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, disruptive-ness, 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 recredential-ing. 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
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.
Statement on the aging surgeon