Surgeon Retirement – When should the operating stop?

Recently while settling in for take-off, I was surprised to see that the captain looked much older than the mandatory retirement age of 65. I tried to imagine myself in the pilot’s shoes with the knowledge that on the eve of my 65thbirthday I would be judged fully fit and capable of flying an airliner and the next day I would not.

Congress has mandated that airline pilots over 40 need more frequent skill testing and that the retirement age is 65. Similarly, it has mandated the following retirement ages: FBI agents at 57, air traffic controllers at 56 and National Park rangers at 57[i].

Clearly policies with merit but based on chronological age rather than functional age and the ability to perform the required duties.

An unusual example of the importance of functional age is demonstrated by an internist aged 104 who was still seeing patients three days a week.

Patient advocates ask: “Why there is no similar testing requirements and a mandatory retirement age for surgeons?”

However, there is appropriate growing awareness and progress on the competency testing of aging surgeons.

We know that surgeons suffer from the same age-related changes as the general population in hearing, vision, memory, motor skills and cognitive skills, and that with these changes there is an increasing rate of complications, especially with complex cases for the aging surgeon.

There is an editorial in the ANZ Journal of Surgery[ii], commenting on an article by Tribble et al[iii]discussing the increased number of complaints against surgeons, especially older surgeons, compared to non-surgeons.

Truskett in his editorial discusses the formation of an “Expert Advisory Group” (EAG) by the Medical Board of Australia (MBA) and that the EAG has recommended that all medical practitioners, from the age of 70, undergo appropriate health checks and cognitive screening together with a formal management performance review every 3 years.

Katic et al[iv]in an article discusses “The Aging Surgeon Program” of similar assessments at the Mt. Sinai Hospital of Baltimore.

Blatt et al[v]discuss in a review article, “When should surgeons retire?” the general problem and how surgeons could transition into non-operative duties and teaching.

The AMA considers that “physicians should be allowed to remain in practice as long as patient safety is not endangered.”

Those of us in the professions are very fortunate to be able to reduce our work load as we age and continue practicing our profession much longer than laborers and workers whose bodies have been worn down with the years of physical labor.

For my part, I stopped operating at 70 and was then able to transition into being a ‘non-operating’ orthopaedic surgeon doing clinical work.

So, what’s the answer?

I agree with the recommendation that surgeons should stop operating when they cannot perform all the requirements and therefore place their patients at added risk. Certainly, before being asked to or told to.

For most of us, I think we intuitively know when ‘it’s time.’

Yet I believe that organized medicine needs to champion programs to assist all medical practitioners on their journey to choosing retirement.

 

-Anthony Dwyer, M.D.

 

(The opinions stated in this blog are those of the author Dr. Anthony Dwyer and not necessarily those of the American College of Spine Surgery).

[i]https://en.wikipedia.org/wiki/Mandatory_retirement.

[ii]Truskett PG. Surgeons: Cause for complaint. ANZ J. Surg.2018; 88: 259-260.

[iii]Tibble HM, Broughton NS, Studdert DM, Spittal MJ, Hill N, Morris JM and Bismark MM. Why do surgeons receive more complaints than their physician peers? ANZ J. Surg.2018; 88: 269-273.

[iv]Katic MR and Coleman JA. The aging surgeon. Ann of Surg. Aug. 2014-Volume 260; pp 199-201.

[v]Blatt NR, Morris M, O’Neil, Gillis A and Ridgeway PF. When should surgeons retire? BJS2016; 103, 35-43.

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