Asking surgeons to retire at a certain age is a poor surrogate for continued assessments of competency, attendees argued at the Canadian Surgery Forum.
The forum, held in September, heard pros and cons in the timely debate about whether older surgeons should face mandatory retirement.
The topic has become a hot one recently because a number of surgical specialties are faced with a glut of trained residents with nowhere to practise. This trend has, in part, been blamed on physicians remaining in practice after the age of 65.
Dr. Gerald Fried, chairman of the surgery department at McGill University’s Faculty of Medicine in Montreal, argued against mandatory retirement based on age, calling it an arbitrary measure of a surgeon’s abilities.
“We need to better monitor performance throughout a surgeon’s career,” he told attendees.
Surgeons need to implement evidence-based, valid recertification standards to assess knowledge, judgment and skills throughout a surgeon’s career, Fried said. This way, changes in competency due to other factors besides age—such as depression or financial and personal trouble—can be caught before a mishap occurs in the operating room.
He stressed that a surgeon’s physical and cognitive health should also be tested, and he suggested that the interval between testing could become shorter as a physician ages.
Arguing in favour of mandatory retirement was Dr. Ralph George, a surgeon and medical director of the CIBC Breast Centre at St. Michael’s Hospital in Toronto. George cited numerous studies showing a marked physical, cognitive and neurophysiological decline with age, including a precipitous drop between the ages of 67 and 72.
He cited a 2008 paper in the Journal of the American College of Surgeons by Linas Bieliauskas, a neuropsychologist at the University of Michigan in Ann Arbor, showing there was no relationship between a surgeon’s self-reported cognitive change and an objective measure of cognitive change.
This lack of self-awareness of decline, George said, is the “most troubling” finding. He said he was concerned that, without monitoring, an older surgeon’s first hint of his own decline could be a mistake in the operating room.
Fried countered that age has little to do with accidents in the operating room. He said that, in his experience, accidents happen when a person has bad insight in terms of their skills, regardless of age. “The problem is people doing things beyond their capabilities.”
One role for older surgeons, George suggested, would be to take on administrative, teaching and leadership roles not popular with younger surgeons.
However, Fried stated that without time in the operating room, older surgeons in these roles would no longer be “surgeons leading surgeons.”
George agreed that financial difficulty is probably a “very pertinent” reason why older surgeons may resist retiring. He suggested that a pension would help alleviate financial trouble. Both George and Fried agreed that mandatory retirement at age 65 is currently not an option, as there are still some areas where no other surgeons are available.
“A lot of people would like to retire, but there is no one to take their job,” Fried said.
George said the mandatory retirement issue is one that surgeons should discuss and address before “it is mandated for us.” Most regulations disallow mandatory retirement based on age, unless age is demonstrated as a real occupational requirement for the job.
As of December 2012, mandatory retirement based on age is not allowed for employees in federally regulated industries (such as aviation, but not healthcare) under the Canadian Human Rights Act.
This story originally appeared in our sister publication .