Clinicians Are Talking About Aging Surgeons

Gordon H. Sun, MD, MS

Disclosures

July 21, 2014

In This Article

Mandatory Age Restrictions: Healthcare and Other Industries

There is no national mandatory retirement age for surgeons and other healthcare providers in the United States. This reflects the current American legal climate; and with rare exceptions, the Age Discrimination in Employment Act of 1967 and subsequent amendments outlaw compulsory retirement on the basis of age.[5] Still, several readers felt that a mandatory age limit for surgeons might be needed, and suggestions ranged from 65 to 75 years. One surgeon jokingly mentioned the so-called "rule of 210": "If the combined age of the surgeon, patient, and anesthetist is greater than 210, the mortality rate is 100%."

Select individual medical staffs and healthcare organizations have voluntarily begun discussing increased screening of older healthcare providers. As of September 1, 2012, Stanford University Medical Center began requiring medical staff, including physicians and PhD-level practitioners, aged 75 years or older, to undergo physical examination, cognitive screening, and peer assessment of clinical performance every 2 years. The threshold of age 75 was chosen by the Stanford task force that developed the policy because the incidence of Alzheimer disease increases significantly starting at age 75.[6]

The University of Virginia Health System and Driscoll Children's Hospital (Corpus Christi, Texas) require periodic testing for physicians beginning at age 70 years.[7] However, such programs are still rare. According to Jonathan Burroughs, a national healthcare consultant and CEO of the Burroughs Healthcare Consulting Network, Inc., only 5% of the more than 900 US hospitals with which he has consulted have any active policy for screening older providers. "Most high-risk professions in America, such as the aviation industry and military, require a 'fitness for work' assessment for all professionals," Dr. Burroughs said, commenting that it would be reasonable for healthcare to follow suit to address potentially treatable undiagnosed impairments in a more proactive and supportive way.

Little information has been published on recommendations or policies on aging surgeons or other healthcare providers outside of the United States. One physician in India reported that the retirement age there was 65 years; this threshold appears to have been raised recently as a result of staffing shortages in state-run hospitals.[8] In Pakistan, the physician age limit is 70 years; beyond this threshold, physicians are either obligated to retire or continue in a nonclinical setting such as teaching or research.[9] In contrast, a surgeon from Italy wrote that in his country, surgeons who reached 65 years of age were obligated to continue work, rather than retire, in the public healthcare sector unless they voluntarily switched to a private delivery model. In the United Kingdom, the mandatory retirement age of 65, across all professions, was phased out in 2011.[10,11] However, Pulse, a UK publication for general practitioners, reported in 2012 that on the basis of the case of Selsdon vs. Clarkson Wright and Jakes, medical practices might be able to justify a mandatory retirement age for older physicians if the chosen age was "proportionate" and for a "legitimate aim."[12]

Observers have commented that age restrictions exist outside of medical practice in industries where consumer safety is directly at stake. In 1959, the US Federal Aviation Administration (FAA) instituted the controversial "age 60 rule," in which commercial airline pilots were obligated to retire upon their sixtieth birthday, a policy that was based on research sponsored by the FAA and supported by Congress.[13] In December 2007, the Fair Treatment for Experienced Pilots Act was signed into law, raising the mandatory retirement age to 65 years. This is one of only a few examples in the United States in which a mandatory retirement policy is not considered age discrimination.[14]

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