When Should We Quit Operating?

The importance and variety of many decisions which practicing operative surgeons are obliged to make throughout their careers are discussed, together with the multiple factors which may influence those decisions, and to what extent those factors are adversely affected as surgeons age. Since the 1986 legislation against age discrimination, there are no uniformly accepted regulations or guidelines for determining when surgeons should quit operating. Studies to justify rules or recommendations for retirement from active major surgical operative and patient management have addressed this issue increasingly during the past five decades, but have not yet produced definitive answers to the question. Safety and competency do not correlate uniformly with age, and currently the decision has been largely left to the discretion of the surgeon. Efforts to examine surgeons objectively for cognitive and technical skills and proficiency, eyesight, eye-hand coordination, strength, endurance, and other indices that might validate the safety, efficacy, competence, judgment, and wisdom of the surgeon have not been embraced to date by the surgical community, but are beginning to gain support from professional societies, governing and credentialing bodies, hospitals, and other health care institutions. Resolution of the multiple complex issues which must occur to solve this vexing problem and to answer this important question, which is critical both to patients and to the surgeons, is forthcoming.