DB Kramer et al. NEJM 2026; 394: 402-407. Promoting Fairness in Screening Programs for Late-Career Practitioners

This is an interesting article regarding screening late-career physicians (LCPs) to assure competency.

An excerpt:

Late-career physicians (LCPs) are an integral part of the U.S. medical workforce. Nearly a quarter of practicing physicians in the United States are over 65 years of age, and they are serving at a time of overall physician scarcity.^1,2 Older physicians bring valuable wisdom and expertise to patient care, but many will experience cognitive and physical decline that may affect their clinical skills.^3,4 Interest has grown among hospitals in mandatory screening programs that could proactively identify physicians whose ability to deliver safe care may be compromised, before patient harm occurs.⁵…

Yet physicians also have interests related to being screened that deserve respect, and LCP programs can and should protect these interests by ensuring procedural fairness…

Evidence that LCPs can pose risk to patients has motivated health care institutional leaders to develop mandatory screening programs.^5,12 LCP policies may require testing of the aspects of physicians’ cognitive and physical functioning that are relevant to clinical activities; such testing is usually triggered when a physician reaches an age threshold (commonly 70 years) and is tied to renewal of privileges….Among physicians’ objections are that tests have imperfect predictive accuracy and that erroneous results could threaten their reputation and livelihood…

 Fair assessment requires that the screening tests and processes employed provide an accurate, impartial assessment of relevant skills. An appeals process should be developed that gives physicians a meaningful opportunity to contest any restrictions on their privileges based on test results. Physicians who participate in LCP programs, like employees in other industries, retain recourse to the Equal Employment Opportunity Commission and the courts to contest wrongful termination, age discrimination, and disability discrimination…

The other key component considered by courts evaluating individual burden is known as least infringement. In the context of LCP programs, such an inquiry would center on whether an adverse action taken on the basis of test results is the least-restrictive option that is commensurate with the goal of protecting patient safety…

Care should be taken not to mistakenly hold LCPs to a higher standard than younger physicians simply by applying greater scrutiny to their practice.²⁶ 

My take: In theory, screening of late-career physicians makes a lot of sense to protect patient welfare. In practice, it may be difficult to design tests that have adequate sensitivity and specificity with regard to physician capability. This is true for both older and younger physicians.

Related blog post: “You Still Going to be Doing This?”