Clinicians Are Talking About Aging Surgeons

Gordon H. Sun, MD, MS

Disclosures

July 21, 2014

In This Article

Should Age Be the Only Factor?

Many readers argued that age is not the only factor influencing surgeon performance, and that older surgeons have more experience to draw upon than do younger surgeons. An analysis of approximately 460,000 Medicare patients undergoing major surgery in 1998-1999 suggested that for most procedures, surgeon age did not predict operative risk. However, when certain complex procedures such as pancreatectomy, coronary artery bypass grafting, and carotid endarterectomy were performed by surgeons older than 60 years, particularly those with low operative volumes, mortality rates were higher than when the surgeon was aged 41-50 years.[15]

A systematic review of 62 studies examining the relationship between physician age and clinical knowledge or performance found that about half of the studies suggested an association between increasing years in practice and poorer performance. These results may not be attributable to older age per se, but rather to the possibility that older physicians are not consistently updating their body of knowledge to incorporate more modern tools and techniques.[16]

Several readers commented that rather than age, any focus on the surgeon's performance should be concerned with "objective" measures that may or may not be age-related, such as hand tremors. Aging influences many aspects of human biology, such as strength, manual dexterity, visuospatial ability, and cognitive function. However, many of the deleterious effects of aging can be counteracted to a substantial degree in older adults with extended practice.[17]

Results from the American College of Surgeons (ACS)-supported Cognitive Changes and Retirement among Senior Surgeons (CCRASS) survey show that 61% of practicing surgeons aged 60 years or older performed within the range of surgeons aged 45-59 years on 3 subtests of the Cambridge Neuropsychological Test Automated Battery, which tests sustained visual attention, reaction time, and visual learning and memory. Specifically, 78% of surgeons aged 60-64 years and 38% of those aged 70 years and older performed within the range of younger surgeons, and no senior surgeon performed worse than young surgeons on all 3 tasks. The study concluded that older age does not guarantee that cognitive deficiency is present.[18]

Of interest, other readers believe that forcing out surgeons simply on the basis of advanced age does not take into consideration whether older surgeons are equipped to deal with work and life outside of the operating room. A cardiac surgeon who voluntarily stopped operating at age 64 years finds that many surgeons have "not made any plans on what to do in retirement and are fearful of being bored and banished to playing golf," whereas an otolaryngologist feared that retired surgeons might "fall into depression." A 1994 survey of 659 American Surgical Association members found that fewer than half had any retirement plans, including 40% of surgeons older than 70 years who were not yet retired.[19] In 2011, a survey conducted by the physician staffing firm Jackson & Coker found that as a result of the recent economic recession, 52% of 522 physicians postponed their retirement plans.[20] Financial security aside, many readers proposed a wide range of solutions to occupy older surgeons' time after retirement, many of which involve continued participation in medicine: writing, teaching, research, and volunteer work.

One issue not raised by any reader was surgeon workforce sustainability. The 2.6% rate of growth in the number of US surgeons was slower than the 7.8% growth in the number of physicians overall.[3] The ACS has reported that the influx of newer surgeons also has not maintained pace with overall population growth and thus may not be sufficient to replace older surgeons as they retire.[21]

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