But it doesn’t happen to everyone to the same extent, or at the same rate. The effect of cognitive and physical diminishment depends not only on the rate of decline, but also on the starting point — both of which vary widely in a group as heterogeneous as surgeons. And it seems relevant to note that there’s no inflection point in age-related performance; that is, there’s no one particular age when, on average, performance shows an especially sharp decline. It’s all gradual, variable and widely distributed.

Because of all that, the sense that calls for a mandatory retirement age for surgeons are probably misguided. To declare, by fiat, that all surgeons must retire at, say, age 65 would necessarily cost us the contributions of many competent practitioners — and setting a retirement age too high might give undeserved cover to too many incompetent ones. There has to be a better way.


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In addition to the mandatory retirement age, commercial aviators are also subjected to a biennial battery of medical and performance tests to assure us, again and again, of their ongoing competence.  It’s not obvious why surgeons aren’t obliged to complete a similar process. Most specialties are required to re-up their board certification every 10 years, and this requirement is certainly a step in the right direction.

But it also represents a trivial threshold for most practicing surgeons; for example, at least as of a few years ago, no sitting orthopedic surgeon had ever failed to achieve the recertification requirements, although some had required multiple sittings.5 Either all surgeons who are no longer competent go quietly into that good night by self-diagnosis in a timely fashion, or the recertification process is allowing some number of incompetent surgeons to slip through the cracks. If I were a gambling man, I’d bet the farm on the latter.

But there’s no reason why something as critical as assuring that our surgeons are competent should be left to chance. A few institutions around the country have periodic competency testing programs in place; but in many others, this sort of testing is either entirely voluntary or compelled only when there’s extrinsic evidence of incompetence or misconduct.

Part of the problem, undoubtedly, lies with our own attitudes. Surgeons are notorious for conflating professional performance with self-esteem and the mere admission that we might — even as a group — benefit from more frequent or stringent competency testing could create a dissonance that many of us would find detrimental or simply unacceptable. More than that, surgeons rightly see our work as an unparalleled privilege to provide society with a unique benefit. It’s easy to see how that can be hard to walk away from.

Senator McCain, I’m sure, sees his job the same exact way. The difference, though, is that he’s up for re-election every 6 years and is subject to a de facto public evaluation of his skills and capacities every time he’s filibustering in the Senate chamber or arguing on MSNBC. He’s constantly forced to prove his competence to the people who decide whether he keeps his job. Shouldn’t surgeons be able to say the same?

References

  1. Grady D. “McCain’s Surgery May Be More Serious Than Thought, Experts Say.” New York Times. Updated July 16, 2017. www.nytimes.com/2017/07/16/health/john-mccain-blood-clot-recovery.html?mcubz=0. Accessed August 8, 2017.
  2. Greenfield LJ and Proctor MC. “When Should a Surgeon Retire?” Advances in Surgery. 1999;32:385.
  3. Rovit RL. To everything there is a season and a time to every purpose: retirement and the neurosurgeon. J Neurosurg. 2004;100(6):1123-1129.
  4. Trunkey D and Botney R. Assessing competency: a tale of two professions. J Amer Coll Surgeons. 2001;192(3):385-395.
  5. Blasier RB. The problem of the aging surgeon: when surgeon age becomes a surgical risk factor. Clin Orthopaed Rel Res. 2009;467(2):402-411.

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