Hanging up the surgical cap: Assessing the competence of aging surgeons

Table 1 Surgeon certification compared to non-medical professions

Occupation	Mandatory retirement age (yr)	Certification based on cognitive and/or physical requirements
Surgeon[33]	None	Complete residency and board examination. Continuous self-learning or medical education (CME) for credit with periodic examination for certification. May have case list peer-reviewed and be evaluated by in-hospital staff. No physical exam or performance-based skills currently defined
Airline pilot[34,35]	65	Every 24 mo, complete flight review with instructor: Ground/flight training. Must demonstrate proficiency, competency, and sound judgement within approved standards during training. Medical certificate every 12 mo or every 6 mo if age > 40 yr
Air traffic controller[36-38]	56, 61 with exception	Apply at < 31 yr. Medical exam. Pass biographical assessment, pass the ATSA, and pass training course at FAA academy. The ATSA is designed to measure the cognitive, visuospatial reasoning, and psychomotor abilities of candidates. Must submit to yearly physical exam, and job performance twice a year, with periodic drug screenings. Certificate valid until surrendered, suspended, or revoked
Firefighter[39,40]	57	Complete CPAT. Complete annual medical exam and physical testing, depending on department discretion. Physical testing consists of exercises related to firefighting such as step tests, and leg lifts
United States State Judge[41,42]	70-75	Obtained law degree and passed Bar examination. State court often requires mandatory retirement for state court judges

ATSA: Air traffic controller specialists skills assessment battery; CPAT: Candidate Physical Ability Test; CME: Continuing medical education; FAA: Federal Aviation Administration.