What can a surgeon do when he/she becomes too old to practise?

[Horowitz]

By age 60, we'll all probably experience a decline in eye-hand coordination and in finger dexterity. Say if you become a practising surgeon at age 30, you'll probably only have about 30 years to practise as a surgeon. What can they do after? Other than teaching?

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[Mobius1985]

1) Become an administrator at your local hospital or HMO. Preferably part-time.
2) Become involved politically, as in: President of the American Surgeons Society (or whatever they call it).
3) Babysit for your granddchildren.
4) Golf, crochet, ski, etc.
5) Enjoy your second home in a warmer state, and advise surgeons-to-be on SDN.
6) Go back to school and learn something completely unrelated, or get an MBA before you do #1).
7) Teaching is a good option, too.
8) Get to know the spouse you've barely seen for the last 30 years.
9) Lead overseas medical missions and do hernias, or other procedures that require less dexterity, visual acuity. (There's a retired general surgeon in my home town that leads a team to Haiti four times a year.)

Be optimistic. I've met a surgeon in his eighties still going strong in the OR.

 

[Horowitz]

1) Become an administrator at your local hospital or HMO. Preferably part-time.
2) Become involved politically, as in: President of the American Surgeons Society (or whatever they call it).
3) Babysit for your granddchildren.
4) Golf, crochet, ski, etc.
5) Enjoy your second home in a warmer state, and advise surgeons-to-be on SDN.
6) Go back to school and learn something completely unrelated, or get an MBA before you do #1).
7) Teaching is a good option, too.
8) Get to know the spouse you've barely seen for the last 30 years.

Be optimistic. I've met a surgeon in his eighties still going strong in the OR.

I know these are good options, but given the number of years spent in surgical training, one would hope that the skills and knowledge acquired can be used to the max. When do surgeons usually retire by the way?

 

[Maxx4]

It seems that the range is 60-65 years old.

 

[smq123]

By age 60, we'll all probably experience a decline in eye-hand coordination and in finger dexterity. Say if you become a practising surgeon at age 30, you'll probably only have about 30 years to practise as a surgeon. What can they do after? Other than teaching?

It seems that the range is 60-65 years old.

Actually, from what I've seen, the reason why most surgeons stop operating does NOT have to do with a loss of finger dexterity and eye-hand coordination.

Most former surgeons that I have met stopped operating because their back pain was debilitating. I have heard stories of attendings who have to take a break in the middle of an operation, lie down on the floor for 10 minutes, and then resume - because the pain is crippling.

If you're interested in surgery, it's really a good idea to work on your physical fitness and (especially) focus on your core strength. The lower back pain that comes after years of hunching over an operating table can be killer.

2) Become involved politically, as in: President of the American Surgeons Society (or whatever they call it).

ACS. American College of Surgeons.

 

[nonesuchgirl]

John Cameron is like, 5 million years old*. In the OR everyday. Still doing Whipples, too.

I won't finish training until I'm ~40, so I figure I've got 30 years, minimum.

* This is one of the reasons I like being semi-anonymous. He's in his seventies, for real, I think. He is planning to retire in 2009.

 

[smq123]

* This is one of the reasons I like being semi-anonymous. He's in his seventies, for real, I think. He is planning to retire in 2009.

I think he's 71 or 72, specifically.

 

[nonesuchgirl]

I think he's 71 or 72, specifically.

Sounds about right. I didn't feel like doing the math.

He's really short, too, maybe that's why he's still practicing- he doesn't have to hunch over as much.

I am so getting my butt kicked if the boys find out I posted this.

 

[smq123]

He's really short, too, maybe that's why he's still practicing- he doesn't have to hunch over as much.

Ohhh - no, no, no.

I can guarantee you that Dr. Cameron is not hunching over when he operates, but it's not because he's short. It's because he's the attending, former chairman, and one of the most famous surgeons in the country - and can dictate how high the operating table is. (Which is something you can't always do as a resident or fellow.)

