When should surgeons retire?

Abstract

Background: Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age.Methods: A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance. Results:The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world. Conclusion:Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons.

Does Physician Retirement Affect Patients? A Systematic Review

“…In specialties such as primary care medicine and psychiatry, it is easier to define a retiring physician's panel of patients due to longitudinal care, and patient outcomes such as access to care may be more sensitive to disruptions in continuity. In consultative specialties such as surgery or radiology, it can be more challenging to define the panel of patients of a retiring physician if visits are infrequent, and many articles expressed concerns that retirement should be well timed lest skill deprecation lead to unfavorable clinical outcomes …”

Selbst- versus Fremdeinschätzung des alternden Chirurgen. Ein Vorschlag aus der Schweiz

“…Das Durchschnittsalter der Chirurgen hat im Verlaufe der vergangenen 2 Jahrzehnte offenbar deutlich zugenommen. Zum Beispiel sind in Australien 19 % der aktiv praktizierenden Chirurgen über 65 Jahre alt [1]. Laut dem American Medical Colleges Physician Specialty Data Report waren im Jahr 2017 44,1 % der 103 032 aktiven Chirurgen in den Vereinigten Staaten 55 Jahre oder älter.…”

Learning curves in surgery: variables, analysis and applications

“…Part of this decline can be attributed to the physiological effects of ageing. This is recognised in Canada, India and Ireland where doctors have a mandatory retirement age of 65 years and in Russia and China where the retirement age is 60 years 15. Reforms to the NHS pension scheme means surgeons may need to work until 68 years of age 16…”