{"id":2150556,"date":"2026-02-04T05:00:00","date_gmt":"2026-02-04T10:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?post_type=article&#038;p=2150556"},"modified":"2026-02-04T08:50:44","modified_gmt":"2026-02-04T13:50:44","slug":"doctor-cognitive-decline-assessment-ageism","status":"publish","type":"article","link":"https:\/\/kffhealthnews.org\/news\/article\/doctor-cognitive-decline-assessment-ageism\/","title":{"rendered":"When the Doctor Needs a Checkup"},"content":{"rendered":"\n<p>He was a surgical oncologist at a hospital in a Southern city, a 78-year-old whose colleagues had begun noticing troubling behavior in the operating room.<\/p>\n\n\n\n<aside class=\"block--sidebar alignright \">\n\t\n\n<div class=\"wp-block-kaiser-health-news-partner block--partner\">\n\t\t\t\t\t\t<a class=\"partner__image--link\" href=\"https:\/\/www.nytimes.com\/2026\/01\/31\/health\/doctors-cognitive-decline.html\">\n\t\t\t\t<img decoding=\"async\" class=\"partner__image\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2019\/09\/The_New_York_Times_logo.png?w=120\" alt=\"Partner logo\" \/>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t<p class=\"partner__content\">\n\t\tThis story also ran on <a href=\"https:\/\/www.nytimes.com\/2026\/01\/31\/health\/doctors-cognitive-decline.html\">The New York Times<\/a>. It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/doctor-cognitive-decline-assessment-ageism\/view\/republish\/\">republished for free<\/a>.\t<\/p>\n<\/div>\n\n\n\n<div class=\"is-style-classic  wp-block-kff-common-promo\">\n\t\t<div class=\"wp-block-kff-common-promo__inner\">\n\t\t\t\t\t<h3 class=\"wp-block-kff-common-promo__title\">\n\t\t\t\t<a class=\"wp-block-kff-common-promo__link\" href=\"http:\/\/kffhealthnews.org\/topics\/the-new-old-age\/\">\n\t\t\t\t\tAbout \u201cThe New Old Age\u201d\t\t\t\t<\/a>\n\t\t\t<\/h3>\n\t\t\t\t\t\t<p class=\"wp-block-kff-common-promo__excerpt\">\u201cThe New Old Age\u201d is produced through a partnership with <a href=\"https:\/\/www.nytimes.com\/column\/the-new-old-age\" target=\"_blank\" rel=\"noreferrer noopener\">The New York Times<\/a>.<\/p>\n\t\t\t\t\t\t<a class=\"wp-block-kff-common-promo__read-more wp-block-kff-common-promo__link\" href=\"http:\/\/kffhealthnews.org\/topics\/the-new-old-age\/\">Read More Columns<\/a>\n\t\t\t<\/div>\n<\/div>\n\n<\/aside>\n\n\n\n<p>During procedures, he seemed \u201chesitant, not sure of how to go on to the next step without being prompted\u201d by assistants, said Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore.<\/p>\n\n\n\n<p>The chief of surgery, concerned about the doctor\u2019s cognition, \u201cwould not sign off on his credentials to practice surgery unless he went through an evaluation,\u201d Katlic said.<\/p>\n\n\n\n<p>Since 2015, when Sinai inaugurated a screening program for surgeons 75 and older, about 30 from around the country have undergone its comprehensive two-day physical and cognitive assessment. This surgeon \u201cdid not come of his own accord,\u201d Katlic recalled.<\/p>\n\n\n\n<p>But he came. The tests revealed mild cognitive impairment, often but not necessarily a precursor to dementia. The neuropsychologist\u2019s report advised that the surgeon\u2019s difficulties were \u201clikely to impact his ability to practice medicine as he is doing presently, e.g. conducting complex surgical procedures.\u201d<\/p>\n\n\n\n<p>That didn\u2019t mean the surgeon had to retire; a variety of accommodations would allow him to continue in other roles. \u201cHe retained a lifetime of knowledge that had not been impacted by cognitive changes,\u201d Katlic said. The hospital \u201ctook him out of the OR, but he continued to see patients in the clinic.\u201d<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"dc9818bd64\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/article\/2150556\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>Such incidents are likely to become more common as America\u2019s physician workforce ages rapidly. In 2005, more than 11% of doctors who were seeing patients were 65 or older, the American Medical Association said. Last year, the proportion reached 22.4%, with nearly 203,000 older practitioners.<\/p>\n\n\n\n<p>Given physician shortages, especially in rural areas and key specialties like primary care, nobody wants to drive out veteran doctors with skills and experience.<\/p>\n\n\n\n<p>Yet researchers have documented \u201ca <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28724142\/\">gradual decline in physicians\u2019 cognitive abilities<\/a> starting in their mid-60s,\u201d said Thomas Gallagher, an internist and bioethicist at the University of Washington who has studied late-career trajectories.<\/p>\n\n\n\n<p>At older ages, reaction times slow; knowledge can become outdated. Cognitive scores vary greatly, however. \u201cSome practitioners continue to do as well as they did in their 40s and 50s, and others really start to struggle,\u201d Gallagher said.