Age and the urologic surgeon: When is it time to stop?

Gopal H. Badlani, MD

As I age, I think about, when is the right time to let go? I’ve looked around me for rules, guidance, and examples. Bottom line: You are largely on your own to decide.

I searched the ancient scripture, the Vedas. There is a system of stages of life discussed. They are student, work and householder, detachment, and finally, renunciation. However, they were for medieval times, so life span was much shorter.

On July 1, 1928, surgeon and Mayo Clinic cofounder William J. Mayo, MD, told his secretary that he had just performed his final operation. “I want to stop while I’m still good," he said. "I don’t want to go on like some others I’ve seen, past my prime, doing the surgery that younger, surer men ought to be doing.”¹ Contrast that with Alan Retik, MD, a highly regarded pediatric urologist and chief at Boston Children’s Hospital, who worked until 2 weeks before he passed away at age 90.

The Age Discrimination in Employment Act of 1967 (ADEA) protects individuals who are 40 years or older from employment discrimination. In direct contrast to the ADEA, numerous professionals are subject to mandatory retirement age—most notably, air traffic controllers, airline pilots, Federal Bureau of Investigation agents, and other federal law enforcement officers. Professions with a mandatory retirement age seem to support the viewpoint that performance is inversely proportional to age, causing some to advocate a “one size fits all” compulsory retirement age for surgeons—regardless of performance status and without empirical data to support this position.

Setting a mandatory retirement age fails to account for the fact that physicians “age out of their skills” at different points in their lives. Some may still be at the top of their game at an arbitrarily set retirement age, whereas perhaps others should consider retiring even sooner. How do you balance this? Although older physicians may be physically frail, they generally have a wealth of knowledge and years of experience that hospitals would be loath to lose.

According to a report from AMA Insurance, Inc, a subsidiary of the American Medical Association, the largest percentage of physicians retire between the ages of 65 and 70.²

Who sets the rules is a question that is unanswered. In the absence of guidance from the American Board of Urology, American Urological Association, and state licensing boards, some hospital systems have set up rules or guidance. For example, Stanford University Medical Center recently endorsed a policy requiring medical staff 75 years and older to have a “physical examination, cognitive screening, and peer assessment of…clinical performance” every 2 years. “If the findings…point to potential concerns for patient safety, the service chief and the credentials committee will, on a confidential basis, consider the results and recommend further evaluation as necessary.”³

I asked for anonymous opinions from a senior urologist who is still very active, a renowned surgeon who decided it is time to stop operating, a urologist representing the Society of Academic Urologists, a past member of the American Board of Urology, a resident working with senior faculty, and a geriatrician at the famous J. Paul Sticht Center on Aging and Rehabilitation at Wake Forest Baptist Medical Center. Each contributed insightful editorials on the subject, which will be available on www.urologytimes.com in the coming weeks.

I also posed questions to my fellow editorial board members, and I would also like your opinion on this topic. To complete my brief, confidential survey, go here: https://www.research.net/r/F8C7TSH

Am I close to an answer? Yes, my inner being tells me it is time to initiate letting go.

“Age is inevitable. Aging isn’t.”—Marv Levy

References

1. Clapesattle H. The Brothers Mayo. The University of Minnesota Press; 1941:698

2. Asserson DB, Janis JE. The aging surgeon: evidence and experience. Aesthet Surg J. 2022;42(1):121-127. doi:10.1093/asj/sjab145

3. SHC late career practitioner policy FAQs. Stanford University Medical Center. October 17, 2013. Accessed August 20, 2023. https://stanfordhealthcare.org/content/dam/SHC/health-care-professionals/medical-staff/policies/faqs-late-career-practitioner-policy-10-13.pdf