As the national physician workforce gets older, concerns about cognitive decline among doctors are increasing, highlighting the need for testing late-career practitioners, said Sharona Hoffman, a specialist in law and bioethics, at a recent Harvard Law School panel.

Hoffman, who teaches at Case Western Reserve University School of Law, spoke at a conference on law, healthcare, and aging sponsored by the Petrie-Flom Center. The event covered topics that included challenges to healthcare systems in adapting to patients with increased longevity, older adults and issues of discrimination, protection, and paternalism, and technology and commercialization in aging.

“Cognitive decline in the physician workforce is a problem, and it’s a problem that has come to the attention of healthcare organizations,” said Hoffman.

Yale New Haven Hospital tested 141 clinicians who were 70 and older between October 2016 and January 2019 and found 12 percent had cognitive deficits that could affect job performance, said Hoffman.

12 percent

Of tested clinicians 70 and older were found to have cognitive deficits.

Nationwide, a large number of doctors practice beyond typical retirement age. Hoffman cited a report by the Association of American Medical Colleges, which found that in 2024, 20 percent of working physicians were 65 and older, and 22 percent were between 55 and 64 years old.

Cognitive decline often results from brain changes caused by the narrowing or blockage of arteries by atherosclerotic plaque, which starts developing around age 60. Some of its signs are slow processing speed, difficulties recalling words or names, and concentration and attention problems.

Veteran professionals may be at risk of cognitive decline and should be tested to protect both patients and doctors, said Hoffman.

But a testing program’s implementation should be done with care, said Hoffman, because it could exacerbate the nation’s physician shortage. In the same report, the AAMC predicted the country will face a shortage of up to 86,000 physicians by 2036.

Employers who might want to establish a testing program for late-career practitioners should also be aware of ethical obligations and legal implications regarding age and disability discrimination, said Hoffman.

State medical boards, which are in charge of protecting public welfare and implementing license renewal procedures, could play a role in identifying clinicians with cognitive decline, said Hoffman, but they would have to include due process protections.

“The state medical boards could use experts and figure out the right kind of test and the right cut-off score,” Hoffman said. “I’m assuming there would be a lot of resistance to any kind of testing program at all, but hopefully we could convince people that actually this is in their best interest. It is meant to protect them and make sure that their career doesn’t end in disaster.”

In another talk, Alessandro Blassime, lecturer at the Department of Health Sciences and Technology at ETH Zurich, spoke about the challenges that increased life expectancy pose to healthcare providers and the allocation of health resources.

“We are all perfectly aware of the fact that life expectancy is on the rise across the globe,” said Blassime. “This is a phenomenon that has been going on for quite some time, and there are indications that it’s not going to stop, at least not in the next couple of decades, which increases the burden of age-related diseases and makes it particularly challenging for healthcare systems to cope with that.”

With the arrival of the concept of biological age in the medical sphere, there has been a shift in how experts define health and longevity, said Blassime. People age at different rates, with some remaining healthy and active well into old age while others become frail and develop health conditions that can shorten their life span.

Biological age reflects the body’s actual health condition and is affected by genetics, lifestyle, and environment. Experts see it as a more accurate measure of aging than chronological age, which only refers to a person’s age.

Unlike chronological age, which cannot be changed, biological age can be altered by changes in diet, exercise, stress management, sleep quality, and other healthy behaviors.

“Biological age describes the difference between the expected and the actual state of a person,” said Blassime.

In his remarks, Blassime raised concerns over the use of biological age as it becomes more widespread in an effort to prioritize healthspan over lifespan.

“We need to understand that biological age is something that can be tempting to use, but biological age models, like any other predictive models, may reproduce or amplify biases in the data that we use to create them,” said Blassime. “Disadvantaged people are more likely to have higher biological ages than others … And there are possible misguided uses of biological age, for example, using this criterion to rush to interventions that are not proven to slow down aging.”