Is there an age at which older surgeons — hampered by the physical laws of diminishing returns — should turn in their scalpel?
Conversely, if you were looking for a surgeon, should you pass up the newly-minted surgeons just out of their residencies and look for someone with more experience?
Those are hot questions in the surgical field, particularly after earlier studies highlighted problems older primary care doctors have had handling new procedures or gaining recertification.
Dr. Jennifer Waljee, a 32-year-old general surgery resident at the University of Michigan medical center, set out to find an answer. Drilling through a mountain of outcome data gathered by Medicare, Waljee and her co-authors divvied up surgeons into three groups: those under 40, 40 to 51 and over 60, and sifted through the mortality rates of each.
"For the most part, age didn't play a role in five of the eight procedures we looked at," said Waljee. But in three of the complex procedures — pancreatectomy, coronary artery bypass grafting, and carotid endarterectomy — surgeons past 60 were collectively linked to a slightly higher mortality rate.
But Waljee said age has a lot less to do with the results than an old adage in the medical world: practice maintains perfection. Surgeons who had a lower volume of surgeries experienced higher mortality rates, but older surgeons who kept a large caseload had the same mortality rate as their mid-aged colleagues — suggesting that gradually cutting back on caseloads could be the wrong choice. As for those surgeons under 40, she added, the mortality rates kept pace with the 40- to 50-year-old age group.
"We found that the relationship between age and patient mortality primarily mediated through practice volume," said Waljee, whose study was published in the September issue of Annals of Surgery.
To come up with their conclusions, Waljee and her colleagues poured over the results of 460,738 Medicare-reimbursed surgeries, studying the rates at which patients died before discharge or within 30 days of surgery.
"I thought we would also see a higher mortality rate for the younger surgeons, as opposed to 40-to-50," said Waljee. "This study's results should be very encouraging not only for patients, but also for younger and older surgeons whose operative skills may previously have been the subject of scrutiny."
But the issue is far from resolved. According to the AMA, the percentage of doctors over the age of 65 jumped from 13 percent in 1975 to 18 percent in 2004. And with a generation of boomers heading into retirement age, that figure is likely to keep on growing.
So will the argument over aging doctors.
Just last year, a team of researchers from Harvard Medical School concluded that an analysis of 40 years' worth of healthcare quality data showed that older doctors were less up-to-speed on the latest medical research. And one study concluded that the heart attack patients of doctors at least 20 years out of medical school were 10 percent more likely to die than patients treated by more recent medical school graduates.
The problem, the research team concluded, centered on a major shift in practice modes. Older doctors had been taught to be more self-reliant when it comes to treating patients, while younger doctors were encouraged to pay more attention to the latest research in medicine. Those younger doctors were also more likely to stay current on the voluminous amount of new data that now streams continuously out of research projects.
Those conclusions have helped spur a debate on how closely doctors should be monitored and recertified as they grow older. It has also raised questions of whether physicians, like airline pilots, should face a mandatory retirement age.
More research is being done. Dr. Lazar Greenfield, a coauthor of the recent study on surgeons' mortality rates, said he's now exploring how older surgeons' mental skills and physical reflexes withstand the effects of time.
