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January 14, 2019

Assessing the Performance of Aging Surgeons

Author Affiliations
  • 1Sinai Center for Geriatric Surgery, Department of Surgery, Sinai Hospital, Baltimore, Maryland
  • 2Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles
  • 3Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
JAMA. 2019;321(5):449-450. doi:10.1001/jama.2018.22216

The surgical workforce is aging. According to the Association of American Medical Colleges Physician Specialty Data Report, in 2017, 44.1% of 103 032 active surgeons in the United States were 55 years or older. The percentage of surgeons 55 years or older varies by surgical specialty, ranging from a low of 40.9% in vascular surgery to a high of 58.1% in thoracic surgery.1 This is an important issue because older surgeons have more experience caring for patients, which needs to be balanced with the potential impairment in their ability to provide high-quality surgical care because of age-related functional limitations.

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4 Comments for this article
Mandatory Retirement Would Be "Illegal, Inappropriate, and Unfair"?
Thomas Hilton, PhD | Private Practice
The statement that "Establishing a mandatory retirement age for surgeons would be...illegal, inappropriate, and unfair because of the variability in function among older individuals of a given age" strikes me as odd on several fronts.

Illegal? When it comes to public safety, the government makes exceptions: commercial pilots, air traffic control specialists, and the armed forces all have mandatory retirement ages.

Inappropriate? We license physicians and surgeons. Nobody considers that to be inappropriate. We also license automobile drivers, and increasingly states are requiring more frequent testing of drivers past a certain age.

Unfair? It would be unfair to put patients' health at risk because their physician is unwilling to admit that his/her competence is waning. Physicians are not well-qualified to judge their own competence. Too often it is malpractice insurance companies who put incompetent physicians out to pasture - usually for cause. That means somebody got hurt.

Finally, what was not mentioned was economic hardship. By age 65, the vast majority of physicians no longer need to practice to sustain their standard of living and quality of life. Thus, even economic hardship is a flimsy excuse to resist mandated retirement.

Mandatory Retirement
Paul Cunningham, MB; BS, FACS | East Carolina University (RETIRED)
While I share concerns that without oversight there is risk of harm to the public and of course the surgeon remains oblivious of their diminished capabilities, I am also equally concerned that a solution that is triggered by a single parameter such as age is naive at best.

It would make good sense to me that we develop and utilize a data-driven testing sequence for surgeons of all ages - not just those who are superannuating. What will be essential is that this process is peer reviewed, and carefully and consistently administered by the medical profession and not by
poorly informed regulators.

The profession has a need to be reliable in self regulation. This reliability has been questioned of course, and is need of attention.

The ability to be reliably self-monitoring is the essential difference between a profession such as medicine and those otherwise engaged in doing a job. The convenient comparisons that are made between professionals in medicine and other highly vaunted professions are often superficial and flawed.

Apples and oranges are both fruit, but are phenotypically different.
Wisdom Substitutes For Knowledge
J David Spence, M.D., FRCPC, FAHA | Robarts Research Institute, Western University, London, Canada
When I turned 35, my parents asked me what my career plans were. They reminded me that during my internship I advised them never to see a doctor over age 35, because older doctors would be out of date. My reply was that I had since learned that wisdom is more important than knowledge.
Outcomes-Based vs Predictive Testing
William Forgey, MD | Indiana University School of Medicine
It is much more efficient to implement a program utilizing an outcomes-based review of surgeons than it is to develop and implement 2-day or other extensive, possibly inappropriate batteries of tests. Yes, great careers and numerous papers can probably be written concerning various test modalities and their predictive accuracy regarding future behavior or outcome. However, contemporary, real-time observation of surgical outcomes should identify issues rapidly, provide very accurate evaluations and be safe for patients if properly proctored and when other observed behavior is also factored into the evaluation.