I was recently at dinner with a brilliant engineer who runs an international company specializing in energy development. He is An intense, sophisticated workaholic who spends more than 300 days a year on the road. As the evening progressed, he proclaimed with gusto that he had decided to sell his company and retire. In his usual calculating manner, he said he couldn’t wait for every day to be a Saturday—a day unencumbered by the weariness of the week’s toil and buffered by Sunday before returning to the grind. He went on to describe a large retinue of hobbies that he would undertake to fill his time, most of which sounded vacuous to me, but as a genteel Southerner, I smiled and said they sounded great.
As I reflected the next day on the conversation and having recently retired from clinical surgery, I contemplated the fact that this new life of persistent Saturdays comes at the expense of a loss of Mondays, a day marking the beginning of another week in the arena of the grand calling of surgery, which includes a week of full caseloads, testing emergencies, joyful team dynamics, duties of the sickroom, and invigorating daily challenges, as well as the magic and rewards of being a healer. In short, Monday is emblematic of a life of weeks and weeks of making a difference and a life of a noble calling and high purpose—the surgeon’s life.
As the old saying goes, “If the creek doesn’t rise and you don’t die young, retirement comes to all of us.” Retirement is an event in life that protects professionals in fields that require a high level of function from staying past their ability to perform, and there often is a resistance to this withdrawal that we commonly see among athletes and entertainers who just can’t seem to give up the field or the stage. Similarly, the siren’s call of the surgical arena is a strong one that provides purpose, personal identity, joy, financial security, and a wonderfully fulfilling life.
Despite all of this, most of us, no matter how great the ride, don’t want to be the doctor who needs his patients more than they need him. The time ultimately comes when we should get off the stage and turn off the overhead lights.
This time is different for different people. Sir William Osler, MD, opining on this subject in 1905, said that physicians should quit at age 60 due to what he perceived as the natural decline in fluid intelligence that begin in middle age.1 Most healthcare practitioners today would think this assertion is too rigid and certainly not consistent with the modern natural known and observed performance capabilities noted of practitioners across the age spectrum of practice.
Along with this more elevated understanding of individual capability is the fact that modern operative advances, such as minimally invasive surgery, technologic advances like robotics, the rise of artificial intelligence, and the increasing availability of physician extenders, decrease the physical human toil of providing surgical care.
Along with the concerns of technical and neurocognitive performance for senior surgeons, there are practical effects of retirement on the surgical workforce. Currently, 26% of US surgeons and 40% of the total physician workforce are over the age of 65.2,3 The graying surgical workforce, as well as a relatively static number of graduate medical education (GME) training slots, are projected to result in a shortage of surgeons of approximately 19,000 by 2036.4
Adding to this pending surgical manpower crisis is the fact that we have a significantly aging national demographic. At this time, 22% of the population is projected to reach age 65 by 2036 with an expanding lifespan,5 which is the subset of the population that requires the greatest amount of medical and surgical care. This pending surgeon supply and patient demand incongruity will negatively impact the availability of surgical care in the upcoming decades. For more information on the surgeon shortage, see the article, “Surgeon Shortage Calls for Action,” earlier in this issue.
