The Aging Surgeon Program at Sinai Hospital of Baltimore has been developed to offer a comprehensive, multidisciplinary, objective and confidential evaluation of physical and cognitive function for surgeons. The program is designed to protect patients from unsafe surgeons and guard surgeons from arbitrary or unreliable methods of assessing competence or cognitive capacity. Additionally, we aim to support surgeons by identifying potentially treatable or reversible disorders that, if properly treated, could restore or improve functional capacity.
Hospital administrators are already lauding the evaluation as a valuable risk management tool to help them further reduce liability risk.
Note: We cannot assist patients who have complaints about a surgeon. Patients should speak with their surgeon directly, their hospital, their personal physician, or their state medical board.
Why the program is important
Physicians and, more specifically, surgeons (along with U.S. Supreme Court justices and the pope) don’t currently face a mandatory retirement age.
Airline Pilots
Surgeons are healthier and living longer than ever before and are choosing to practice into their senior years for a number of personal and even financial reasons. Many surgeons continue to operate successfully and make positive contributions to medicine well into their 70s and beyond. However, subtle cognitive or physical changes that could become barriers to safe practice are often difficult to identify.
Safeguards are needed to not only protect patients from unsafe surgeons, but to protect surgeons and hospitals from liability risk.
Current methods such as certification and peer review are simply not adequate, and most medical staff bylaws do not even address the issue of aging surgeons. Unfortunately, a patient death or serious negative event are currently the only things that prompt action to prevent a surgeon from practicing.
Our program recognizes that while human faculties undoubtedly diminish with age, chronologic age alone is not a fair determinant of a surgeon’s ability to perform his or her duties. The evaluation offers a balanced assessment of a surgeon’s functional age as determined by his or her physical and cognitive capacity and identifies treatable medical causes of impairment.
Patients and society in general take for granted that medical institutions have policies in place to guard against surgeons continuing to practice into their senior years despite diminished abilities. Our program, founded by Mark R. Katlic, M.D., MMM, FACS and his multidisciplinary team, has been established as a pioneering resource for hospitals and health systems throughout the country to fulfill their ethical and professional duty to police their surgical staffs on this critical and burgeoning issue.
Protocol
Participants in the Aging Surgeon Program follow a specific and comprehensive protocol. See below for what to expect before, during and after your time with us.
Pre-Visit Screen
- Client completes history form
- Client sends medical records, including last H&P, last 5 years of discharge summaries, and any actual images (especially MRI, CT of brain and spine—and imaging reports)
Check-In
- Check in to the Delta by Marriott Baltimore North
Day 1 at Sinai Hospital
- Drive or shuttle to Sinai Hospital of Baltimore
- 8:00 a.m. - Welcome, Introduction to the Program
- 8:30 a.m. - General physical examination; hearing screen
- 9:30 a.m. - Neurology examination
- 10:30 a.m. - Physical/Occupational Evaluation A
- 12:00 p.m. - Lunch/Rest
- 1:00 p.m. - Neuropsychology Evaluation A
- 4:30 p.m. - Drive or shuttle to Delta by Marriott Baltimore North
Day 2 at Sinai Hospital
- Drive or shuttle to Sinai Hospital of Baltimore
- 8:00 a.m. - Neuropsychology Evaluation B
- 12:00 p.m. - Lunch/Rest
- 1:00 p.m. - Physical/Occupational Medicine Evaluation B
- 2:30 p.m. - Ophthalmology Examination
- 4:00 p.m. - Exit Interview
- 4:30 p.m. - Drive or Shuttle to hotel; depart for home
Program Costs
The Aging Surgeon Program requires a one-time fee that covers the two-day comprehensive evaluation and resulting report. Additional expenses include travel to and from Baltimore, hotel, breakfasts and dinners.
Please contact us for the current program cost, to learn more about our special rates at a nearby hotel, or to ask any questions. You may complete the contact form or call us at 410-601-9927.
