Surgeons must always be at the top of their game. The slightest mishap could spell disaster for a patient as well as a hospital.

“The issue is not one of age as measured in years. It has to do with the individual’s rate of physiologic decline,” one expert said.

So what happens when surgeons get older and face neurocognitive, sensory, and neuromuscular impairments that could mean life or death for patients?

It’s an ongoing battle within the health and medical communities. As a society, we want competent professionals — but we don’t want to insult them with mandatory screening or age-related restrictions. And there is no mandatory retirement age for doctors — which pretty much means they can practice as long as they choose.

“The issue is not one of age as measured in years. It has to do with the individual’s rate of physiologic decline,” Dr. Paul J. Schenarts, a professor in the surgery department at the University of Nebraska Medical Center in Omaha, Nebraska, said. “Each person is different and declines at a different age.”

About one-third of all active surgeons are over the age of 55, according to a 2016 study in Surgical Clinics. Of 241,641 doctors over the age of 65, there are 95,000 still engaged in patient care.

Doctors renew their medical licenses regularly, but that renewal doesn’t include a screening for physical declines. Some argue simple screenings aren’t enough anyway, as they miss behavioral changes.

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At Stanford University Medical Center in California, medical staff age 75 and over must undergo a cognitive screening, peer assessment, and physical exam every two years to ensure patients are in the best possible hands. Other medical centers have similar programs, though there is no national policy that requires this type of screening.

Self-Diagnosing
Just like anyone else, physicians decline as they age. Unfortunately, a doctor’s ability to self-assess is often inaccurate, according to a 2014 article in an American College of Surgeons newsletter.

An ailing surgeon may have personally mentored younger surgeons, so there’s a loyalty factor there.

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“Various American surgical societies have been coming to grips with this question for more than a decade now, but there has been no effective progress toward a solution,” Dr. Ralph B. Blasier, an orthopedic surgeon from Illinois, wrote in a 2009 report published in Clinical Orthopedics and Related Research.

Surgeons must undergo ongoing professional practice evaluation every six months, but it’s focused on statistics and patient outcomes, said Dr. Mark R. Katlic, chief of surgery at Sinai Hospital in Baltimore, Maryland.

“That alone isn’t good enough to ensure patient safety,” Katlic told LifeZette.

It’s also hard for hospital administrators to pinpoint incompetent doctors. Many surgeons who are older are perfectly capable in their jobs, so a mandatory retirement age would remove perfectly good doctors from the system — something that would be difficult to justify, considering the serious shortage of doctors today, Katlic said.

To further complicate things, it’s hard to talk to a doctor about his or her competencies with regard to natural aging.

[lz_bulleted_list title=”Older and Still Operating” source=”American College of Surgeons”]Concerned about the skill set of an aging surgeon? Speak up to a hospital staff member or the chief of surgery. You can also hire a patient advocate or see if the facility offers one.[/lz_bulleted_list]

Oftentimes, Katlic said, younger surgeons do not want to report an aging doctor’s mishaps because he or she is so highly respected — an ailing surgeon may have personally mentored younger surgeons. Some surgeons also attract patients and research dollars to a facility, which makes it harder to discuss splitting ways.

Financial reasons may be another reason some surgeons work until they are older, as so much of their self-worth is tied up in the career they love, Katlic noted.

Katlic has come to realize an objective third party works best to address the situation, which is why he founded an Aging Surgeon Program. The two-day screening is voluntary and the outcome is based on skill, not age. Surgeons are given a series of tests that create a whole and accurate picture of their competencies. Fine motor skills, hand-eye coordination, and balance are things tested, among other things.

After the evaluations, a committee of multidisciplinary professionals who assessed the doctor — including ophthalmologists and neurologists — draft a report.

“Ours is a more intensive program focused principally on surgeons,” he said.

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Katlic admits the program is pricey, at about $17,000 per evaluation, but it’s often the only other course of action that health systems have to effectively screen doctors aside from having their own process in place. Plus, it’s completed by an objective third party.

“There are no other good ways to deal with the problem of aging surgeons who maybe should step down from operating,” he said.

“What we really offer is an objective evaluation to help that hospital make a decision,” Katlic added.