<\/p>\n\n\n\n<p>A few health organizations have responded by establishing <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39496180\/\">late-career practitioner programs<\/a> mandating that older doctors be screened for cognitive and physical deficits.<\/p>\n\n\n\n<p>UVA Health at the University of Virginia began its program in 2011 and has screened about 200 older practitioners. Only in four cases did the results significantly change a doctor\u2019s practice or privileges.<\/p>\n\n\n\n<p>Stanford Health Care launched its late-career program the following year. Penn Medicine at the University of Pennsylvania also put in place a testing program.<\/p>\n\n\n\n<p>Nobody has tracked how many exist; Gallagher guesstimated as many as 200. But given that the United States has more than 6,000 hospitals, those with late-career programs constitute \u201ca vast minority,\u201d he said.<\/p>\n\n\n\n<p>The number may actually have shrunk. A federal lawsuit, along with the profession\u2019s lingering reluctance, appears to have put the effort to regularly assess older doctors\u2019 abilities in limbo.<\/p>\n\n\n\n<p>Late-career programs typically require those 70 and older to be evaluated before their privileges and credentials are renewed, with confirmatory testing for those whose initial results indicate problems. Thereafter, older doctors undergo regular rescreening, usually every year or two.<\/p>\n\n\n\n<p>It\u2019s fair to say such efforts proved unpopular among their intended targets. Doctors frequently insist that \u201c\u2018I\u2019ll know when it\u2019s time to stand down,\u2019\u201d said Rocco Orlando, senior strategic adviser to Hartford HealthCare, which operates eight Connecticut hospitals and began its late-career practitioner program in 2018. \u201cIt turns out not to be true.\u201d<\/p>\n\n\n\n<p>When Hartford HealthCare published data from the first two years of its late-career program, it reported that of the 160 practitioners 70 and older who were screened, <a href=\"https:\/\/catalyst.nejm.org\/doi\/pdf\/10.1056\/CAT.20.0215\">14.4% showed some degree of cognitive impairment<\/a>.<\/p>\n\n\n\n<p>That mirrored results from Yale New Haven Hospital, which instituted mandatory cognitive screening for medical staff members starting at age 70. Among the first 141 Yale clinicians who underwent testing, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31935030\/\">12.7% \u201cdemonstrated cognitive deficits<\/a> that were likely to impair their ability to practice medicine independently,\u201d a study reported.<\/p>\n\n\n\n<p>Proponents of late-career screening argued that such programs could prevent harm to patients while steering impaired doctors to less demanding assignments or, in some cases, toward retirement.<\/p>\n\n\n\n<p>\u201cI thought as we got the word out nationally, this would be something we could encourage across the country,\u201d Orlando said, noting that Hartford\u2019s program cost only $50,000 to $60,000 a year.<\/p>\n\n\n\n<p>Instead, he has seen \u201czero progress\u201d in recent years. \u201cProbably we\u2019ve gone backward,\u201d he said.<\/p>\n\n\n\n<p>A key reason: In 2020, the federal <a href=\"https:\/\/www.eeoc.gov\/newsroom\/eeoc-sues-yale-new-haven-hospital-age-and-disability-discrimination\">Equal Employment Opportunity Commission sued Yale New Haven<\/a> over its testing efforts, charging age and disability discrimination. The legal action continues (the EEOC declined to comment on its status), as does the hospital\u2019s late-career program.<\/p>\n\n\n\n<p>But the suit led several other organizations to pause or shut down their programs, including those at Hartford HealthCare and at Driscoll Children\u2019s Hospital in Corpus Christi, Texas, while few new ones have emerged.<\/p>\n\n\n\n<p>\u201cIt made lots of organizations uncomfortable about sticking their necks out,\u201d Gallagher said.<\/p>\n\n\n\n<p>Instituting later-career programs has always been an uphill effort. \u201cDoctors don\u2019t like to be regulated,\u201d Katlic acknowledged. Late-career programs have \u201cin some cases been very controversial, and they\u2019ve been blocked by influential physicians,\u201d he said.<\/p>\n\n\n\n<p>As health systems wait to see what happens in federal court, most national medical organizations have recommended only voluntary screening and peer reporting.<\/p>\n\n\n\n<p>\u201cNeither works very well at all,\u201d Gallagher said. \u201cPhysicians are hesitant to share their concerns about their colleagues,\u201d which can involve \u201cchallenging power dynamics.\u201d<\/p>\n\n\n\n<p>As for voluntary evaluation, since cognitive decline can affect doctors\u2019 (or anyone\u2019s) self-awareness, \u201cthey\u2019re the last to know that they\u2019re not themselves,\u201d he added.