The Graying of the White Coat: Hospitals Weigh Mandatory Testing for Aging Doctors
As America’s physician workforce ages at an unprecedented rate, a quiet but urgent debate is reshaping hospital policies: should older doctors be required to prove they are still fit to practice? The issue came to a head recently when a 78-year-old surgical oncologist in a Southern city was flagged by colleagues for “troubling behavior” in the operating room. Assistants reported he appeared hesitant and required prompting to complete standard surgical steps.
The incident highlights a growing challenge for the medical community. Dr. Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore, noted that the hospital’s chief of surgery refused to sign off on the oncologist’s credentials without a formal evaluation. The doctor underwent a comprehensive two-day physical and cognitive assessment at Sinai, which revealed mild cognitive impairment. While he was removed from the operating room, the hospital retained him for clinical consultations, allowing him to utilize his lifetime of medical knowledge without risking patient safety during complex procedures.
Deep Search: The Data Behind the Concern
This case is not an anomaly. According to the American Medical Association, the proportion of practicing physicians aged 65 or older has doubled since 2005, reaching 22.4%—nearly 203,000 doctors—by last year. Unlike commercial airline pilots, who face a federally mandated retirement age of 65, physicians have no standard age limit or mandatory testing requirement in the United States.
In response, a small but growing number of institutions are implementing their own screening protocols.
Sinai Hospital launched its screening program for surgeons 75 and older in 2015.
Yale New Haven Hospital requires mandatory cognitive screening for medical staff starting at age 70.
Hartford HealthCare and UVA Health have similar programs.
Data from these initiatives suggests a tangible risk: approximately 12% to 14% of screened clinicians demonstrated cognitive deficits likely to impair their ability to practice medicine independently.
Objections: The Fine Line Between Safety and Ageism
The push for mandatory screening faces significant resistance. Critics argue that such policies border on ageism and fail to account for the high variability in how people age. “Some practitioners continue to do as well as they did in their 40s and 50s, and others really start to struggle,” noted Dr. Thomas Gallagher, an internist and bioethicist at the University of Washington.
Furthermore, there is a pragmatic fear that aggressive screening could exacerbate existing physician shortages, particularly in rural areas and critical specialties like primary care. Driving out veteran doctors who may have slowed physically but retain immense diagnostic value could hurt healthcare access. “Nobody wants to drive out veteran doctors with skills and experience,” Gallagher added.
Physicians also fear that a single poor test result could end their careers abruptly. To address this, experts emphasize the need for “soft landings”—policies that allow aging doctors to transition into non-clinical, teaching, or supervisory roles rather than forcing a total retirement. Safeguards such as confidentiality, appeals processes, and procedural fairness are cited as essential to gaining the trust of the medical community.
Background: Cognitive Decline vs. Experience
Research documents a gradual decline in average cognitive abilities starting in a person’s mid-60s, including slower reaction times and difficulties with fluid intelligence (solving new problems). However, crystallized intelligence—the accumulation of knowledge and experience—often remains robust well into old age. This discrepancy creates a complex scenario where a doctor may be encyclopedic in their medical knowledge but slower to react in a high-pressure emergency.
While the Federal Aviation Administration mandates retirement for pilots to mitigate public safety risks, the medical field has traditionally relied on self-regulation and peer reporting—systems that many experts now argue are insufficient for detecting subtle cognitive sliding. As the “silver tsunami” of aging doctors continues to swell, the medical profession is being forced to balance respect for seniority with the absolute imperative of patient safety.
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