Surgeons face unique challenges in maintaining competency as they age, ensuring patient safety, and preserving professional dignity.
The question of when to retire resonates deeply within the physician community, with over 40% of US physicians expected to be 65 or older within the next 10 years.
A recent study published in the Journal of the American College of Surgeons by the American College of Surgeons (ACS) Board of Governors (BoG) Physician Competency and Health Workgroup aims to address these challenges.
The study provides a comprehensive strategy for sustaining lifelong competency among surgeons, offering an evidence-based roadmap for supporting current and future generations throughout their careers.
Dr Todd K Rosengart, the lead author and professor at Baylor College of Medicine, highlighted the decline in motor and cognitive capabilities often accompanying ageing.
This decline can potentially impact a surgeon’s clinical performance, raising concerns about maintaining acceptable competency levels.
While current recommendations suggest mandatory cognitive testing from age 65 and career transition planning from mid-career, there remains ambiguity regarding the practical implementation of these guidelines.
In contrast to professions like aviation, which have rigorous guidelines including annual certification requirements, the surgical community lacks clear protocols.
Rosengart emphasised the need for comprehensive, multimodality clinical assessments, including neurocognitive testing and early implementation of long-term transition planning within a culture of safety, collaboration and equity.
Dr Adam M. Kopelan, co-author of the study, stressed the importance of empowering surgeons to actively participate in competency assessments throughout their careers.
This approach aims to destigmatise concerns about age-related performance decline and foster a supportive environment for ongoing professional development.
The study rejects the idea of a mandatory retirement age, advocating instead for objective assessments of fitness tailored to individual needs.
While countries like India, China, Spain, and Australia have mandatory retirement ages for physicians, the US does not impose such restrictions.
Research findings on age-related decline vary, with some studies suggesting decreased medical knowledge and adherence to standards of care among older surgeons.
However, the experience gained over the years can somewhat offset cognitive decline, improving outcomes.
Warning signs of age-related decline may include forgetfulness, poor clinical judgement and major changes in behaviour or appearance.
The study also addresses the leadership role in implementing competency assessments and policies, suggesting surgeons should take the lead rather than rely on external mandates.
The proposed strategy allows for individualised training to address cognitive and motor decline, potentially extending a surgeon's active service.
The authors emphasise the importance of long-term transition planning, preparing surgeons for alternative roles as they approach retirement.
Opportunities for continued contributions include mentoring, research, education, and community outreach, which offer meaningful ways to remain engaged beyond the operating room.
The study presents a forward-thinking approach to maintaining surgeon competency throughout their careers, emphasising flexibility, individualised assessment, and proactive planning.
By addressing the challenges of ageing proactively and inclusively, the surgical community can ensure continued excellence in patient care while supporting its members’ professional growth and wellbeing.
