The Aging Surgeon
The Aging Surgeon
The public believes that we police ourselves, but this is illusory. Initial certification to be a surgeon is difficult but recertification is relatively easy. Ongoing professional practice evaluations, mandatory in all hospitals every 6 months, are hospital-specific and highly variable. Our malpractice system is neither constructed nor capable of hobbling bad doctors. We are left with the scrutiny of our peers, and, with respect to the aging surgeon, many barriers to this exist.
Senior surgeons are the most respected members of their community. They have been the teachers and mentors of their younger colleagues, some of whom may now be their chief. These younger colleagues may even become "enablers," assigning senior residents to assist, the best scrub nurse, the most experienced anesthetist. The senior surgeons have brought fame to their hospital and have been the "rain-makers" for surgical volumes. Few medical staff bylaws contain any provision for dealing with an aging staff physician. Some changes in performance may be hard to document, falling into a gray zone of worrisome-but-within-standard-practice. It often takes a patient death or a sentinel event to force action.
We must do better, or others will impose arbitrary rules such as mandatory retirement. We are a profession (from the Latin, "to speak forth"), and it is ethically imperative. Ironically, in many states, it is more difficult to maintain one's driving privileges than one's surgical privileges. Two states, Illinois and New Hampshire, require a road test at age 75 and 10 states require a vision test at a specific age.
What can we do that balances patient safety and liability risk with respecting the dignity of a committed surgeon and his or her value to society? (Fig. 1)
(Enlarge Image)
Figure 1.
The aging surgeon: Balancing the issues.
But Does the Surgical Profession Police Itself?
The public believes that we police ourselves, but this is illusory. Initial certification to be a surgeon is difficult but recertification is relatively easy. Ongoing professional practice evaluations, mandatory in all hospitals every 6 months, are hospital-specific and highly variable. Our malpractice system is neither constructed nor capable of hobbling bad doctors. We are left with the scrutiny of our peers, and, with respect to the aging surgeon, many barriers to this exist.
Senior surgeons are the most respected members of their community. They have been the teachers and mentors of their younger colleagues, some of whom may now be their chief. These younger colleagues may even become "enablers," assigning senior residents to assist, the best scrub nurse, the most experienced anesthetist. The senior surgeons have brought fame to their hospital and have been the "rain-makers" for surgical volumes. Few medical staff bylaws contain any provision for dealing with an aging staff physician. Some changes in performance may be hard to document, falling into a gray zone of worrisome-but-within-standard-practice. It often takes a patient death or a sentinel event to force action.
We must do better, or others will impose arbitrary rules such as mandatory retirement. We are a profession (from the Latin, "to speak forth"), and it is ethically imperative. Ironically, in many states, it is more difficult to maintain one's driving privileges than one's surgical privileges. Two states, Illinois and New Hampshire, require a road test at age 75 and 10 states require a vision test at a specific age.
What can we do that balances patient safety and liability risk with respecting the dignity of a committed surgeon and his or her value to society? (Fig. 1)
(Enlarge Image)
Figure 1.
The aging surgeon: Balancing the issues.
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