Tuesday, 23 Apr 2019

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Assessing the Performance of Aging Physicians

A JAMA Viewpoint article examines the performance of aging surgeons and notes that the effects of aging affects physicians variably and that physician competency should be based on functional age (and abilities) rather than chronologic age. This argues against a mandatory retirement age for surgeons. 

The surgical workforce is aging. Recent reports show that in 2017, 44% of 103 032 active surgeons in the United States were 55 years or older.

Older surgeions are gifted with skill, knowledge and competencies drawn from time. However, time may also affect performance with changes in physical and cognitive function, vision and hearing, reasoning, verbal memory, etc.

Studies have addressed visual sustained attention, reaction time, and visual learning and memory.

While one study found that surgeons (n = 359) performed better than the age-appropriate norms in psychomotor areas, although there was “considerable decline with age” in virtually every test. Unfortunately, older surgeons have a self-awareness problem as most senior surgeons, defined as those older than 65 years, reported no changes in cognitive abilities with age.

Some studies showed that operations by an older surgeon did not adversely affect patient outcomes. While others found that, compared with younger surgeons (ages 41-50 years), older surgeons (older than 60 years) had higher operative mortality rates for pancreatectomy, coronary artery bypass grafting, and carotid endarterectomy. However, these differences were small and limited to surgeons having low procedure volumes.

Individual variability in the rate of cognitive and physical decline—variability that increases with age—argues against having a mandatory retirement age for surgeons.

Another reason not to pursue mandatory retirement age is that treatable causes of poor performance may be found such as medication adverse effects, depression, neurologic disease, sleep apnea, and correctable vision problems. An unintended consequence of a mandatory retirement age would be the depletion of surgeons who have long served rural communities where there is no immediate replacement surgeon available.

Human faculties deteriorate with age, but there is great variability in this process among individuals. Older surgeons may have greater judgment and decision-making capacity than younger surgeons that conceivably offset cognitive or technical declines. Striking the appropriate balance between patient safety and preservation of an effective surgical workforce remains a challenge.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

As a biased mature physician, I applaud this article. Because government bureaucracy has caused us to lose 11,000 physicians a year we are losing this valuable medical asset in our country. We are losing rheumatology and other specialty brain trusts and my advice is to stop such government nonsense so we can keep this valuable resource and sustain our leadership.

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