Commercial airline pilots must retire at 65 according to Federal Aviation Administration regulations. This isn’t ageism; it’s about safety. In contrast, physicians, whose decisions can be equally life-or-death, have no such mandate. As a former internist, chief medical officer, and hospital CEO, I have witnessed the consequences when physicians continue practicing beyond their peak. The outcomes can be perilous, tragic, and completely avoidable.

When the notion of “going out on top” fails

During my time as CEO, I received numerous reports of troubling behavior concerning a respected physician. Nurses informed me he roamed the unit searching for a patient who had been discharged days prior. Colleagues noted confusion while performing routine tasks. Although I wasn’t present to evaluate him, I suspected early dementia. I urged him to retire gracefully for the sake of his patients and his own reputation. He declined. What ensued was distressing: tense discussions with his family, increasing safety issues, and ultimately a precautionary suspension of his hospital privileges. This situation is not uncommon. Families often fail to acknowledge the decline (or are unwilling to) until danger is imminent. Hospital leadership faces an untenable decision: safeguard patients while risking the humiliation of a cherished doctor, or postpone action and jeopardize care.

The evidence is unmistakable

Physicians are not exempt from the effects of aging. Research indicates age-related declines in memory, processing speed, and dexterity, all of which influence diagnosis, decision-making, and procedural safety.

We cannot leave this to chance, families, or makeshift committees.

A reasonable, pragmatic approach

I am not suggesting mandatory retirement. The Age Discrimination in Employment Act rightly prohibits forcing physicians to retire solely based on age. However, we can and should mandate regular competency evaluations for older physicians. Here’s what I suggest:

– Standardized testing: Cognitive, motor, and physical assessments every two years for physicians aged 65 and older as part of the license renewal process.
– Oversight: Conducted by state medical boards to ensure fairness and consistency.
– Due process: Clear appeals and review mechanisms for physicians who do not pass.

Why this benefits everyone

– Patients receive assurance that their clinicians are safe to practice.
– Physicians benefit from a fair, objective process instead of facing quiet pressure to resign or public humiliation.
– Hospitals achieve legal clarity and protection from liability.

Respect, not punishment

When physicians continue to work beyond the point of safe practice, everyone suffers. Their reputations, established over decades, may suffer during their final years. Patients may experience preventable harm. Competency testing aims not to force physicians out but to uphold dignity, safeguard patients, and honor the profession we cherish. Pilots undergo regular evaluations to ensure passenger safety. Our patients deserve at least that.

Joseph Pepe is a physician executive and author with years of experience throughout the healthcare continuum, from home health aide to hospital system chief executive officer. As president and CEO, he managed a 330-bed acute care hospital, a heart and vascular institute, physician practices, urgent care centers, and a joint venture ambulatory surgery center, steering the business of healthcare while remaining rooted in clinical medicine. Dr. Pepe is the author of the upcoming On All Sides of the Bed, an 80,000-word memoir that intertwines captivating bedside narratives with insights on leadership, ethics, and resilience. He has contributed to healthcare ethics literature in the Cambridge Quarterly of Healthcare Ethics, speaks on moral leadership, and mentors both clinicians and executives. He writes a well-received Substack newsletter and shares insights on Instagram at @jack_and_homer, focusing on mortality, meaning, and the human aspect of medicine. Through his work, Dr. Pepe encourages readers to contemplate how we live, heal, and lead.