Too old to operate? Group recommends mandatory cognitive, physical testing of surgeons by 65

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Sure to be controversial, the Society of Surgical Chairs is recommending mandatory cognitive and physicial testing for older surgeons. (Pixabay)

To protect the safety of patients, a group made up of academic surgical department chairs recommends mandatory cognitive and psychomotor testing of surgeons by at least age 65.

In a special communication published Wednesday in JAMA Surgery, the Society of Surgical Chairs came out with guidance and recommendations focused on end-of-career transitions for older surgeons.

Among their proposals was the sure-to-be-controversial recommendation that senior surgeons undergo mandatory testing, potentially as a component of ongoing professional practice evaluation.

Given an aging physician workforce, there has been a controversial but growing trend among healthcare organizations to require physicians at a certain age to undergo testing to measure thinking skills and physical dexterity. Proponents say testing is needed to ensure the aging clinical workforce remains competent to provide safe patient care. Opponents, including many doctors, say testing is ageist and does not determine whether they are still fit to practice medicine.

The Society of Surgical Chairs, whose membership of 185 department of surgery chairs represents approximately 70% of the nearly 70 academic departments of surgery in the country, is the latest group to take a stand on the controversial topic. The group conducted a panel discussion at its 2017 annual meeting and surveyed its membership in 2018 to develop insights and recommendations for the transitioning of senior surgeons.

In the communication, its five surgeon authors point out that aging is well documented to be associated with declines in cognitive function and psychomotor performance. But, they note, there is only limited guidance from medical professional societies or regulatory agencies on how to translate that into appropriate monitoring of physician performance.

The physician workforce is aging. The commentary says the number of U.S. physicians older than 65 increased from 50,000 in 1975 to more than 240,000 in 2013. There are 12,000 aging or senior surgeons (those older than 70 years of age) practicing in the U.S., making up approximately 10% of the surgeon workforce. An additional 5,000 surgeons who are 55 to 69 years of age will soon enter senior status.

RELATED: Doctors are divided on whether testing for older physicians is ageism or a patient safety necessity

“Monitoring of aging surgeons who engage in patient care, which requires a complex interplay of cognitive and psychomotor functions, will thus pose a growing challenge to ensuring patient safety,” the authors wrote. 

In its own membership survey, surgical department chairs were divided on the issue. The Society of Surgical Chairs found 53 of 80 respondents (67%) thought a mandatory fitness assessment would be moderately or highly helpful in evaluating the physical and cognitive skills of surgeons.

In the commentary, the authors said that rather than forcing senior surgeons to retire, their recommendations were made to facilitate a well-planned and gradual transition of senior surgeons to nonclinical roles when they face declining operative and clinical skills. That “is preferable and more manageable than an abrupt and seemingly unforeseen and disrespectful forced retirement of the senior surgeon,” they wrote.

Other recommendations include: career transition discussions with surgeons beginning early in their careers; respectful consideration of the potential financial needs, long-standing work commitments and work-life concerns of retiring surgeons; and creation of teaching, mentoring or coaching, and/or administrative opportunities for senior surgeons in modified clinical or nonclinical roles.

In an accompanying commentary, one surgeon, who has taken on an administrative role, supported the idea of testing but acknowledged the uncertainty it can create for doctors.

“So, I am age 64 years, and reading this article that recommends the mandatory evaluation of surgeons by age 65 years really resonated with me. What if the results are not good? Will they make me stop operating? Then what will I do? What will people say? Should I stop now so I will not have to find out? Why do we need to get tested anyway? The answer is for the patients we serve,” wrote Julie Ann Freischlag, M.D., CEO of Wake Forest Baptist Health in Winston-Salem, North Carolina, and dean of Wake Forest School of Medicine.

Freischlag, who said she supports getting tested at age 65, added it’s important that surgeons plan ahead for the day when they will retire from operating and ensure they are financially able to do so.