Fairness in late-career physician screening programs

Supporting late-career physicians

At a time of overall physician shortages, late‑career physicians (LCPs) represent a vital share of the U.S. medical workforce.

Their continued service reflects their dedication to their patients and communities and the value of their institutional knowledge and expertise.

With nearly one in four practicing physicians over the age of 65, institutions are offering more support for LCPs, including screening programs for potential age-related concerns that may affect patient care.

These policies, however, naturally raise questions of fairness, respect and acceptance among physicians.

“Health systems have taken a risk because these policies create controversy and require buy-in from medical staff. Older physicians have to accept more oversight, which some might naturally resist,” said Dr. Andrew White, professor (General Internal Medicine) an  author on a Nov. 5, 2025 paper assessing institutional policies related to late-career physicians.

Further research, published today in the New England Journal of Medicine, expands on these concerns and reinforces the importance of fair, thoughtful approaches to LCP screening for supporting both patient safety and physician dignity.

Co-authored by White and Dr. Thomas Gallagher, professor (General Internal Medicine), the article outlines principles that support equitable LCP policies.

Ensuring fairness

The authors highlight that procedural fairness is central to an effective LCP program.

Their assessment the few institutions with mandatory late-career screening programs found that most lack basic fairness protections for doctors, potentially limiting their engagement with these programs.

The authors have identified several elements that help create processes physicians view as legitimate, respectful, and trustworthy.

“Thinking carefully about ensuring these programs are fair to physicians is not only kind and considerate to those on the medical staff, it is integral to physicians being more likely to accept and participate in LCP initiatives, which in turn can enhance patient safety,” Gallagher said.

Give physicians a voice

Physicians should be engaged early and often in shaping LCP policies. Clear communication about why a policy is needed, paired with opportunities for physicians to share concerns and suggestions, helps build understanding and trust. This input is especially important for informing program design, such as determining age thresholds, selecting screening tools, and outlining next steps when concerns arise.

Universality

Policies applied consistently to all physicians according to a set age threshold were preferred over those triggered by subjective concerns. Researchers point to literature suggesting beginning screening around age 70 for clinicians in all specialties.

Minimize burden

Screening processes should be simple, accessible, and focused only on what is relevant to safe practice. Assessments should be accurate, consistent, and clearly anchored to baseline expectations for clinical capability. When concerns arise, institutions should consider individual circumstances and provide reasonable accommodations. Any actions taken should be as non‑intrusive as possible.

Safeguards

LCP programs must protect physician privacy and include clear avenues for appeals, legal representation, and second opinions. Transparent protections help ensure that physicians feel supported, instead of singled out.

Preserving dignity

Late‑career physicians are an asset to care teams and the learning environment because of their deep experience, clinical judgement and perspective. As institutions design and refine LCP policies, it is essential that these policies reflect appreciation and respect for the value older physicians bring.

Fair, compassionate LCP programs do more than protect patient safety, they reinforce a culture of continuous learning, support physicians across all stages of their careers, and promote thoughtful transitions when needed. When implemented with humility and care, these programs help ensure that late‑career physicians can continue to practice with confidence while maintaining patient care.

The study’s authors were from the Harvard Medical School Center for Bioethics; Intermountain Health; the Law School and the Department of Health Policy at Stanford University; and the schools of medicine and public health at the University of Washington.