 

[nonesuchgirl]

Ohhh - no, no, no.

I can guarantee you that Dr. Cameron is not hunching over when he operates, but it's not because he's short. It's because he's the attending, former chairman, and one of the most famous surgeons in the country - and can dictate how high the operating table is. (Which is something you can't always do as a resident or fellow.)

Where are you at?

Trust me, everyone knows who JC is.

 

[HEADintheCLOUDS]

Sounds about right. I didn't feel like doing the math.

He's really short, too, maybe that's why he's still practicing- he doesn't have to hunch over as much.

I am so getting my butt kicked if the boys find out I posted this.

Thats gonna suck, I am 6'4"! Cant I raise the table up to my height though?

 

[nonesuchgirl]

Thats gonna suck, I am 6'4"! Cant I raise the table up to my height though?

when you become JC, yes.

until then, no.

one of the trauma surgeons i know is over 7ft tall. I can't imagine how he survived being the low man on the totem pole.

 

[smq123]

Thats gonna suck, I am 6'4"! Cant I raise the table up to my height though?

Errm...it's usually bad form to request this unless you're the most senior person in the room, or at least until you're acting as the primary surgeon for a particular segment of the case. (Sometimes the chief will let the intern dictate the table height if chief is walking the intern through the case.)

If you're the med student, it makes little difference. You generally won't be doing so much that the table height will matter.

As the med student, if I was suturing the incision at the end, I was allowed to ask anesthesia to raise the table to my height. (Well, I usually ended up needing the table to be lowered, since I'm not that tall.) During OB, I was encouraged to do this, because I was warned that I would trash my back if I did not.

It depends on who is doing what during the course of the case. When you do your rotation, you'll learn when it is okay to ask and when it is not.

 

[tacrum43]

Most former surgeons that I have met stopped operating because their back pain was debilitating. I have heard stories of attendings who have to take a break in the middle of an operation, lie down on the floor for 10 minutes, and then resume - because the pain is crippling.

Why do surgeons always stand while operating anyway? It seems like there must be a better way...And even if they do have to stand, why don't they hike the table up higher so they don't have to hunch over?

I'm 6'5" and so not looking forward to my surgery rotation during 3rd year.

 

[smq123]

Why do surgeons always stand while operating anyway? It seems like there must be a better way...And even if they do have to stand, why don't they hike the table up higher so they don't have to hunch over?

* Some of the ENT guys will operate will sitting down, although not for long cases.

If you sat down while operating in the abdomen, you'd probably have to hold your arms up for prolonged periods of time - which would tire out your shoulders very quickly. Particularly with obese patients, whose internal organs are often "deeper" and harder to reach.

Even if you did find a way to operate in the abdomen while sitting down, it would probably not be easy to maintain a sterile field that way. It would bring your (unsterile) knees up way too close to your sterile wrists for comfort.

* Attendings DO put the table up, to a height that is convenient for them.

But sometimes you still have to hunch over, at least somewhat. If you're operating on the liver, and the patient's obese, there's only so much you can do while standing straight up.

Plus, some surgeons with poor core strength (or those with a sizable gut) will find that just standing for prolonged periods of time, and even the mild amount of bending over required, is too much for their back.

And when you're a resident, there's no guarantee that the attending will be willing to allow you to adjust the table height. On OB, the attending (who is very tall) adjusted the table to his height...which forced the resident (who was about 5' 2") to stand on 2-3 step stools. Some attendings are very relaxed about it, and some attendings are not.

 

[jetxiu]

I think he's 71 or 72, specifically.

 

[Law2Doc]

If you're the med student, it makes little difference. You generally won't be doing so much that the table height will matter.

In my experience med students often get the worst of it actually. You are holding a retractor or limb at a bad angle and often pushed far to the side to make room for the attending, resident, intern etc. The bad angle combined with the low table can be quite rough on the back. Depends on your height as compared to the surgeons. The ex jocks in ortho often keep the table comfortably high, while the predominantly petite women surgeons in GYN might as well be operating on the floor.

