COVID brought surgeons out of retirement. Should they stay in the game?

By Naveed Saleh, MD, MS | Fact-checked by MDLinx staff

Published January 4, 2023

Key Takeaways

COVID-19 inspired many physicians to return to medicine. Although certain barriers were lowered for doctors who retired in recent years, re-entering surgeons still needed to demonstrate continued acumen.
Physical and cognitive skills decline with age, so surgeons should be evaluated for any deterioration starting at age 65.
When approaching retirement, physicians should maintain a healthy mindset and realize that it’s still possible to make positive contributions to medicine outside of the OR.

The COVID-19 pandemic greatly increased the public’s need for physicians. Many doctors dutifully re-emerged from retirement to help during this unprecedented crisis.

But when this occurred, questions were raised concerning the physicians’ fitness to resume practicing medicine after years away from the job—especially in cases of surgeons, given the unique demands of that role.

What barriers could prevent a surgeon—or any other highly procedural specialist—from continuing to practice, even during a time of need such as a worldwide pandemic? And if their skills decline with age, when is it time for these physicians to step down for good?

Concerns that come with aging

To assist physicians who came out of retirement to help during the COVID-19 pandemic, the Federation of State Medical Boards developed a repository of state-issued guidelines. The guidelines concerned expediting licensing for healthcare workers whose licenses were inactive or expired, according to an article published by the AAMC.^[]

Some states rolled back some requirements for physician re-entry—but physicians usually had to be recently retired (for no more than 2–5 years).

Due to its highly procedural nature, returning to surgery understandably poses some challenges. According to The American Board of Surgery, re-entry for surgeons is an intensive process requiring letters of reference, having a physician “champion,” proctoring, and an outcomes assessment.^[]

Noted heart surgeon Michael DeBakey, MD, famously quipped, “I wouldn’t mind being operated on by a 91-year-old surgeon”—when he was still practicing at age 91.^[]

Nevertheless, operating at an advanced age is rare—although thanks to their decades of experience, physicians in their 70s often serve as role models, according to an article published by ENTtoday.^[]

Mandatory retirement age?

In 2016, the American College of Surgeons (ACS) issued comprehensive guidance on many aspects of surgeon retirement.^[] The ACS recognized that surgeons are prone to age-related decline in physical and cognitive skills but did not pin down a firm retirement age.

"The ACS does not favor a mandatory retirement age because the onset and rate of age-related decline in clinical performance [vary] among individuals."

— The American College of Surgeons

“Furthermore, a mandatory retirement age may have a deleterious impact on access to experienced surgical care, particularly in rural and underserved areas,” the ACS added. “Objective assessment of fitness should supplant consideration of a mandatory retirement age.”

Although age-related deterioration is different for everyone, gradual declines in health, physical dexterity, and cognition occur beginning at age 65 years, according to the ACS.

Therefore, the ACS recommended that physicians aged between 65 and 70 years should voluntarily engage in a confidential baseline physical examination and visual testing performed by their personal physician to assess their overall health.

The ACS also recommended that surgeons voluntarily take an online neurocognitive function test. Any self-perceived deficits should be reported by the physician themselves. Cognitive and physical skills should then be assessed periodically.

Signs of deterioration

The ACS highlighted the role of colleagues and other healthcare staff in bringing attention to any deterioration in physical or cognitive functioning, given that surgeons may not be the best at recognizing their own declines.

Potential red flags include forgetfulness, tardiness/absences, poor clinical judgment, personality changes, disruptiveness, drastic changes in referral patterns, changes in appearance, and late/incoherent documentation.

Writing in Clinical Orthopaedics and Related Research, Ralph B. Blasier MD, JD, underscored other concerns that come with advancing age, including time elapsed from graduation resulting in older physicians being out of step with the current state of medicine.^[]

"In general, older surgeons have had less education, at a more remote time, which is less applicable to present technology."

— Ralph B. Blasier MD, JD, Clinical Orthopaedics and Related Research

“There is weak evidence from clinical studies that links older surgeon age with more complications and less adoption of modern technology,” Dr. Blasier continued. “Other occupations (aviation) have statutorily mandated retirement ages. Other nations (United Kingdom) have statutorily mandated retirement ages for surgeons.”

Gracefully retiring

There’s no denying that for many surgeons, retirement is tough. Few want to give up their professional passions at any age. Perhaps when approaching retirement, surgeons can adopt the following worldview, as per Dr. Blasier:

Surgical skills diminish with age.
An enjoyable retirement can be gratifying.
Retirement doesn’t equal loss of self-worth or “imminent death.”

"Educating surgeons, colleagues of surgeons, hospital administrators, patients, and the plaintiff’s bar may bring about changes that will induce surgeon retirement at an appropriate time."

— Ralph B. Blasier MD, JD, Clinical Orthopaedics and Related Research

When considering retirement, surgeons should keep in mind that they can be a wonderful resource to generations of students and trainees. Just because they may no longer brandish a Bovie in the OR doesn’t mean that they can’t contribute.

"Surgeons relinquishing clinical roles can contribute significantly to teaching, surgical assisting, research, or administration. If their abilities permit, and if they are willing, they should be given opportunities to contribute to these areas."

— The American College of Surgeons

What this means for you

In light of an epidemic and an impending physician shortage, surgeons are especially valued, and many have resumed practice after retirement. But everyone ages, and ultimately, retirement is a personal decision that depends on many factors. For surgeons, age-related declines in physical or cognitive skills warrant scrutiny, and colleagues can play important roles in recognizing warning signs. Of course, retirement from the OR doesn’t have to mean retirement from medicine; older surgeons can become great teachers, researchers, or administrators.

Caring During COVID speaks directly to clinicians who are still facing the realities of the pandemic. Each week we feature perspectives, lessons, research, guidance, and more. Submit any question or topic you'd like to see covered, and let us know if you’d like to be a guest author.

If their abilities permit, and if they are willing, they should be given opportunities to contribute to these areas.