Retiring from the operating room but not from life

Raj S. Pruthi, MD

Pruthi is past president of the Society of Academic Urology and chair of the American College of Surgeons Advisory Council for Urology.

It is widely agreed that most surgeons (and others in technical professional trades) reach their peak of overall performance around the second half of the fifth decade (45 to 50 years of age). For the next 2 decades, what appears to be happening is that growing experience can and does more than compensate for diminishing physical skills.¹

As Irving Bunking, MD, remarked in his thoughtful 1983 JAMA commentary, one cannot easily dismiss ego-enriching moments of diagnostic challenge and technical conquests with the eternal gratitude of patients and families and respect of peers. But the day does come. “Honest, balanced surgeons apprehensively await…warnings [that say], ‘This was not an impeccable performance!’ … And when [the warnings] arrive, they become demons of the night. At first, while you are sleepless, staring into the dark, they will be a secret that you will keep from your wife at your side; but soon she will know.”²

The question of when a surgeon should retire has been the subject of debate for decades. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more remote they are from his/her initial training. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize 1) their skills will decline, 2) a properly planned retirement can be satisfying, and 3) the retired surgeon has much to offer the medical and teaching community.¹ Trunkey and Botney calculated that if surgeons failed a hypothetical medical test at the same rate that US commercial pilots fail their semiannual medical tests, then 39 surgeons per year would lose privileges in the United States attributable solely to medical problems.³ Their calculation is undoubtedly an oversimplification, and an argument can be made that they are too low or too high in their estimation. However, the fact remains that some surgeons become incompetent because of loss of capabilities with aging, and there presently is no systematic method to accurately identify such individuals, and surely, some must be continuing to practice.

The possible methods to prevent decreasing surgical skills resulting from age from becoming a major risk to patients naturally fall into 1) mandatory measures (external forces that compel surgeons to cease operating) and 2) education (A. increasing surgeon and societal awareness of this potential problem and encouraging surgeons to use heightened insight into their own limitations, and B. making surgeons and our medical communities aware of the many areas that physicians can contribute outside of the operating room). Neither approach is effectively in use in this nation currently.

Personally, I agree with the American College of Surgeons’ position discouraging a mandatory retirement age because the onset and rate of age-related decline in clinical performance varies among individuals. Furthermore, a mandatory retirement age may have a deleterious impact on access to experienced surgical care, particularly in rural and underserved areas. I believe that we should focus on the second approach—educating not only surgeons, but also society and our medical community as to the potential opportunities that may exist for senior surgeons. Senior surgeons play a vital role in their hospitals and communities, and their knowledge and years of experience can be valuable resources. Surgeons relinquishing clinical roles can contribute significantly to teaching, surgical assisting, research, or administration. If their abilities permit, and if they are willing, they should be given opportunities to contribute to these areas.

References

1. Bunkin IA. When does a surgeon retire? JAMA. 1983;250(6):757-8

2. Blasier RB. The problem of the aging surgeon: when surgeon age becomes a surgical risk factor. Clin Orthop Relat Res. 2009;467(2):402-411. doi:10.1007/s11999-008-0587-7

3. Trunkey DD, Botney R. Assessing competency: a tale of two professions. J Am Coll Surg. 2001;192(3):385-95. doi:10.1016/s1072-7515(01)00770-0