 

[smq123]

In my experience med students often get the worst of it actually. You are holding a retractor or limb at a bad angle and often pushed far to the side to make room for the attending, resident, intern etc. The bad angle combined with the low table can be quite rough on the back.

The bad angle combined with the high table wasn't a picnic either.

I thought that it was physically uncomfortable no matter what the height of the table was. If the table was lower than I would have liked, I'd have to stoop slightly to suction or retract. If the table was at my height (or I was standing on a step stool), I'd have to twist my back to get the suction over the resident's arm, without blocking the view of the attending, and without contaminating myself on the resident's back.

Basically, the take home message: if you're a med student, prepare yourself for a lot of pain and physical discomfort, no matter how tall you are.

 

[Ashers]

I always appreciated it after the attending left the resident and me to suture, the resident always told me to adjust the table height, so I wouldn't hunch over so much. Of course, during the actual main part of the case, it wasn't adjusted for me.

As for the original point of this thread, my dad's retiring this year (orthopaedist), he'll be nearly 62 due mostly to hospital politics, clinic politics, and he's having a harder time recovering after a night of traumas. He may due locum tenens somewhere because he still likes to operate.

 

[smq123]

As for the original point of this thread, my dad's retiring this year (orthopaedist), he'll be nearly 62 due mostly to hospital politics, clinic politics, and he's having a harder time recovering after a night of traumas. He may due locum tenens somewhere because he still likes to operate.

Ashers - did your dad's malpractice insurance rates change as he grew older? I know that some of the OB/gyn attendings are "encouraged" to stop operating after a certain age, because their malpractice rates start to soar as they get older. (Here in the great state of PA - the land crawling with litigation lawyers. )

I don't know where your dad practices, but I was wondering if this was true of other surgical fields, or if OB was unique in this respect. You mentioned hospital politics, and I was curious if malpractice rates played into those politics.

 

[Mobius1985]

ACS. American College of Surgeons.

Thanks.

 

[Law2Doc]

Basically, the take home message: if you're a med student, prepare yourself for a lot of pain and physical discomfort, no matter how tall you are.

Yep, just grin and bear it. What doesn't kill you makes you stronger. Worked for MRSA, and it will work for med students too.

 

[Blade28]

(1) The OR table height is dictated by the most senior person operating
(2) Sitting down is usually discouraged because it's tough to maintain sterile technique (though it can be done)

 

[SocialistMD]

(1) The OR table height is dictated by the most senior person operating

I've been lucky enough to operate with a few attendings who always ask me what height I would like the table. I can usually have it high enough such that they don't have to stand on steps, but they are willing to operate at a height that they normally wouldn't. Personally, I think it makes more sense to operate with the table at the height of the tallest person in the room, as it is much easier to add steps than it is to hunch over, but I am 6'2", so I have a bias.

 

[Ashers]

Ashers - did your dad's malpractice insurance rates change as he grew older? I know that some of the OB/gyn attendings are "encouraged" to stop operating after a certain age, because their malpractice rates start to soar as they get older. (Here in the great state of PA - the land crawling with litigation lawyers. )

I don't know where your dad practices, but I was wondering if this was true of other surgical fields, or if OB was unique in this respect. You mentioned hospital politics, and I was curious if malpractice rates played into those politics.

He actually doesn't have to pay his own malpractice -- he works for a managed HMO, so the his is paid for him by the company (not sure what it was like in CA). As for hospital politics -- there's one hospital where I'm from (Maui), and it's owned by the state (it's also the only hospital owned by the state that's profitable), and the state won't approve another hospital to be built. The area has grown, so our hospital is way too small to support the population, and it's not a level 1 trauma, but it pretends it is so sometimes there's a delay (we have to send our big traumas to another island). The hospital stuff's been a major issue where some doctors have left Maui because of it.

