How Old is Too Old to Practice Medicine?

Seventy two year-old, DR. AMB (name obscured) , doesn’t like to think about what’s coming. “I’ll feel really old when I retire-really old,” says the Surgeon. AMB is past the average retirement age for doctors in Government, but he’s still working 40-hour per week in private and hasn’t set a date for when he will stop practicing. Maybe 2025, he says, adding that he doesn’t like to contemplate life as a retiree. “One of the most satisfying and cool things you can do is to be a Practicing Doctor,” he says. “I know I’ll really miss it.”

Do Doctors Have to Retire at A Certain Age?

Deciding when doctors should retire from active medical practice is a complex and multifaceted issue that involves considerations of physical and mental health, competency, patient safety, and professional fulfilment. There is no one-size-fits-all answer to this question, as individual circumstances vary widely. However, in this piece we are exploring the complexities of the issue which can compromise safety in high-risk industries like healthcare.A number may be arbitrary, but age-related cognitive skills decline among older doctors is a 'valid concern'. Medicine is a demanding profession that often requires long hours, intense focus, and the ability to handle stressful situations. It's essential for doctors to be honest with themselves and their patients about their well-being which can impact their ability to provide high-quality patient care with safety. It may be an indication to step back from active practice. The popular stereotype of older workers is that everyone is counting the days until they can retire, but that’s not the case for many doctors, who have a more complicated relationship with retirement than do many other professionals. Many doctors wait to retire until their late 60s or 70s, but if you're considering an early transition to retirement, you're not alone. Nearly 30% of doctors retire between 60 and 65 years old, and 12% retire before 60, according to survey research conducted by AMA Insurance Agency Inc., a subsidiary of the AMA.

When Should Surgeons Stop Operating?

Operating for extended periods, being on call at night, and maintaining a busy schedule next morning in outpatient clinics, wards, and the operating theatre can become increasingly challenging for older individuals. The physical and mental stamina required for surgical practice can diminish with age, along with factors such as diminished dexterity, slower reaction times, and increased fatigue may become more pronounced. Studies have found that surgeons with hand tremors can influence patient outcomes due to difficulty with precision movements and may be more likely to make mistakes during surgery potentially impacting a surgeon's performance and the overall quality and safety of patient care. Recognizing these challenges, it's not uncommon for aging surgeons to consider transitioning to less demanding roles or reducing their working hours.

Patient Safety and Ethical Considerations:

Ensuring patient safety is paramount in healthcare. It's crucial to ensure that your health condition allows you to perform your duties safely and effectively. If there are concerns that your abilities may compromise patient care, new technologies and procedures become challenging to practice medicine effectively and safely it is responsible to reconsider your active role in surgery. Peer evaluations and performance assessments, including observations in clinical settings, Regulatory bodies can provide a more comprehensive understanding of a doctor's abilities and are crucial to maintaining quality and safety in the medical profession.

Competency and Continuing Medical Education:

Continuous medical education (CME) is a standard requirement for practicing medicine and maintaining licensure, but it's also a means for doctors to ensure they are practicing according to current standards. It is essential to strike a balance between respecting the experience of older doctors and prioritizing patient safety with their ability to keep pace with rapidly advancing medical knowledge.

Professional Fulfilment and Identity crisis:

When the demands of the profession become overwhelming, reflect on your professional and personal goals. For some doctors, it’s hard to say goodbye to a career they’ve loved and one which has formed a large part of their identity. During my interaction, many doctors identified losing social interactions at work, a loss of purpose and boredom, loneliness, depression as their top concerns about retirement. Being a Medical practitioner was at the core of who he was, and he worried how he would feel without the work and the states that accompanied it. It's essential for doctors to engage in careful financial planning encouraging a culture that values work-life balance, mental health support, and professional fulfilment throughout a career.

Alternatives to Full Retirement:

While some doctors may choose to retire completely from active clinical practice, others may explore alternative roles within the healthcare system. Transitioning from active practice to a non-clinical, or less interventional role focused on teaching, mentoring, research, educational and administrative roles can allow experienced doctors to continue contributing to the medical field without the demands of direct patient care and enable the transfer of knowledge to the next generation of healthcare professionals can be a fulfilling way to remain engaged in the field.

Succession Planning:

If you have a practice or own a clinic or hospital, consider the development of a succession plan. This involves identifying and mentoring younger medicos and / or family members who can eventually take over your responsibilities while you act in a supervisory role.

When Is It Time to Leave Active Practice?

When we retire at 62 years, we have served the government only for 23 to 25-years. Thereafter, private hospitals throw a bait at us. Our point is, why should the government lose the services of such doctors who are at the pinnacle of medical practice? They can be retained for the benefit of patients and for the spread of their rich knowledge to medical students,” reasoned a senior doctor who sought anonymity.

The decision of when doctors should retire from active medical practice is highly individualized and influenced by a myriad of factors. A common piece of advice from successfully retired doctors is,” don’t retire from practice too early, especially if you still love being in practice but don’t wait too long to retire because poor health will not allow you to enjoy your retirement, assuming your finances are in order. According to the AAFP there are six signs that your doctor should 'call it quits'.1. The doctor confuses a patient he or she has been seeing for years with another patient or forgets who the patient is entirely.2.The doctor is unusually dismissive or impatient.3.The doctor responds to patients' questions with confusing or convoluted answers.4.The doctor forgets to complete a task he or she was expected to do, such as ordering a test, researching a question, or calling a patient.5.The doctor refers patients to a specialist or other medical professional for every ailment and6. The doctor is shaky when handling instruments or has difficulty hearing or seeing things clearly.

Safety is paramount in certain professions, high-risk industries keep a close watch for these sorts of changes, in hopes of protecting the public for example some airline pilots, firefighters must step down by 65 implement age-related policies or retirement programs often include regular cognitive screenings, and health assessment to ensure that employees can meet the demands of their roles safely.

Healthcare is a high-volume, high-risk profession. Although retirement policies govern Govt jobs there are no nationwide age-related cutoffs, or NMC guidelines required assessment guidelines to make sure doctors can do their jobs safely.

We would hope most of our colleagues would recognize the signs and know when to scale back from practice or to gracefully bow out. Ultimately, the goal is to strike a balance that prioritizes patient safety, respects the expertise of experienced doctors, and acknowledges the diverse needs and aspirations of healthcare professionals.

(The author is a Practicing surgeon, Certified professional in Healthcare Quality, National and international expert on Healthcare standards, policy planning and reforms)