What if doctors had to take a cognitive test after the age of 70?

A 78-year-old surgical oncologist began to worry his colleagues in the operating room. He hesitated during procedures, seemed less certain of the next step, and required more guidance from the team. His chief of surgery then refused to renew his privileges without an evaluation. Tests concluded he had mild cognitive impairment that could affect his ability to operate as before. The doctor, however, did not retire. He left the operating room but continued to see patients in the clinic.The story, reported by journalist Paula Span in the New York Times, illustrates the idea that is currently dividing a portion of the American medical community: should doctors' cognitive abilities be assessed after a certain age to protect patients? The debate is not limited to fringe institutions. New Haven Hospital, Hartford HealthCare, Penn Medicine, Stanford Health Care, and Sinai Hospital in Baltimore are cited in medical literature and specialized media for having implemented, studied, or discussed this type of program.While these initiatives remain relatively uncommon, they are often based on the same principle. Once they reach a certain age, frequently around 70, physicians must undergo an evaluation (cognitive tests, physical or vision examination, neuropsychological assessment, depending on the program) before renewing their hospital privileges. The stated objective is to identify earlier any loss of capacity that could compromise patient safety.This issue is not unique to the United States. In Quebec, too, physicians are aging, and many continue practicing well beyond the age at which most of their patients have retired. As of March 31, 2026, the Collège des médecins du Québec (Quebec College of Physicians) counted 23,727 active physicians. Among them, 1,640 were 70 years of age or older, the oldest approaching 94. The issue is therefore not merely theoretical.This is not about ageism by assuming that a physician in their seventies is less competent. In a review published in JAMA Surgery1 on aging physicians, authors noted that between 40 and 75 years of age, average cognitive ability declines by more than 20%, but that trajectories vary greatly from person to person, with some physicians maintaining their skills very well.Age isn't everythingThis is where the issue becomes delicate. We're not just talking about experience or clinical wisdom, but also about functions essential to the job: information processing speed, working memory, attention, executive functions, and the ability to integrate changing data. "Cognitive decline is sometimes difficult to recognize ourselves. We might be the last to realize it," notes organizational psychologist Julie Carignan, founder of the consulting firm Humance.Hence the tension at the heart of the debate: how to identify at-risk situations without turning age into suspicion?Behind the principle, there is no single model. At Yale New Haven Hospital, for example, clinicians aged 70 and over who requested the renewal of their privileges had to undergo a cognitive assessment. This battery of 16 brief tests lasted 50 to 90 minutes and explored, among other things, information processing speed, working memory, verbal fluency, and executive functions. The results were not interpreted according to a simple pass/fail logic, but rather placed within the context of the privileges requested.Striking resultsThe figures published by Yale New Haven Hospital² have made a strong impression. Between October 2016 and January 2019, 141 clinicians aged 70 and over were assessed. Eighteen of them (12.8%) presented cognitive deficits deemed likely to compromise their ability to practice independently. None of these 18 clinicians had previously been reported to hospital management for performance issues. Hartford HealthCare, for its part, reported a 14.4% incidence of cognitive impairment in its age-70 screening program.3 However, a word of caution: these results come from specific programs and do not mean that one in seven 70-year-old physicians is incompetent.This model has also revealed its blind spots. A cognitive test alone does not assess a physician's full clinical competence and can produce falsely concerning results if its specificity is not very high. Its validity can also be difficult to assess when it remains confidential, as at Yale New Haven Hospital, to prevent clinicians from preparing for it.Controversial testsThe issue is not only scientific. It is also legal, professional, and human. A concerning result can affect a physician's hospital privileges, reputation, income, and even their retirement. In 2020, the Equal Employment Opportunity Commission (EEOC) sued Yale New Haven Hospital, alleging that its program constituted discrimination based on age and disability. According to journalist Paula Span, this litigation has contributed to deterring several organizations and slowing down or suspending certain programs elsewhere in the United States.In the New England Journal of Medicine, however, authors argue for a "strong case" in favor of mandatory programs in the name of patient safety. But on one condition: that they be governed by genuine procedural fairness. They advocate for "compassionate, thoughtful, and principled" policies, with clear information, confidentiality, relevant testing, the possibility of appeal, and accommodations before any major restrictions are imposed.The CMQ relies on other mechanismsWhen questioned about this type of approach, the Collège des médecins du Québec (CMQ) did not directly comment on whether it should be adopted. In his written responses, its head of professional inspection, Dr. Yves Gervais, clarified that the CMQ does not systematically require neurocognitive assessments for its members after a certain age.The College relies on other mechanisms, notably the General Surveillance Program and the short questionnaire for physicians aged 70 and over. Implemented in 2012, this questionnaire primarily aims to establish a comprehensive overview of practice. According to Dr. Gervais, the targeted risk factors “are no different from those used to assess other groups of physicians.” In 2025, 766 physicians were targeted by this short questionnaire.What the college can doThe College also clearly distinguishes between assessing a physician’s health and assessing their professional competence. “During a professional inspection, inspectors are not mandated to assess the health of the physician being inspected. Their role is to evaluate the physician’s competence to practice medicine,” explains Dr. Gervais.If a health condition, particularly a cognitive one, is suspected and appears to impact the quality of practice or public safety, inspectors must inform the person responsible for the inspection. This person may then consider appropriate interventions, up to and including a formal assessment request under section 48 of the Professional Code. The CMQ also reminds physicians that section 119 of the Code of Ethics requires them to report to the College any colleague they believe to be unfit for practice.The Administrative Monitoring Program complements this system. It is aimed at physicians whose physical or mental health condition—including certain progressive neurological conditions—may compromise exercise and may provide for periodic reports from treating professionals on health status, fitness to exercise and recommended limitations or restrictions.A question of proportionThe fundamental question remains: how far should we go? Julie Carignan draws a parallel with a driver's license: when an activity poses a risk to others, an assessment can be justified. "A medical procedure is an act where we hold people's health in our hands. So it's a risky act, and risk management can justify it." Provided, the organizational psychologist continues, that abuse is avoided. "The monitoring mechanism must be proportionate to the risk."Perhaps the dividing line lies there: being able to request an assessment when there are signs of concern, without resorting to automatic systematization based on a fixed age.François Courcy doesn't comment on the validity of the tests themselves, as he isn't sufficiently familiar with them. But the organizational psychologist urges us not to see the assessment as a dismissal. "A good neurocognitive assessment doesn't mean the person is thrown away." On the contrary, if there are difficulties, she can certainly play different, equally contributing, but distinct roles.This article has been translated from its original French and first appeared on our sister site Profession Santé. References:Dellinger EP, Pellegrini CA, Gallagher TH. The aging physician and the medical profession: a review. JAMA Surgery. 2017;152(10):967-971. doi:10.1001/jamasurg.2017.2342Cooney L, Balcezak T. Cognitive testing of older clinicians prior to recredentialing. JAMA. 2020;323:179-180. doi:10.1001/jama.2019.18665Young KP, Robinson KJ, Dicks RS, Kumar A, Orlando R 3rd. Assessing late career practitioners for cognitive decline: an evidence-based approach. NEJM Catal Innov Care Deliv. 2021;2(2). doi:10.1056/CAT.20.0215Kramer DB, Gallagher TH, Osinska PH, White AA, Garrett KD, Mello MM. Promoting fairness in screening programs for late-career practitioners. N Engl J Med. 2026;394(4):402-407. doi:10.1056/NEJMms2510494.

What if doctors had to take a cognitive test after the age of 70?

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