The words ‘former’ and ‘past’ are used to describe our affiliations on retirement – terms that will precede our name one day. Retirement has different connotations for different individuals, at different times, in different places. Mandatory superannuation is a no-brainer. However, continuing in a profession, where the public is directly involved, ignoring one’s age and without external, formal checks and balances, is debate-worthy. Even private cars failing a fitness test after 20 years are deemed ELV (End of Life vehicles) and must be scrapped.
Pilots have a tremendous responsibility. Hundreds of lives depend on their skill. “No one else has their skills tested so frequently. Every year we undergo six checks with the risk of losing our licenses and jobs. An examiner in the air, asks scores of questions about hypothetical problems. Two other checks are on the simulator, with two annual theory refreshers. Pass marks are 70 % with regular health screenings and preflight tests. Retirement is at 60.” This is what my patient, a pilot, told me decades ago.
What about me ? Madras University certified that I was competent to be a neurosurgeon in 1980. After that, there has not been a single, formal, external evaluation of my continuing competence! About 70% of the diagnostic armamentarium and therapy available today, was non-existent then. About 50% of neurosurgical practice today, did not exist during my training in the ‘Jurassic Park’ era. It is assumed that I am omnipotent and have mastered the skills of unlearning and relearning. After all, just to survive, I have to be up to date. Personally, at times, I feel that I am a menace to society!
Being a super-specialist is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. As surgeons age, they may experience physical or cognitive decline, impacting their ability to perform surgeries safely.
Doctors also age. Facial muscles sag with wrinkles. The north pole shows reduced foliage with silver colouring. Hearing aids, dentures and intraocular lenses become the new wearables! Bones soften and joints creak. Aroma, odour and gustatory responses are best described by grandchildren – “weird”. Siesta is not uncommon. Acceleration of programmed neuronal loss leads cynics to conclude that only wine and cheese improve with age.
A personal decision
For doctors, the decision to retire is a personal one, rather than a mandatory age. With a shortage of clinicians in the country, it is tempting to keep old warhorses in harness. Every time a doctor retires, we lose 40 years of experience. A doctor couple, at 62, at the peak of their career voluntarily stopped direct patient management and “cutting and stitching”. In the subsequent 12 years they have made a stupendous contribution in their second career – writing books, blogs and using the digital media to share their extensive wisdom. Non-operating surgeons can contribute significantly to teaching, mentoring, writing, research, and administration. Developing a second passion for a second career is the answer. Retiring does not mean only gardening and playing golf (most of us cannot afford the latter!)
Adequate differential weightage has to be given to a plethora of factors before deciding on formal retirement. These include physical and mental fitness, financial health, assets, liabilities and post “retirement” plans. One needs to remember that dealing with patients, often with Yama in the background, sharpens skills. Combined with teaching and interacting with young, enquiring minds, the resulting mental fodder makes one younger.
Exercising accurate and valid judgement in critical situations, sustained attention, the ability to learn and remember, excellent vision, short reaction time, corrective reflexes, dexterity, smooth, tremor-free purposive movements and excellent, undiminished functional abilities determine one’s capabilities. Acknowledging a failing in oneself is difficult. Self-assessment is riddled with bias and conflict of interests.
Not the end of the road
Retirement is not the end of the road. It is the beginning of a new highway, a chance to become Ganapathy 2.0! At the winter of my life do I hit ‘replay’ or ‘fast forward’? Recycling a used brain surgeon (not a brainy one as my grandson pointed out ) is challenging. Retirement is more difficult than work! Stepping down, only means an occupational change. With no accountability and individual patient management responsibility, I now do what I also wanted to do!
The take home message: In spite of the World Health Organization recognising 66-79 as the new middle age, doctors above 70, desirous of continuing practice, should have their license reviewed once in two years after a thorough evaluation. Exceptions can be accepted but rules and regulations need to be formulated. Re-assessment by younger individuals will pose unique challenges!
(The author a former distinguished professor at IIT Kanpur and is past president of the Neurological Society of India, the Indian Society for Stereotactic & Functional Neurosurgery and the Telemedicine Society of India.)
Published – March 22, 2025 01:57 pm IST