Greenfield L J, Proctor M C
Department of Surgery, University of Michigan Hospitals, Ann Arbor.
Ann Surg. 1994 Sep;220(3):382-9; discussion 387-90. doi: 10.1097/00000658-199409000-00014.
This study examined attitudes and practices with respect to retirement in a senior group of surgeons. The authors studied the extent of planning for retirement and factors that should determine withdrawal from performing operations.
Federal law prohibits mandatory retirement or withdrawal of operating privileges based on age. Some surgeons fail to recognize the effects of aging, which may place their patients and themselves at risk. There currently is no established method to deal with these issues until adverse outcomes occur.
A survey was returned from 75% (659/882) of the members of the American Surgical Association. Work load, level of planning for retirement, and methods to determine when one should cease performing operations were collected. Responses were coded and the data were analyzed. Additional subgroup analyses were conducted, stratified by age and level of operative activity.
Less than 50% of respondents reported any retirement plan, and among those who did, 75% planned activities in medicine. The extent of planning varied by age. In the youngest group (40-50 years), only 6.5% had a plan versus 40% of those older than 70 years who were not retired already. With respect to withdrawal of privileges, the majority of those surveyed favored determination by peer review or onset of physical disability rather than age. The level of activity declined significantly between 60 and 70 years; however, 18% of those older than 70 years of age continued to perform operations.
Both personal and institutional problems can arise when surgeons continue to practice despite limitations of aging. More positive attitudes toward retirement are needed as well as methods for evaluation of performance that reflect a surgeon's response to aging.
本研究调查了一组资深外科医生对退休的态度和做法。作者研究了退休规划的程度以及应决定停止手术的因素。
联邦法律禁止基于年龄强制退休或取消手术特权。一些外科医生没有认识到衰老的影响,这可能会使他们的患者和自身处于危险之中。在不良后果出现之前,目前尚无既定方法来处理这些问题。
美国外科协会75%(659/882)的成员回复了一项调查。收集了工作量、退休规划水平以及确定何时应停止手术的方法。对回复进行编码并分析数据。按年龄和手术活动水平进行分层,开展了额外的亚组分析。
不到50%的受访者报告有任何退休计划,在有退休计划的人中,75%计划从事医学相关活动。规划程度因年龄而异。在最年轻的组(40 - 50岁)中,只有6.5%有计划,而在70岁以上尚未退休的人群中这一比例为40%。关于特权的取消,大多数受访者赞成通过同行评审或身体残疾的出现来决定,而不是依据年龄。60岁至70岁之间活动水平显著下降;然而,70岁以上的人群中有18%仍继续进行手术。
当外科医生不顾衰老的限制继续执业时,个人和机构层面都会出现问题。需要对退休有更积极的态度,以及能反映外科医生对衰老反应的绩效评估方法。