Regulatory Approaches to Addressing Cognitive Decline in Aging Physicians.

Abstract

The incidence of cognitive decline increases exponentially with age, presenting important implications for professionals in cognitively demanding fields such as medicine. Despite an aging health care workforce, how jurisdictions assess for and address cognitive decline in physicians remains poorly understood. To compare existing regulatory frameworks in the US, Canada, and the other Group of Seven (G7) countries addressing cognitive decline in aging physicians. A comparative policy analysis was performed using qualitative case study methods involving a review of documents from the peer-reviewed and gray literature from June 2, 2025, to March 10, 2026. The focus was on policy documents, government reports, scholarly works, and other official federal or jurisdictional documents. We examined national-, state-, provincial-, and territorial-level policies concerning cognitive decline in aging physicians in the US and Canada and national-level policies in the remaining G7 countries (France, Germany, Italy, Japan, and the UK). These data were contrasted with how other safety-critical fields (judges, commercial pilots, and air traffic controllers) manage aging-related cognitive risks within their regulatory systems. The structured search identified 342 documents for analysis. No G7 country has implemented a standardized, national approach to directly assess cognition among aging physicians. Most jurisdictions rely on self-regulation, collegial oversight, and broad professional requirements for maintenance of competency rather than proactive cognitive screening. Exceptions exist in the US, where a few health systems have introduced mandatory age-based cognitive evaluations for physicians; however, implementation remains challenging. In contrast, mandatory retirement is required for most judges, commercial pilots, and air traffic controllers across all G7 countries. Explicit policies addressing cognitive decline in aging physicians are uncommon across G7 countries. Marked differences exist between medicine and other safety-critical professions, highlighting ethical, legal, and practical tensions surrounding age-based assessments for physicians. Efforts to integrate age-based assessments in medicine should be viewed within the broader context of population safety and public trust, emphasizing that cognitive screening can serve as a supportive measure for physicians and their patients rather than a punitive tool. Further empirical and policy work is needed to inform equitable and evidence-based strategies to address cognition among aging physicians.