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The ageing surgeon: a qualitative study of expert opinions on assuring performance and supporting safe career transitions among older surgeons
  1. Rupert Sherwood1,2,
  2. Marie Bismark1
  1. 1 School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Division of Women’s and Children’s, Western Health, St Albans, Victoria, Australia
  1. Correspondence to Dr Rupert Sherwood, Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia; rupert.sherwood{at}


Background Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons.

Methods In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory.

Results 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns—remediate, restrict or retire—and emphasised the need for co-ordinated and timely responses.

Conclusion Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age.

  • governance
  • healthcare quality improvement
  • patient safety
  • surgery

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  • Contributors RS and MB developed the study idea and questions for the interviews. RS conducted the interviews and analysed the results, with input from MB. Both authors reviewed and agreed on the submitted version of the manuscript.

  • Funding RS used funds available through the continuing medical education allowance as employee of Western Health, VIC, who also approved 6 months Sabbatical Leave to facilitate the research. MB was funded by a research grant from the Avant Foundation and an NHMRC Early Career Fellowship.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The University of Melbourne (grant no. 1852289.1).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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