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Home E-Weekly August 22, 2017

When Are Surgeons Too Old to Operate?

Published: August 21, 2017

GOLDEN YEARS Forcing older surgeons into retirement could be discriminatory and might take many competent physicians out of practice.

Octogenarian Richard Rothman, MD, PhD, founder of the renowned Rothman Institute in Philadelphia, Pa., is still performing hip and knee replacements and has shown no signs of slowing down with the scalpel. But what if Dr. Rothman were no longer allowed to operate simply because he was considered too old?

That's the dilemma addressed in a recent report published in JAMA Surgery, which calls for non-punitive evaluations of physicians' cognitive and physical skills as they age in order to support those who continue to deliver great care based on their decades of experience and to protect patients from those who are unable to practice safely.

The report notes that nearly one-fourth of practicing physicians were at least 65 years and older in 2015. The report also says the average person's cognitive ability declines by more than 20% between 40 and 75 years of age. However, mental capacity and physical skill vary among aging individuals, so age-based evaluations are needed in health care, similar to what's used to test the competency of workers in other fields, such as commercial aviation.

The testing itself would not be discriminatory if applied to all physicians at a certain age threshold, according to E. Patchen Dellinger, MD, a 73-year-old general surgeon and co-author of the report. He says any action that followed based on the results of the testing would not be discriminatory, because it would be based on the assessment of competence.

"We recommend that healthcare institutions, through their medical staff offices, consider mandatory testing of physicians as they age, as several leading institutions are already doing," says Dr. Dellinger.

By starting at a time when most physicians are fully competent and before they are "old," facilities can avoid the stigma of age discrimination, points out Dr. Dellinger. He adds, "There are going to be trade-offs with any age thresholds that are set — start too early and do lots of testing that turns out to be unnecessary, start too late and miss some physicians whose competence has declined — but we can't let this difficulty keep us from moving forward."

Daniel Cook

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