Who determines when physicians ought to retire?

As the national medical workforce ages, worries regarding cognitive deterioration among doctors are amplifying, emphasizing the importance of evaluations for seasoned practitioners, noted Sharona Hoffman, an expert in law and bioethics, during a recent Harvard Law School forum.

Hoffman, who teaches at Case Western Reserve University School of Law, presented at a symposium on law, healthcare, and the aging process hosted by the Petrie-Flom Center. The conference addressed issues such as the challenges healthcare systems face in adapting to individuals with greater longevity, discrimination, protection, paternalism concerning older adults, and technological and commercial considerations in aging.

“Cognitive decline within the physician workforce is an issue, and it has garnered the attention of healthcare entities,” stated Hoffman.

Yale New Haven Hospital assessed 141 practitioners aged 70 and above from October 2016 to January 2019, discovering that 12 percent exhibited cognitive impairments that could influence job efficiency, according to Hoffman.

12 percent

Of evaluated clinicians aged 70 and older who were identified with cognitive impairments.

Across the nation, a significant number of doctors continue to practice beyond the conventional retirement age. Hoffman referenced a report from the Association of American Medical Colleges, which revealed that in 2024, 20 percent of active physicians were aged 65 and older, while 22 percent were between 55 and 64 years old.

Cognitive decline often arises from neuroanatomical changes induced by the narrowing or obstruction of arteries from atherosclerotic plaque that typically develops around the age of 60. Symptoms may include sluggish processing speed, trouble recalling words or names, and issues with focus and attention.

Veteran practitioners might be susceptible to cognitive decline and should undergo assessments to safeguard both patients and physicians, argued Hoffman.

However, the deployment of a testing regimen should be executed thoughtfully, warned Hoffman, as it may worsen the nation’s physician deficit. The same report indicated that the AAMC foresees a shortfall of up to 86,000 doctors by 2036.

Employers considering the establishment of a testing initiative for seasoned practitioners must also contemplate ethical responsibilities and legal consequences surrounding age and disability discrimination, according to Hoffman.

State medical boards, responsible for ensuring public safety and overseeing licensing renewal processes, could assist in identifying practitioners with cognitive decline, as noted by Hoffman, but they would need to incorporate due process safeguards.

“The state medical boards could enlist experts to determine the appropriate type of examination and the suitable cut-off score,” remarked Hoffman. “I anticipate significant opposition to any testing initiative; nevertheless, we hope to persuade individuals that this is fundamentally in their best interest. It aims to protect them and ensure that their careers do not culminate in catastrophe.”

In another session, Alessandro Blassime, a lecturer at the Department of Health Sciences and Technology at ETH Zurich, discussed the difficulties that increased life expectancy poses to healthcare providers and the distribution of health resources.

“We are acutely aware of the fact that life expectancy is elevating globally,” stated Blassime. “This trend has been ongoing for quite a while, and there are signals that it won’t cease, at least not in the next couple of decades, which intensifies the strain from age-related illnesses and complicates the ability of healthcare systems to manage these challenges.”

With the introduction of the concept of biological age into the medical landscape, there has been a transformation in how professionals interpret health and longevity, according to Blassime. Individuals age at differing rates, with some maintaining good health and activity well into their later years, while others become frail and develop health issues that may shorten their lifespan.

Biological age indicates the actual health status of the body and is influenced by genetics, lifestyle choices, and environmental factors. Experts regard it as a more precise reflection of aging compared to chronological age, which solely refers to a person’s age in years.

In contrast to chronological age, which is immutable, biological age can be adjusted through modifications to diet, physical activity, stress management, sleep quality, and other healthy practices.

“Biological age represents the discrepancy between the anticipated and the actual condition of a person,” explained Blassime.

In his discourse, Blassime expressed concerns regarding the increasing utilization of biological age as efforts intensify to emphasize healthspan over lifespan.

“We must recognize that biological age, while enticing to apply, can introduce biases derived from the data we utilize to construct predictive models,” stated Blassime. “Disadvantaged individuals are more likely to exhibit elevated biological ages than others … Furthermore, there are potential misuses of biological age, such as hastily implementing interventions not validated to mitigate aging.”