|Monday, 11 March 2013|
Whatever our individual views about the proposed changes to pensions which are under discussion, the element which excites the greatest concern in the theatre coffee rooms of the country is the increase in the retirement age.
For clinicians in front line, acute specialties the prospect of working to 68 (a 20% increase in working life) has both professional and personal concerns. If we set aside these personal issues which arise from a change in expectation of when retirement would come, the professional aspects seem not to have been adequately explored.
Working well into the seventh decade of life will have implications for the service and for individuals. We know about the changes in physical attributes which occur with aging. For surgeons and anaesthetists particularly, there are physical issues to be dealt with. These changes in our physical and cognitive reserves, and our ability to recover from sleep disruption, while variable in their impact in the individual, are real and worthy of significant consideration.
We know that performance degrades under stress and that skill levels need to be higher than simply competent, to allow for the degradation to occur and performance to remain acceptably high. Mature clinicians use high skill levels to compensate for physical deterioration in dexterity and/or eyesight and cognitive changes due to fatigue, but there are limits to this. The combined effects of physical and cognitive changes plus acute stress have not been adequately examined.
Many anaesthetists often come off on call rotas at about 55 years of age and some surgeons come off such rotas around 60. Departments can utilise the undoubted skills of these individuals in daytime activity with significant benefit. The numbers don’t tend to work however when the working age is extended out to 67 or 68. We may think that this issue is years away but we will need to have developed solutions within the next 5-10 years.
A number of studies have looked at the phenomena of burnout in surgeons. The largest was carried out by the American College of Surgeons showing that very significant numbers of their Fellows scored significantly for burnout (40%) and depression (30%). Smaller studies in other countries, including the UK, and in other specialties have found similar results.
The median age of the American study was 51 and it would be instructive to know what the results would be in a substantially older cohort. Of the factors which were associated with burnout, the number of nights on call and working hours were important. Being younger was also a significant risk factor but that may have been due to the other factors which were associated with burnout, such as having children, having a spouse employed outside the home and particular areas of specialisation. The effect of a longer work life on this issue need some investigation.
In the following articles, we are reminded of the certainty of change – both demographic and professional – and the consequent need for change in the profession. The Greenaway Report on the shape of training may well also have something to say about the shape of the profession and career progression within it. In the subsequent three articles we explore these issues from different perspectives.