[Skip to Navigation]
Sign In
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
Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    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.