Dr. Stephen Miller talks about the known effects of aging on physician clinical performance. He compares the regulatory standards for the aviation and medical fields. He contrasts clinical outcomes for older physicians compared to younger physicians. He highlights the confounding age-related issues such as lower caseload volume. He notes that physicians believe in reporting an impaired colleague in theory, but have fallen short when it is called for. Dr. Miller ends by advocating regular evaluations of mental/physical health throughout one’s career, and suggests other ways to ensure competency for physicians.