 

[smq123]

Personally, I think it makes more sense to operate with the table at the height of the tallest person in the room, as it is much easier to add steps than it is to hunch over, but I am 6'2", so I have a bias.

I'm quite a bit shorter than you are (5' 4"), but this makes sense to me as well.

As long as you're conscious about where you're setting your feet, or how you position yourself, you won't stumble off the edge of the stepstool or anything.

I guess having stepstools tends to clutter up the area around the table, which can be a little annoying when you shift positions (i.e. if someone scrubs out, etc.), but it's not as big a deal as some circulating techs can make it out to be.

 

[dizzyorange]

So the perfect height for a resident surgeon is 5'8"?? Sweet!

 

[njbmd]

The most senior surgeon operating dictates the position of the OR table period and may (out of deference to the person actually performing the case, lower or raise the table). Most of the time, if I am allowing a junior resident to do some parts of a case, I will ask anesthesia to adjust the height of the table for that person. Most of my attendings will adjust allow me to adjust the height of the table since they are usually assisting me.

Since I am 5'8" tall, I rarely have a problem with the table unless I am operating with someone who is under 5'2" (doesn't happen very often). For the short people, get a riser to stand on and for the taller folks, learn how to turn sideways and lean a hip against the table as this makes you shorter and you are not bending over.

If you keep yourself in good physical condition, you can operate as long as you have the interest. Contrary to popular belief, your hands, eyes and back do not become "crippled" from a surgical career. Most people retire when they are no longer interested in the day to day work of surgery (not because they are too feeble).

When I was a resident, my best vascular attending was well into his 70s and showed no signs of slowing down. He loved the pace of the OR and would do case after case with relish. He was also a superb teacher with a great understanding of how to teach techniques to residents.

Many folks have tired of operating and clinic at age 45 and elect to do other things in medicine too. It's not the physical edge that you lose but the mental interest. When that happens, one should do the patients a favor and move on.

 

[Blade28]

One of the sweet "perks" of operating with the same team every day is when you enter the OR and all the necessary stepstools (for interns, med students, etc.) are already laid out in the appropriate locations around the OR table.

Ah, harmony in the OR.

 

[nonesuchgirl]

Ah, harmony in the OR.

 

[Castro Viejo]

John Cameron is like, 5 million years old*. In the OR everyday. Still doing Whipples, too.

Just how much does Cameron do himself in the OR these days?

 

[nonesuchgirl]

Just how much does Cameron do himself in the OR these days?

I suspect d@mn near everything... he has a PA(?) but most of the residents are scared ****less of him... he throws hissyfits, apparently.

 

[dchaos]

Just how much does Cameron do himself in the OR these days?

I don't imagine he'll have much time to operate anymore; I was told recently that Dr. Cameron is to be the next President of the American College of Surgeons, and so will be leaving/has recently left the chair at Hopkins.

 

[smq123]

I don't imagine he'll have much time to operate anymore; I was told recently that Dr. Cameron is to be the next President of the American College of Surgeons, and so will be leaving/has recently left the chair at Hopkins.

He stepped down as chair of surgery at Hopkins a few years back - a vascular surgeon from California (?) replaced him. Don't know when (if) he's leaving for good.

I suspect d@mn near everything... he has a PA(?) but most of the residents are scared ****less of him... he throws hissyfits, apparently.

When you're as big as Cameron is, I don't see the need to go into hissy fits to make the residents scared "****less" of you.

I know he's a fabulous educator, and one of the greats in American surgery, and one of the most prolific Whipple guys in the US, but still.

[/personal rant]

 

[nonesuchgirl]

He stepped down as chair of surgery at Hopkins a few years back - a vascular surgeon from California (?) replaced him. Don't know when (if) he's leaving for good.

When you're as big as Cameron is, I don't see the need to go into hissy fits to make the residents scared "****less" of you.

