When a Medscape commentary asked in March 2026 whether older physicians should be screened for competence, few readers answered with a simple yes or no. Most replied with a question of their own: Why single out age?

“Surely discriminatory to only test older doctors,” one commenter wrote — a sentiment that surfaced again and again in the responses. Few readers objected to the idea of checking whether a doctor is still fit to practice. What they rejected was the premise that a birthday, rather than performance, should decide who gets checked.

The commentary that prompted the discussion weighed a recent The New England Journal of Medicine (NEJM) analysis of late-career screening programs, which found that many lack clear standards for due process, appeals, and legal representation. Readers seized on that gap and on a broader one. Published research has long held that chronological age is a poor proxy for competence: Cognitive and functional decline vary enormously from one person to the next. Late-career decline is real, but age alone is a blunt instrument for finding it.

If you test the older physician, you must test all physicians in a fair and equal manner.

Test Everyone, or No One

For most readers, the objection was not to scrutiny but to selectivity. If competence is the concern, they argued, then competence — not age — should be the trigger, and it should apply to everyone. “If implemented should apply to everyone,” one wrote. Another pushed the logic past medicine altogether: “If we’re going to impose age or competency rules on physicians, then apply them across the board. Judges, politicians — everyone.”

Others turned the age framing on its head, asking whether a struggling younger physician or a veteran nurse should be screened too if patient safety is really the point. One commenter said they would submit to regular testing without complaint — provided it applied to everyone and the results were made public so that a patient choosing a surgeon could see them.

The demand, in the end, was for consistency: a single standard applied across the profession or a more individual way of judging who is actually fit to practice. It was also, several noted, a matter of fairness to the physicians being judged — the same procedural gap the NEJM analysis identified where screening programs often lack protections doctors would take for granted anywhere else.

The Case for Experience

If age can flag decline, readers countered, it can just as easily obscure what years of practice add. Experience, several pointed out, is not merely time served; it is judgment, technical fluency, and the confidence to act under pressure.

One reader remembered an obstetrics and gynecology attending, probably in his eighties, who taught them lessons they still drew on. A physician still working at 74 wrote that after decades spent on hiring and practice management, the riskiest doctors they had encountered were usually the ones “NEW to practice,” not the oldest. A reader who had retired at 73 said former colleagues still brought them their hardest cases and called the loss of 45 years of practice and teaching “a loss for everyone.”

That argument landed harder against the backdrop of a stretched workforce. As health systems lean more heavily on less experienced clinicians and nonphysician staff, some readers bristled at the idea of ushering seasoned doctors out the door. One, still smarting from a recent hospital stay, put it bluntly: “What I would have given to see a 72-year-old neurosurgeon this week.”

Where Readers Granted the Point

Not everyone dismissed the case for screening. A smaller group agreed that some physicians do stay too long and that the profession is not always honest about it.

A reader who retired at 69 said they had watched older colleagues keep practicing as their skills slipped, often without seeing it themselves. A neuropsychologist described the same pattern among aging professionals: diminishing ability paired with limited awareness of the change. “If you have responsibility to provide competent care, is it too much to demonstrate that competence, especially as you age and are more likely to experience cognitive decline?” they asked.

The sticking point, even for those readers, was how to measure it. One argued that some current cognitive tests are “really not adequate” to catch meaningful decline, and that testing should start earlier in a career so later changes can be judged against a physician’s own baseline rather than a population average. A credible system, the same reader suggested, would combine peer review, simulation, cognitive testing, and physical assessment, tracked over a working lifetime — not a single exam administered late.

Why Some Can’t Just Retire

Underlying much of the debate was a practical reality: Leaving is not always a choice. Late-career practice is shaped as much by finances as by ability — by debt, insurance costs, and the sheer economics of walking away.

More physicians would retire earlier, one reader argued, if health coverage in retirement were affordable. Instead, a late start on real earnings, years of educational debt, mortgages, and later-in-life families keep many working longer than outsiders assume. “We have to wait to start earning until we’re about 29 years old (or older) and pile us with debt that takes between 13 and 20 years to repay,” the reader wrote.

For others, the breaking point was the job itself. “My test was how many Medicare cuts I could tolerate and how many mouse clicks I could do in a day. Left medicine at age 69,” one wrote — a sentiment recent physician surveys bear out, with burnout, administrative load, and financial strain repeatedly cited among the reasons doctors cut back or quit.

What Would Actually Be Fair

Taken together, the responses sketched the outline of a system readers might actually accept. Its first principle was symmetry: Test everyone or test no one because age-based screening is hard to defend when the same standard is not applied across the profession. Any testing should begin early and track change over time because a late-career result means little without a personal baseline. It should reach beyond a single cognitive exam to peer review, simulation, and hands-on clinical assessment — and it should not be mistaken for judgment, given how much good care those tools fail to capture. It would need real procedural protections, including a fair appeals process. And where possible, it should keep experienced physicians in the system through teaching or lower-risk roles rather than pushing them out.

What readers were describing, in the end, was less a screening program than a fairer bargain: Prove competence, by all means — but prove it for everyone, measure it honestly, and don’t waste the expertise you already have.