Urologic surgeons share thoughts on age and performance

Gopal H. Badlani, MD

In my last editorial, I wrote about my quandary as to determining the right time to let go of my career.¹ I am grateful to those who took time to fill out the recent Urology Times survey regarding age and performance and sent me emails. Urology Times has also published the perspectives of individuals from whom I sought comment on this topic.^2-7

Almost 75% of the responders had been in practice more than 21 years, so in a way this was of interest to those who are sailing in the same boat with me. Perspectives varied in the answers to the open-ended questions and the individual comments.

More than 70% said they consider age a relevant factor in the performance of the specialist surgeon (Figure 1). When asked for domains of practice they felt were reflected in “performance,” 45% selected cognition, 54% picked motor skills, 32% chose surgical complications, 24% opted for surgical mortality, and 68% said “all of the above.” (Figure 2). Most respondents (57%) felt that aging-related changes in performance are more relevant to procedural specialties such as surgery, whereas 43% said they felt such changes are equally relevant to procedural and nonprocedural specialties (Figure 3). Only 32% of responders reported being aware of an aging colleague who may have put a patient at risk due to age-related changes (Figure 4). More than half of urologists (55%) said they felt a mandatory age-based assessment should not be introduced for surgeons, compared with 45% who said an assessment should be implemented (Figure 5).

Respondents were asked, “If an underperforming surgeon is identified by mandated age-based assessment, how do you see this best managed? Who should lead this peer review process?” In response, 76% of urologists said such a process should be led internally at the institution/practice level, whereas 18% selected “external agency/group” and 6% said “other.” (Figure 6). When it comes to leading age-based assessment and management of surgeon reviews, 50% of respondents felt surgeons themselves would be best for this role, 10% selected employers (hospitals), 16% chose the American Board of Urology, 7% went with regulatory authorities (state licensure boards), 3% picked medical indemnity organizations, and 15% said “other” (Figure 7).

Nearly 70% of respondents said they knew of a surgeon who struggled with the transition to retirement (Figure 8). When asked to describe how the surgeon struggled, write-in answers included “became very stubborn and uncooperative,” “felt a lack of purpose and accomplishment,” and “they miss their relationships with their patients and colleagues.”

The survey also asked respondents for reasons to continue working beyond age 70 years; responses included “no real self-worth or loss of identity outside of work” and “limited outside interests and thus were not prepared.” In a column for The DO, Daniel J. Waters, DO, MA, writes, “Medicine is a life of service, of sacrifice, and of putting the needs of others before the needs of yourself and those you love…Hopefully, you’ll be able to decide before you get to Malcolm Gladwell’s Tipping Point.”⁸

Some responders, however, felt they were more efficient than their younger colleagues. Some are in a situation in which patients need clinical care but there are insufficient urologists to care for the patient population. The US population is increasing at a higher rate than that of available urologists. If a program were to be designed, senior urologists could adjust to a more office-based practice.

In either work or personal life, the balance evolves with each decade unless you trip and fall. First, you feel like a mountain climber; soon, you realize you are a hamster spinning in your wheel, unless you are in the minority who manage to launch from that spinning wheel with your partner in tow or alone. Soon, you start to recognize the family you have taken for granted still loves you and is willing to take you back. If we are lucky, we get the equanimity, you start to enjoy work as the “want” goes away. In every aspect of our lives, we set expectations, sometimes consciously but often subconsciously. We do not prepare ourselves to meet those expectations, hence the disappointment and hurt. To quote Wayne Dyer, “Give yourself a gift of 5 minutes of contemplation in awe of everything you see around you. Go outside and turn your attention to the many miracles around you. This 5-minute-a-day regimen of appreciation and gratitude will help you to focus your life in awe.” •

REFERENCES

1. Badlani GH. Age and the urologic surgeon: when is it time to stop? Urology Times. Published onlineSeptember 8, 2023. Accessed January 16, 2024. http://tinyurl.com/3yypx68t

2. Dmochowski R. The American Board of Urology: considerations for the urologist in career transitions. Urology Times. September 14, 2023. Accessed January 16, 2024. http://tinyurl.com/2ttkdne3

3.Urology Times contributor. Training with the aging urologist. Urology Times. September 19, 2023. Accessed January 16, 2024. http://tinyurl.com/uzupx6bk

4. Atkinson HH. The aging surgeon: a geriatrician’s perspective. Urology Times. September 22, 2023. Accessed January 16, 2024. http://tinyurl.com/4tdkx443

5.Urology Times contributor. Staying involved with urology later in your career. Urology Times. September 25, 2023. Accessed January 16, 2024. http://tinyurl.com/52fnu2xy

6. Urology Times contributor. A urologist on why the time is right to let go. Urology Times. September 28, 2023. Accessed January 16, 2024. http://tinyurl.com/579jk4j3

7. Pruthi RS. Retiring from the operating room but not from life. Urology Times. October 6, 2023. Accessed January 16, 2024. http://tinyurl.com/2s4ccsuv

8. Waters DJ. Retiring from medicine: knowing when it’s time to get out. The DO. January 3, 2023. Accessed January 16, 2024. http://tinyurl.com/yjra4kha