Mandatory Cognitive, Psychomotor Testing Urged for Older Surgeons

By Marilynn Larkin

May 29, 2019

NEW YORK (Reuters Health) - Mandatory cognitive and psychomotor testing of surgeons by at least age 65 should be implemented as part of ongoing professional evaluations, career transition discussions and other initiatives to support an aging workforce while ensuring patient safety, according to recommendations from the Society of Surgical Chairs (SSC).

Dr. Todd Rosengart of Baylor College of Medicine in Houston told Reuters Health that the SSC report, online May 15 in JAMA Surgery, "provides guidelines for transitioning the senior surgeon that we view as extrapolatable to all physicians. It was undertaken because this is largely an unaddressed issue in the medical community, at a time when (as noted in the paper) there is a growing population of physicians and surgeons over the age of 70 and an expectation over the next 10-20 years of an increasing shortage of surgeons and physicians."

"There is clear evidence of an age-related decline in the cognitive and psychomotor function of physicians and surgeons (20% between age 40 and 75 years)," he said by email. "In some, but not all cases, this may be compensated for by a provider's experience, baseline capabilities and training efforts undertaken to compensate for this cognitive decline."

"Thus," he said, "this work was undertaken to ensure protection of patent safety while avoiding unnecessary cuts to a growing undersupply of the physician workforce."

Dr. Rosengart and colleagues surveyed the SSC membership, which includes 185 department of surgery chairs (approximately 70% of the academic surgery departments in the US) on how best to optimize management of the aging surgeon. The online survey achieved a 60% response rate (80 respondents), of whom 94% were supportive of a report on the topic, with 30% viewing the issue as "very significant" and 57% viewing it as "somewhat significant."

Of the 47 respondents who defined an age for an aging surgeon, 25 (53%) selected 65 and 14 (30%), 70. None believed that those under age 60 should be defined as an aging surgeon.

Thirty-three respondents (41%) reported that they encountered issues associated with clinical, technical, or cognitive skills of aging surgeons at least occasionally, whereas 17 (23%) reported that they received questions associated with aging surgeons' maintenance of privileges at least occasionally.

Twenty respondents (25%) identified a policy in place at their institution to help resolve cognitive competency issues or a destination to which surgeons could be referred for fitness evaluations

"An important component of our proposal is our recommendations for monitoring the performance of senior surgeons, which should include a regular composite analysis including mandatory cognitive testing as well as actual clinical performance (which may or may not be compromised by cognitive testing capabilities) and the steps that can be taken to ensure the smooth transition of senior physicians to non-operative or non-clinical roles," Dr. Rosengart said.

"These should include early career counseling to guide physicians to develop outside interests, financial planning, and medical skill sets that would allow contributions outside of the operating room or clinical arena," he explained.

"Also important is the institutional development of non-clinical opportunities for senior physicians, including important roles in mentoring/coaching junior physicians, peer review, community outreach and administrative responsibilities," he added. "These efforts are underway sporadically across the US, but not in an organized or systematic fashion."

Dr. Julie Freischlag of Wake Forest Baptist Medical Center in Winston-Salem noted in an accompanying editorial that she is 64 years old, "and reading this article that recommends the mandatory evaluation of surgeons by age 65 years really resonated with me. What if the results are not good? Will they make me stop operating? Then what will I do? What will people say? Should I stop now so I will not have to find out? Why do we need to get tested anyway? The answer is for the patients we serve."

Dr. Freischlag told Reuters Health by email, "Although not mandatory, there are some hospitals that offer testing to senior surgeons and other physicians if they desire. Sometimes it is part of assessment of someone who has had some change in attitude or behavior."

"To my knowledge, there is no place that mandates testing at 65," she said. "However, some hospital systems (in the US and elsewhere) do have mandatory retirement at a certain age for all physicians. With the use of this kind of testing, those who do not want to retire could show their abilities to carry on as a competent surgeon or physician."

"The financial freedom to retire is what the young surgeon needs to understand, as few surgeons demonstrate physical or mental changes before they retire," she added. "However, if you have managed your finances well and needed to retire for any reason, you could."


JAMA Surg 2019.