Promoting Fairness in Screening Programs for Late-Career Practitioners
Promoting Fairness in Screening Programs for Late-Career Practitioners
SHP's Michelle Mello argues there are late-career physician programs that can balance patient safety with procedural fairness.
In an NEJM article, SHP’s Michelle Mello and colleagues note that late-career physicians make up roughly 25% of the U.S. medical workforce and provide critical experience amid a physician shortage. Yet age-related cognitive and physical decline has fueled interest in mandatory screening programs to protect patient safety. These efforts have faced pushback over concerns about age and disability discrimination. The authors argue, however, that well-designed late-career physician programs can balance patient safety with fairness to physicians—and offer recommendations informed by hospital leaders’ experience.
They write:
“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. Older physicians bring valuable wisdom and expertise to patient care, but many will experience cognitive and physical decline that may affect their clinical skills. 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.
“Concerns among medical staff about LCP programs have hindered their widespread implementation. In 2020, Yale New Haven Hospital was sued by the federal Equal Employment Opportunity Commission, which alleged that its LCP program constituted age and disability discrimination. Whatever the merits of the claim or its fate in the Trump administration, the suit reflects many physicians’ view that LCP policies are unfair, burdensome, unnecessary, and even offensive.
“We believe there is a strong case justifying deployment of mandatory LCP programs to promote patient safety. Principles of medical ethics recognize that the interests of patients should be professionals’ chief concern. 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. After analyzing LCP policies and interviewing hospital leaders about their perceptions of and experiences with LCP programs, we have developed recommendations for balancing patient safety and physicians’ interests.”
