What to do with the Older Anesthesiologist?!

Kenneth W. Travis, M.D.

To the Editor

The recognition that anesthesiology is a stressful specialty and the concern that a practitioner’s performance may be adversely affected by such mundane yet ubiquitous factors as sleep disturbance or deprivation (APSF Newsletter Vol. 7, No. 4, 37), combined with knowledge of the inevitable, although individually variable, neurophysiologic consequences of aging,’ raises the risk management issue for individual practitioners and organizations of what (if anything) to do with the older anesthesiologist?

At what point does experience no longer compensate for subtly diminished capacity to successfully process multiple simultaneous signals? How can we determine it is time to disengage from the more complex tasks before someone (or worse, some catastrophic event) tells us? How do we factor age, skill, work load, night call and compensation? Are there typically successful phase-out strategies for our specialty? Or, is clinical anesthesiology a young person’s game?

I offer two not particularly original suggestions: The first is that we organize a widespread survey of anesthesiologists regarding how they approach the issues of the disengagement of older colleagues from clinical practice and retirement. A sample questionnaire has been devised and can readily be shared or used for a starting point with the appropriate committee or group.

My second suggestion is that appropriate groups sponsor regional or even national CME/symposium courses which would include such topics as:

The Problem:

1. The physiology of aging, particularly neurophysiologic and neuropsychologic changes;

2. Recognizing the subtle signs of age-related stress for the individual;

3. Recognizing the subtle signs of age-related stress for the department/group. Are there objective indices?

Are there lessons from industry (aviation)?

The Resolution: Preparing for the inevitable

Career redirections within anesthesiology

Career re-directions outside anesthesiology

Examples of successful plans

Future Implications:

Re-certification examinations

New technology to facilitate performance evaluation and to enhance performance

I sincerely believe this is an important topic that deserves our attention. I hope that my interest and that of other like-minded practitioners can stimulate some genuine progress in this important area.

Kenneth W. Travis, M.D. Assistant Professor, Anesthesiology Medical Director, Same Day Program Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire

Reference

  1. Dorfman LJ, Bosley TM. Age-related changes in peripheral and central nerve conduction in man. Neurology 1979; 29; 3844.