i know my hand surgeon is past retirement age, but i wouldn't have wanted
anybody else working on my wrist.  proof's in the pudding.  even my other
ortho (the one who took care of my shoulder), who saw my original wrist
films the day after i shattered it, said my hand surgeon worked wonders with
the mess he saw in my films.

kate

Study Raises Questions on Aging Surgeons' Last
Years; Pilots Must Retire at 60, but Not Docs

            ( PHOTO )
Dr. Marshall Goldin poses in an operating room
at Chicago's Rush University Medical Center,
Friday, Aug. 25, 2006. Goldin is 67, and he
isn't slowing down. He performs about 200 heart
and vascular surgeries a year. A new study,
published in the September Annals of Surgery,
says he has the right approach. (Photo/Julio Cortez)
09-03-2006 11:08 PM
By CARLA K. JOHNSON

CHICAGO --  Most of Dr. Marshall Goldin's
medical school classmates have retired or died,
but at age 67, the heart surgeon believes he
still has good working years ahead.
He performs about 200 heart and vascular
surgeries a year at Rush University Medical
Center. He has given away two sets of golf clubs
because he doesn't have time to play that often.
"If one is still interested and enjoys the work
and the challenge, it's my opinion that one
should and can continue," Goldin said. "I don't
believe my stamina and interest have at all
changed."
Stamina, strength, fine motor skills and sharp
eyesight are traits associated with youth _ and
with surgery. The United States requires airline
pilots to step down at age 60, but there is no
mandatory retirement age for surgeons, who _
like pilots _ hold life in their hands.
A new study raises questions about when older
surgeons should quit the operating room and how
they can stay at the top of their game in the
final years of their careers. With the
percentage of working doctors older than 65
climbing, the questions hold growing importance
for patients.
Previous studies found that older doctors are
less likely to know about new treatments and
medications than younger doctors, and they tend
to perform worse on recertification exams.
The new study, published in the September Annals
of Surgery, found that for three complicated
surgeries, including heart bypass, doctors older
than 60 had higher patient death rates,
especially if they didn't do very many of the
surgeries.
Some doctors nearing retirement reduce their
caseloads, but the study suggests that's not a
good idea.
Practice keeps skills high, so an all-or-nothing
approach to surgery in the pre-etirement years
may be better than gradually fading away, said
study co-author Dr. John Birkmeyer of the
University of Michigan.
"Those who continue to practice in high-risk
areas should maintain their caseloads, but it
may be a good idea when surgeons get into the
pre-retirement mode that they give up the most
complicated and high-risk surgeries altogether,"
said Birkmeyer, who is 43.
Patients should ask how many procedures a
surgeon does a year, rather than focus on the
doctor's gray hair, Birkmeyer said.
Sometimes an aging surgeon is the last to
recognize _ or admit _ it's time to quit. That's
when hospital administrators should step in,
said Dr. Andrew Warshaw, 67, chief of surgery at
Massachusetts General Hospital.
The best hospitals monitor surgeons' rates of
complications, infections, readmissions to the
hospital and deaths _ and use those statistics
to confront doctors about a pattern of problems.
Hospitals also rely on surgeons passing their
recertification exams every 10 years, but those
tests gauge knowledge, not physical skills or
technical mastery.
That forces hospitals to depend heavily on
co-workers reporting on a doctor with failing
skills, Warshaw said.
As department head, he tries to foster a work
climate where colleagues can safely report their
worries about a doctor, and he hopes that would
be true for his own performance. Warshaw himself
performs about 100 pancreas removals a year,
considered a very large number for that rare
procedure.
How will he know it's time to retire?
"I'm counting on the fact that, if I don't
recognize it, somebody will tell me," Warshaw
said. "Maybe I'll be the first to notice, maybe
I won't."
His hospital requires administrators to be
reappointed on a yearly basis after age 65, but
it requires no similar annual reappointment for
aging surgeons, he said.
The new study examined Medicare files on 461,000
patients who had one of eight different
surgeries. In five of the surgeries, the
researchers found surgeon age made no difference
in patient death rates. But for pancreas
removals, heart bypasses and surgery to clear
blocked carotid arteries, the researchers found
that older surgeons had higher rates of patient
death within 30 days of surgery than younger
surgeons.
Researchers speculated that those three
surgeries are more complex and require more fine
stitching.
"Surgeons are clearly not immune to the changes
of aging," said study co-author Dr. Lazar
Greenfield of the University of Michigan. For a
forthcoming study, he is testing hundreds of
aging surgeons' mental skills and reflexes.
While their mental skills such as short-term
memory tend to decline with age, their reflexes
are better than non-surgeons and don't seem to
slip over time.
"They do maintain remarkably good reflexes,"
said Greenfield, who is 71 and stopped doing
surgery about four years ago when he faced new
techniques for which he didn't feel adequately
trained. "Surgeons of all ages seem to have
reflexes well beyond the capability of control
groups of people."
The percentage of working doctors 65 and older
climbed from 13 percent in 1975 to 18 percent in
2004, according to data from the American
Medical Association. An impending wave of baby
boomers hitting age 65 may push those numbers
even higher.
In the future, aging doctors might be required
to prove their physical abilities, said Dr.
Stephen Miller, president of the American Board
of Medical Specialties, an umbrella group for
the boards that test and certify specialists.
They might have to pass tests on patient
simulators, the high-tech robots that some
nurses and doctors now learn to practice on,
Miller said.
Miller, 65, said he's personally in favor of
requiring physical exams for older surgeons.
"What would be wrong with having a physician
after a certain age be evaluated from a standpoint
of eyesight, from the standpoint of health?"
Miller asked. "That would probably be a good
public health policy."

... Got a seat-belt on my computer chair... no more ROTFL!!