I know he's a fabulous educator, and one of the greats in American surgery, and one of the most prolific Whipple guys in the US, but still.

[/personal rant]

I totally agree with the hissyfit thing. Never taught anyone anything.

Dr. Freischlag is vascular, she is from CA- UCLA. It is very important that she is the first female chair of surgery at Hopkins- that will be on the test!!

Dr. Cameron is retiring next year.

 

[Blade28]

Dr. Freischlag is vascular, she is from CA- UCLA. It is very important that she is the first female chair of surgery at Hopkins- that will be on the test!!

Dr. Cameron is retiring next year.

You're very knowledgeable about all this stuff! I barely knew what an "attending" was when I was in college! You have lots of clinical experience/exposure?

 

[nonesuchgirl]

You're very knowledgeable about all this stuff! I barely knew what an "attending" was when I was in college! You have lots of clinical experience/exposure?

I've been kicking around Hopkins in one way or another since I was 15. Spent a lot of time in the past year and a half in Surgery there. (My mom is a medical office coordinator, I temp (during school breaks).) I don't care for many of the people I've met there, but the ones I like, I love. They're my boys. Good men.

It is all their fault that I gave surgery a second look. They will probably end up regretting that. I'll have to make one of them let me stalk- I mean shadow- them for a bit, I guess.

That, and I don't get out much, so I read.

 

[Blade28]

I've been kicking around Hopkins in one way or another since I was 15. Spent a lot of time in the past year and a half in Surgery there. (My mom is a medical office coordinator, I temp (during school breaks).) I don't care for many of the people I've met there, but the ones I like, I love. They're my boys. Good men.

It is all their fault that I gave surgery a second look. They will probably end up regretting that. I'll have to make one of them let me stalk- I mean shadow- them for a bit, I guess.

That, and I don't get out much, so I read.

Ah, OK, gotcha. Just keep your mind and options open over the next few years.

 

[nonesuchgirl]

Ah, OK, gotcha. Just keep your mind and options open over the next few years.

Cross my heart.

I have a short list of things I'm interested in. Surgery heads it, but it's not the only thing.

 

[Blade28]

I have a short list of things I'm interested in. Surgery heads it, but it's not the only thing.

 

[hans19]

By age 60, we'll all probably experience a decline in eye-hand coordination and in finger dexterity. Say if you become a practising surgeon at age 30, you'll probably only have about 30 years to practise as a surgeon. What can they do after? Other than teaching?

Um... RETIRE!

Maybe its just me, but how about retire like most people do at age 65?!?

If for no other reason- so you don't put patients at risk.

 

[Winged Scapula]

Um... RETIRE!

Maybe its just me, but how about retire like most people do at age 65?!?

If for no other reason- so you don't put patients at risk.

I think we can all agree that those who have lost sufficient skills should retire although perhaps many of us have seen those who do not and others are afraid to tell them they should.

However, the minute diminution in skills that accompanies age doesn't necessarily afflict everyone the same nor does it necessarily require retiring. Perhaps you can not longer do microvascular work but there would be no reason you can't do a lot of other surgical procedures, even after age 65.

And of course you can do what many former general and trauma surgeons do - go into a breast only practice!

 

[DoctaJay]

Actually, from what I've seen, the reason why most surgeons stop operating does NOT have to do with a loss of finger dexterity and eye-hand coordination.

Most former surgeons that I have met stopped operating because their back pain was debilitating. I have heard stories of attendings who have to take a break in the middle of an operation, lie down on the floor for 10 minutes, and then resume - because the pain is crippling.

If you're interested in surgery, it's really a good idea to work on your physical fitness and (especially) focus on your core strength. The lower back pain that comes after years of hunching over an operating table can be killer.



ACS. American College of Surgeons.

What types of exercises are you talking about. Like abs and back, along with everything else, or should we try to really find work outs that work specific muscles in the back?