Table 2

Regulation and governance of ageing surgeons: roles and responsibilities

Stakeholder Groups Roles and responsibilities Quotes from participants
SurgeonsMaintain fitness to practice, notify health impairments that may impact on patient safety to their employer and Medical Board“Ideally the surgeon themselves is the key factor to determine when they stop operating”. (regulator, non-surgeon).
Surgical professional colleges for example, Royal Australasian College of Surgeons (RACS), Royal Australasian & New Zealand college of Obstetricians & Gynaecologists (RANZCOG)Train and award fellowship to specialist surgeons, maintain surgical standards through education, professional development, and practical tools and resources. Facilitate special interest groups. Advocate for the profession for example, through position papers and submissions on law reform“The role of professional colleges is strong leadership, looking into the future, seeing what’s coming, preparing the profession for it, and dealing with it in the most effective way, colleague to colleague”. (surgeon, professional college executive) “The professional colleges have the most proximity and the most experience of the actual requirements of the surgical craft that's being examined and therefore their advice and expertise should be sought by policymakers”. (MDO, legal advisor)
HospitalsEmploy, or grant admitting rights, to surgeons. Credential surgeons to work within an approved scope of practice, and address performance concerns. Ensure the quality and safety of care.“We have got to create an environment where those discussions are much less fraught with suggestions that, because you are getting a bit older, you are not as valuable.” (CMO, doctor)
Medical Defence OrganisationsProvide professional indemnity insurance to members. Seek to reduce claims through education and medico-legal advice.“(MDOs) are able to provide an independent supporting environment and encourage doctors to make changes and to admit to things that they might otherwise not be willing to share with their colleagues. (MDO, medical advisor)” “Over the last 10 years the medical indemnity organisations have become much more proactive in terms of running courses, becoming involved, offering advice.”
Health practitioner regulators for example, Medical Board of Australia, General Medical Council (UK)Ensure that individual practitioners are fit to practice and protect the public from harm. Register medical practitioners and renew annual practising certificates. Develop standards, codes, and guidelines. Investigate complaints and where necessary initiate disciplinary hearings.“Regulatory authorities, it's primarily around safety and quality and, again, the rights of the public must overcome the rights of (an impaired older) surgeon who may think that they are able to practice. (surgeon)” “The role of the regulators (is) to manage serious or significant risks that can’t be dealt with at that local or professional college level.” (advisor, MDO)