Statement on the aging surgeon

The American College of Surgeons (ACS) Board of Governors Physician Competency and Health Workgroup developed the following statement. The ACS Board of Regents approved the statement at its October 2015 meeting in Chicago, IL.

The average age of the practicing surgeon is rising along with that of the American population. Approximately one-third of all practicing surgeons are older than age 55. For the more than 100 years since its founding, the ACS has emphasized the importance of high-quality and safe surgical care. To address concerns that advanced age may influence competency and occupational performance, the ACS has developed the following guidelines:

  • The ACS maintains that it is in the best interests of the surgeon to adhere to a lifestyle that promotes wellness. As such, the ACS stresses the importance of a lifelong approach to physical, mental, and emotional wellness for personal and professional well-being.
  • Surgeons are not immune to age-related decline in physical and cognitive skills. Even so, the ACS does not favor a mandatory retirement age because the onset and rate of age-related decline in clinical performance varies among individuals. Furthermore, a mandatory retirement age may have a deleterious impact on access to experienced surgical care, particularly in rural and underserved areas. Objective assessment of fitness should supplant consideration of a mandatory retirement age.
  • Surgeons may not, on their own, recognize deterioration of their physical and cognitive function and clinical skills with age. Colleagues and coworkers are an important resource for identifying the surgeon who displays initial signs of professional deterioration. Potential warning signs may include forgetfulness, unusual tardiness, evidence of poor clinical judgment, major changes in referral patterns, unexplained absences, confusion, change in personality, disruptiveness, drastic change in appearance, and unusually late and incoherent documentation.
  • Although age-related deterioration varies from individual to individual, gradual decline in overall health, physical dexterity, and cognition generally occurs after the age of 65. For this reason, it is recommended that, starting at age 65 to 70, surgeons undergo voluntary and confidential baseline physical examination and visual testing by their personal physician for overall health assessment. Regular interval reevaluation thereafter is prudent for those without identifiable issues on the index examination. Surgeons are encouraged to also voluntarily assess their neurocognitive function using confidential online tools. As a part of one’s professional obligation, voluntary self-disclosure of any concerning and validated findings is encouraged, and limitation of activities may be appropriate.
  • Colleagues and staff must be able to bring forward and freely express legitimate concerns about a surgeon’s performance and apparent age-related decline to group practice, departmental and medical staff, or hospital leadership without fear of retribution. In addition, the surgeon’s quality and outcomes of patient care is the ultimate measure of ongoing competence and safety for surgeons of all ages. As such, peer-reviewed methods, including ongoing professional practice evaluation, should be performed commonly as part of recredentialing. If a potential issue is identified, additional methods of evaluation may include chart reviews, peer review of clinical decision making, 360-degree reviews and patient feedback, observation or video review of operating room cases, and proctoring. In these cases, once the initial potential issue has been addressed, more detailed and frequent reviews, such as focused professional practice evaluation, may be indicated.
  • Occasionally, the surgeon will need to be referred to a comprehensive evaluation program. These examinations currently are being conducted at a number of specialized centers where a battery of tests for neurocognitive function can be conducted in the form of a neuropsychological assessment. The costs of such testing should be borne by the hospital or medical staff, not the surgeon. These results cannot be used in isolation to determine continuation or withholding of hospital and surgical privilege but should be incorporated as an additional piece of information as part of an overall evaluation as described earlier in this statement. Further research is required to develop accurate and reliable screening tests to help identify surgeons who are potentially experiencing age-related decline in cognition and surgical skills.
  • Decisions regarding hospital and operating room privileges should be made at the medical staff and/or hospital level only after careful evaluation of all evidence available. Medical staff bylaws and due process must be followed. Strict confidentiality is essential. As always, the best interests of the patient remain the first priority, while at the same time the confidentiality, dignity, and contributions of the surgeon must be respected.
  • Senior surgeons play a vital role in their hospitals and communities, and their knowledge and years of experience can be valuable resources. Surgeons relinquishing clinical roles can contribute significantly to teaching, surgical assisting, research, or administration. If their abilities permit, and if they are willing, they should be given opportunities to contribute to these areas.
  • All hospitals and facilities that deliver surgical care are encouraged to develop policies as appropriate for their institution in compliance with state and federal regulations. It also is expected that there will be local variations that cannot be covered or predicted with this statement.

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