As Canadians we pride ourselves on our Constitution. We take pride in the fact that it protects the rights of individuals and that these rights are independent of variables such as sex, race, color, religion, and age. In fact, many of us think that various miscreants hide behind the Constitution and avoid prosecution for crimes because of its safeguards.
It seems ironic then, that the Constitution does not seem to be able to protect one group of Canadians who arguably would be felt to be “good guys.” I am speaking of physicians who work at university teaching hospitals in Vancouver. At the Vancouver General Hospital these physicians must give up their privileges at age 65 (at St. Paul’s it is 70). This, of course, affects surgeons to a very large degree, internists not so much, and family doctors less so. To surgeons it is a big deal. They no longer have hospital privileges and, therefore, they basically cannot work unless then can get privileges at another hospital. It is unlikely that 65-year-old surgeons can obtain privileges in another hospital, but even if they do it means that they have to fill in on-call schedules, have a more significant commute, and get used to a whole new hospital and operating room system. This seems unfair and a poor way to treat individuals who have dedicated years to an institution.
It is also ironic that these very surgeons are the ones who have done extra postgraduate training of 1 to 2 years following their fellowships, and, therefore, their working life is already truncated compared to those surgeons working in other hospitals.
Surgeons by and large have trained for many years—the training of an average surgeon now is 5 to 7 years after medical school. They have accumulated years of experience and understanding of surgical techniques and patient responses. They enjoy the deep satisfaction that comes with being able to make a diagnosis, investigate, and then treat patients. To cast these highly qualified individuals aside because of an arbitrary number—65—seems appalling and, frankly, unbelievable. What are the reasons given for forced retirement of specialists at 65 at the Vancouver General Hospital? Well, I think the main response would be patient safety, but surely, there are several levels of checks and safeguards to protect patients. At the hospital level there are peer assessments, morbidity and mortality rounds, critical incident reports, and in most services at the hospital, ongoing audits. Again ironically, at the academic centre the results of procedures and the outcomes of patients are very diligently and carefully assessed in every discipline and shoddy work is not tolerated. Are there more complaints about senior surgeons at the College level? I don’t think so. Is there any evidence that outcomes are compromised? I don’t think so.
The next reason for forced retirement is that we need to make room for young surgeons with new training and new ideas. There is no question that this is true. The lifeblood of an academic centre is the energetic young surgeons who have been away and bring back new knowledge. It is also true, however, that we need senior surgeons to temper enthusiasm with experience, to leaven bravado and arrogance with humility and the understanding that operations do not always work and that patients do get complications. Dealing with this is a lifelong learning experience not to be ignored.
The situation in which surgeons at 65 at the Vancouver General Hospital are “over the hill” but if they go to St. Paul’s they are not over the hill for another 5 years, and if they go outside the City of Vancouver they can work for at least another 5 years after that can surely be considered absurd. But is it sensible? Is it constitutional?
The bottom line, as we all know (and are often hesitant to say), is that there are some surgeons who are not competent at age 40 and there are some surgeons who are still competent at age 70. The real goal should be to identify those individuals and apply our country’s Constitution appropriately to each.