare in American medicine.

Research in JAMA Network noted that while many countries have mandatory retirement policies for judges, commercial pilots and air traffic controllers, no developed country has similar policies policing physicians. “Most jurisdictions rely on self-regulation, collegial oversight and broad professional requirements for maintenance of competency rather than proactive cognitive screening,” researchers found.

Thee study pointed to possible signs of change as the physician workforce ages. The authors noted, for example, that in the U.S., 25 health systems had publicly available cognitive-screening policies for physicians between 70 and 75. Only three of those systems, however, said they used a validated screening instrument like the Montreal Cognitive Assessment, more commonly known as the MicroCog.

While researchers said that cognitive screening for physicians should be viewed as a patient-safety tool, not a punishment, attempts to implement age-based policies are often attacked as discriminatory. A MedPage Today analysis of the study, for example, looked at a cognitive screening program for physicians at Yale New Haven Hospital. That program was rolled out between 2016 and 2019.

A JAMA study of that policy found that of 141 physicians screened for cognitive impairment, 13% had cognitive issues that were “likely” to impair their ability to practice medicine. Despite those findings, Yale New Haven was sued by the Employment Opportunity Commission for age and disability discrimination.

The lawsuit reached the courts in August of 2026, but no decision has been reached. Legal analysts said that any decision reached in the case will likely head to the Supreme Court.

The recent study in JAMA Network cited data that found increased 30-day mortality among patients cared for by physicians aged 60 years or older with low to medium caseloads. That study, however, found no differences among high-volume physicians.

Researchers in the JAMA Network study pointed out that other data have found that the trajectory of cognitive decline is “highly variable,” with many physicians remaining “cognitively intact” well into older age. Researchers said that makes evaluating cognitive impairment in older physicians “complex,” and that there are “substantial limitations to using age alone as a proxy for clinical ability.”

The MedPage Today article noted that when health care organizations launch programs to screen late-career physicians, there’s often a wave of retirements. One researcher interviewed by MedPage Today said that in those situations, physician retirements are often viewed a good thing for patient safety.

But there’s also a possibility that some physicians are retiring simply to avoid testing that they may think is unfair. And in a health care system with a chronic shortage of physicians, that outcome is likely hurting, not helping, patient safety.

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