When Is It Time For Older Physicians To Hang Up The Scalpel?

My 53rd birthday is fast approaching so when I read an op-ed piece by Michael S. Pinzur, MD, titled “The Aging Surgeon,” it caught my attention.¹ I have no idea how much longer I will practice podiatric medicine and surgery, but I am 25 years out of residency and fellowship. I feel like my career is still on the upward slope.

The article tackles a very tricky subject.¹ How long should a surgeon still do surgery? Dellinger and colleagues reported that since 1975, the number of practicing physicians older than 65 years has increased by 374 percent.² The authors also discovered that in 2015, the 65-and-older group made up 23 percent of practicing physicians.² Mean cognitive ability reduces by 20 percent from age 40 to 75 years but this varies significantly from individual to individual.² Additionally, several professions have age-based testing requirements or mandatory retirements (air traffic controllers, pilots, judges, federal law enforcement officers and military).³ Physical skills also diminish with age.¹

The United States protects against age discrimination. As the U.S. Equal Employment Opportunity Commission notes, “The Age Discrimination in Employment Act of 1967 (ADEA) protects individuals who are 40 years of age or older from employment discrimination based on age. The ADEA's protections apply to both employees and job applicants. Under the ADEA, it is unlawful to discriminate against a person because of his/her age with respect to any term, condition, or privilege of employment, including hiring, firing, promotion, layoff, compensation, benefits, job assignments, and training.”⁴

Herein lies the dilemma: Older physicians do not want to leave practice but patient safety must always take precedence. Some hospitals require mandatory age-based evaluations.² The American Board of Foot and Ankle Surgery (ABFAS) requires recertification testing and documentation of case logs.⁵

I certainly do not know the answer to this question of when it’s time to retire, but I believe the discussion must take place. It would appear to be a local hospital issue. Ultimately, above and beyond the hospital evaluations and recertification examinations, the physician must determine when it’s time to hang up the scalpel.

References

1. Pinzur MS. The aging surgeon. Foot Ankle Int. 2017; epub Sept. 1. 
2. Dellinger EP, Pellegrini CA, Gallagher TH. The aging physician and the medical profession: A review. JAMA Surg. 2017; 152(10):967-971.
3. Mandatory retirement. Wikipedia. Available at https://en.wikipedia.org/wiki/Mandatory_retirement . Accessed Jan. 1, 2018.
4. U.S. Equal Employment Opportunity Commission. Facts about age discrimination. Available at https://www.eeoc.gov/facts/age.html .
5. American Board of Foot and Ankle Surgery. How to register for the ABFAS recertification exam and upload hospital logs. Available at https://www.abfas.org/Portals/0/Documents/2018%20Registration_Instructions_with%20Case%20Upload%20Instructions_December_2017.pdf . Accessed Jan. 1, 2018.