Clinicians Are Talking About Aging Surgeons

Gordon H. Sun, MD, MS

Disclosures

July 21, 2014

In This Article

Time to Throw in the Scalpel?

Medscape recently posted "How Should I Report an 'Aging' Surgeon?" in which an operating room (OR) nurse requested advice on how to address a delicate state of affairs in her workplace. A 75-year-old surgeon's clinical skills were perceived to be declining, potentially leading to suboptimal care and compromised safety.

This is an incredibly sensitive, emotionally charged situation, as a myriad of disparate factors come into play: surgeon autonomy and dignity, the working dynamic between physicians and nurses, patient care quality and safety, evolving standards of care, the aging workforce, and more.

Carolyn Buppert, a healthcare attorney (and nurse practitioner) writing for Medscape, replied that the nurse could first discuss these observations directly with the surgeon in a gentle, nonconfrontational manner backed by specific examples, and consider getting a peer (another surgeon or anesthesia provider) to observe and pass judgment. The OR nurse was also advised to communicate with nursing administrators or the head of surgery. Lastly, the nurse was advised to avoid going to the state medical board until all possible internal mechanisms had been exhausted; otherwise, the nurse could be placed in a no-win situation if no one else at the hospital can corroborate the nurse’s observations. The OR nurse was informed that by discussing concerns with the surgeon in question and with other authorities, the nurse was acting appropriately as the patient's advocate.

Perhaps not surprisingly, the article generated a substantial amount of commentary from Medscape readers, much of which exposed starkly differing viewpoints on this complex situation. From the 250 comments posted online, we have extracted 6 themes that we hope will be informative for anyone in healthcare facing a similar situation. [Editor's note: Some reader comments have been edited for clarity.]

Current Trends on Elderly Surgeons in Clinical Practice

Carolyn Buppert's comment on the aging of physician and nurse "baby boomer" populations is borne out by epidemiologic data in the United States. The Association of American Medical Colleges (AAMC) reported that in 2010, more than 40% of the nearly 800,000 actively practicing physicians in the United States were at least 55 years old, a nearly 3% increase from 2007. Within most surgical specialties, the percentage of providers at least 55 years old was above the 40% national mean. Highest among surgical specialties in the proportion of practitioners older than 55 years were thoracic surgery (51.6%), orthopedic surgery (49.7%), and urology (49.3%).[1]

Peter Carmel, a pediatric neurosurgeon and past President of the American Medical Association (AMA), commented that about 20% of US physicians were older than 65 years.[2] On the basis of 2009 AMA Masterfile data, about 8.5% of all active US surgeons were at least 70 years old, including 11.6% of thoracic surgeons.[3] A 2014 paper in the Annals of Surgery[4] estimated that the number of active US surgeons older than 70 years of age is as high as 20,000.

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