Mandatory retirement for surgeons?

A new study has suggested that older surgeons need to consider when it’s time to retire very seriously:

A new study raises questions about when older surgeons should quit the operating room and how they can stay at the top of their game in the final years of their careers. With the percentage of working doctors older than 65 climbing, the questions hold growing importance for patients.

Previous studies found that older doctors are less likely to know about new treatments and medications than younger doctors, and they tend to perform worse on recertification exams.

The new study, published in the September Annals of Surgery, found that for three complicated surgeries, including heart bypass, doctors older than 60 had higher patient death rates, especially if they didn’t do very many of the surgeries.

Some doctors nearing retirement reduce their caseloads, but the study suggests that’s not a good idea.

Practice keeps skills high, so an all-or-nothing approach to surgery in the pre-retirement years may be better than gradually fading away, said study co-author Dr. John Birkmeyer of the University of Michigan.

Should there be a mandatory retirement age for surgeons as there is for commercial airline pilots? Physicians may not themselves be the best judge of when it’s time to go. Should there be an annual recertification at some point?

This is a tough question and will be increasingly timely as baby boomers reach a certain age. The oldest baby boomers are over 60 now.

10 comments… add one
  • This topic touches on two broad subjects: the ability of the medical industry to self-police, and the imposition of age-based performance measures.

    As a young surgeon (out of fellowship for 6 years now), I can point to many senior surgeons who have achieved an Obi Wan Kenobi level of expertise. Implementing a mandatory retirement age is therefore grossly unfair to them and not in the best interests of the general public. Especially since it doesn’t seem likely we can legislate a mandatory retirement age for e.g. a drivers license.

    The medical marketplace in general is moving towards an outcomes-based model (that’s my perception, anyway). As that matures, I’m sure incompetent or ineffective surgeons will naturally be moved out of positions where they can harm the general public. Remember also that age is not the only correlate of poor surgical skills; there are plenty of younger surgeons who suck.

  • there are plenty of younger surgeons who suck.

    That is SO reassuring…

    But your argument makes a lot of sense. Performance-based evaluations really should be implemented. I have a hard time imagining doctors imposing it on themselves though.

  • Master Farly Link

    As an anesthesiologist, I have had ample opportunity to witness surgeons of all types. Some of the best surgeons I have ever observed have been over the age of 65. Experience combined with a quick mind and dexterous hands can perform the trickiest procedure in a quick and sure manner.

    Personality disorders, addictions, and affective disorders can affect surgeons just like anyone else. It would be best to spot the problem surgeons early and steer them to other fields. Likewise, alzheimer’s and other dementias can affect surgeons, and effectively disable them.

    I’ve seen surgeons get brain tumors that affected their behavior and judgment long before their problem was diagnosed. Young surgeons.

    So it’s not age, it’s performance. There have to be standards that are enforced.

  • I’m not an expert on anything medical related, but I am accident prone. The best stitches I’ve ever had put in were by a doctor in his 80s. Steadiest hands with a needle I’ve ever seen. Threaded the needle on the first try too.

  • tupapi Link

    Yes, but….

    There are many capable older surgeons, and there’s no doubt that their experience is excellent, but as a younger surgeon I’ve had the sad experience of witnessing great surgeons forced to retire after having a terrible complication. I think it’s difficult for surgeons to “let go” and it should not be left up to the individual. A mandatory age is not fair, but there should be a better way in place to evaluate each surgeon and avoid a bad outcome(s) as a red flag for aging.

  • R.A. Link

    there is no major difference in surgeon’s outcomes in surgeons who keep their volumes up. read this interesting article on this subject

    http://scienceblogs.com/insolence/2006/09/surgeon_age_and_complications_1.php

  • R. A.:

    I’m a bit suspicious of the results in the study you cite WRT pancreatectomy. It’s actually a pretty rare procedure: “low volume” hospitals perform one or fewer of these per year and even high volume hospitals frequently perform fewer than 20. At rates of incidence that low the variance in performance among different physicians is probably more significant than the age-derived variance.

    Additionally, I’d be more interested in seeing the actual number of mortalities than the percent. The reporting in the study you cited puts some very common procedures alongside some rather rare ones. That’s a bit peculiar to say the least.

    Essentially, I think that this subject should be studied more exhaustively. There should be a better “early warning system” than merely waiting until a physician is forced out by a terrible outcome.

  • michael Link

    i was saved by a 70 year old heart surgeon on an experimental surgury. older means more eperienced but neccesarly better
    going to become orthopedic sureon myself thanks to my doctors.
    p.s. was in bad car reck nearly fatal to me and my brother.

  • michael Link

    should have to take a test anually to still be a surgeon starting at age 65 would be a good idea so qualifiers can still do there gobs and others can end and enjoy a well needed and earned retirement.

  • michael Link

    soory about spelling up all night and ment (not neccesarlybetter) on my first post

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