<\/p>\n\n\n\n<p>In a recent <a href=\"https:\/\/www.nejm.org\/doi\/abs\/10.1056\/NEJMms2510494\">commentary in The New England Journal of Medicine<\/a>, Gallagher and his co-authors recommended procedural policies to promote fairness in late-career screening, based on an analysis of such programs and interviews with their leaders.<\/p>\n\n\n\n<p>\u201cHow can we design these programs in a way that\u2019s fair and that therefore physicians are more apt to participate in?\u201d he said. The authors emphasized the need for confidentiality and safeguards, such as an appeals process.<\/p>\n\n\n\n<p>\u201cThere are all sorts of accommodations\u201d for doctors whose assessments indicate the need for different roles, Gallagher noted. They could adopt less onerous schedules or handle routine procedures while leaving complex six-hour surgeries to their colleagues. They might transition to teaching, mentoring, and consulting.<\/p>\n\n\n\n<p>Yet a substantial number of older doctors head for the exits and retire rather than face a mandated evaluation, he said.<\/p>\n\n\n\n<p>The future, therefore, might involve programs that regularly screen every practitioner. That would be inefficient (few doctors in their 40s will flunk a cognitive test) and, with current tests, time-consuming and consequently expensive. But it would avoid charges of age discrimination.<\/p>\n\n\n\n<p>Faster reliable cognitive tests, reportedly in the research pipeline, may be one way to proceed. In the meantime, Orlando said, changing the culture of health care organizations requires encouraging peer reporting and commending \u201cthe people who have the courage to speak up.\u201d<\/p>\n\n\n\n<p>\u201cIf you see something, say something,\u201d he continued, referring to health care professionals who witness doctors (of any age) faltering. \u201cWe are overly protective of our own. We need to step back and say, \u2018No, we\u2019re about protecting our patients.\u2019\u201d<\/p>\n\n\n\n<p><em>The New Old Age is produced through a partnership with&nbsp;<a href=\"https:\/\/www.nytimes.com\/column\/the-new-old-age\">The New York Times<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The physician workforce is aging fast, and some hospitals now require that older clinicians undergo testing for cognitive decline. Many have resisted.<\/p>\n","protected":false},"featured_media":2150591,"template":"","meta":{"_cr_original_post":"","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kff_featured_video":0,"kff_show_featured_video":false,"kff_show_mute_audio_button":false,"custom_shortlink":"\/MjE1MDU1Ng","kaiser_health_news_byline_override":"","kaiser_health_news_can_republish":true,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_overlay_color":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_hide_partner":false,"kaiser_health_news_kicker":"The New Old Age","kaiser_health_news_kicker_background_color":"","kaiser_health_news_kicker_text_color":"","kaiser_health_news_kicker_url":"\/topics\/the-new-old-age\/","kaiser_health_news_nav_theme_slug":"compact","kaiser_health_news_nav_transparency":false,"kaiser_health_news_sharing_title":"","kaiser_health_news_show_featured_image":true,"kaiser_health_news_subheadline":"","kaiser_health_news_suppress_kicker":false,"kaiser_health_news_suppress_subheadline":false,"kaiser_health_news_update_time":"","kaiser_health_news_vertical_image":0,"kaiser_health_news_title_align_left":false,"kaiser_health_news_custom_header_image":0,"photo_byline":[],"story_update":"","update_position":"bottom","kaiser_syndication_sites":[],"apple_news_api_created_at":"2026-02-04T10:07:13Z","apple_news_api_id":"17b8547f-44d1-49ff-92f7-d6ab3f16eeb7","apple_news_api_modified_at":"2026-02-04T10:07:13Z","apple_news_api_revision":"AAAAAAAAAAD\/\/\/\/\/\/\/\/\/\/w==","apple_news_api_share_url":"https:\/\/apple.news\/AF7hUf0TRSf-S99arPxbutw","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":["https:\/\/news-api.apple.com\/sections\/20265c01-23d7-4d15-96e0-0691b89c3772"],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"footnotes":""},"categories":[17218,178379,5004,439528530,36835,439530147],"tags":[22247,58401,28049,303192002,1575,1834],"primary-topic":[],"partners":[439524321],"funder":[439524091,439528750,439524084,439525045],"coauthors":[259504290],"class_list":["post-2150556","article","type-article","status-publish","has-post-thumbnail","hentry","category-aging","category-health-industry","category-mental-health","category-southern-bureau","category-syndicate","category-the-new-old-age","tag-connecticut","tag-doctors","tag-maryland","tag-pennsylvania","tag-texas","tag-virginia","partners-the-new-york-times","funder-john-a-hartford-foundation","funder-robert-wood-johnson-foundation","funder-scan-foundation","funder-silver-century"],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>When the Doctor Needs a Checkup - KFF Health News<\/title>\n<meta name=\"description\" content=\"The physician workforce is aging fast, and some hospitals now require that older clinicians undergo testing for cognitive decline. 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