Physicians and Cognitive Decline: A Challenge for State Medical Boards

Older physicians benefit from their many years of experience and the skills they have developed over decades of practice. At the same time, they may be at risk of cognitive decline, which raises concerns about job performance deficits. The question that this article addresses is whether state medical boards have a role to play in identifying clinicians with cognitive decline. It discusses what state medical boards currently do in this regard and analyzes whether they should do more. It also discusses relevant legal constraints and ethical obligations. The article ultimately concludes that state medical boards would be wise to adopt late career screening programs that are carefully designed to balance the interest of clinicians and patient safety. Such programs could be implemented only after experts determine which preliminary tests and more comprehensive follow-up tests can best identify job-related cognitive impairment and at what age the testing program should commence. Any testing program would have to include due process protections, efforts to provide reasonable accommodations to facilitate job performance, and a public relations campaign to build support among clinicians and professional organizations. Although the article focuses on state medical boards, its analysis and recommendation are relevant to all state licensing boards that oversee health care providers.