Program Accommodations
Participants in the Aging Surgeon Program will stay at the Delta Hotels by Marriott Baltimore North, which is located only five minutes from Sinai Hospital, in Baltimore Maryland. The hotel is 100% non-smoking, dog-friendly, and is conveniently located near many of Baltimore’s most scenic destinations.
Delta Hotels by Marriott Baltimore North
5100 Falls Road
Baltimore, Maryland 21210
855-516-1090
Frequently Asked Questions
Comprehensive Evaluation
Who can request an evaluation?
Evaluations may be requested by surgeons themselves, hospitals, or licensing bodies.
Who is a candidate for the program?
Although the program is intended to evaluate the aging surgeon, there is no specific age limit. Surgeons of any sub-specialty are candidates. Exclusions include substance abuse and known psychiatric illness. The surgeon must understand and speak English.
What exactly is being tested?
We are testing general health, eyesight, neurocognitive faculties, visual-spatial and fine motor capability. We are not testing medical knowledge, specific surgical skills, or medical interviewing and documentation skills.
Why does the evaluation take two days?
We recognize the high stakes involved for the doctor being evaluated and therefore constructed the best, most comprehensive schedule. We recently met as a group to discuss the question, “Must the evaluation be this comprehensive, this lengthy?” The answer unanimously was “Yes.”
Legal
Will there be legal documents to sign?
Since our evaluation is objective, unbiased, and based upon the best evidence extant, you must sign an “indemnification document” that protects us if there are subsequent consequences of our report. Also, no doctor-patient relationship is established, as this is more like an independent medical evaluation of a client. We will request permission to contact a significant other and, in the event that a serious issue is discovered, your personal physician.
Contingencies
What treatable disorders might be discovered or suggested?
Some disorders that, if treated, might improve a surgeons capabilities include medication side effects, depression, neurologic disease (i.e., hydrocephalus), sleep apnea, vision problems.
What worrisome disorders might be discovered?
Disorders that could affect a surgeon’s ability to practice include dementia, other cognitive impairment, neurologic disease, significant tremor.
What will we do if a severe impairment is discovered?
If we discover a disorder which is an immediate safety concern to you or others, we will contact, with your prior permission, your personal physician and/or significant other.
The Report
Who receives the report?
The individual or institution who pays for the evaluation will receive the final report.
Is the report confidential?
The report will be kept on an encrypted drive and provided in the form of a locked pdf file. We consider confidentiality an absolutely crucial component of the program.
What is the chance of a “false positive” report?
The chance of reporting a problem that does not exist is extremely low. The range of ‘normal’ in nearly every test is based on the general population. Surgeons tend to perform better than the general population, so an abnormal finding is truly abnormal.
Will the report make recommendations regarding hospital privileges?
No. The report will relate only the objective results of the comprehensive evaluation. A surgeon and/or hospital may use the results to make decisions regarding privileges, lifestyle changes, treatment, etc.
How soon after the evaluation will the report be available?
We will provide the report within two weeks. No preliminary results will be given unless an urgent problem is found.
Practicalities
What are the costs of the program?
The surgeon is responsible for his or her travel, hotel (special rate available at our nearest hotel), breakfasts, and dinners. A one-time all-inclusive fee, paid in advance, will cover the two-day comprehensive evaluation and report. This fee is presently being calculated. You may contact us for the current program cost.
Are meals included?
Lunch will be provided each of the two days. Breakfasts and dinners are the responsibility of the surgeon. Baltimore offers many opportunities for excellent meals.
How do I get from the hotel to Sinai Hospital and back?
There is a convenient shuttle from the Delta by Marriott Baltimore North hotel and back. If a surgeon drives a personal car, we will provide a parking pass each day.
What clothes should I wear?
Comfortable clothes are appropriate. You will not be judged in any way based on your dress. Shoes with heels are discouraged. Room temperatures will be comfortable but an additional layer of clothing such as a sweater may give you more flexibility. The tests are not physically stressful, though the day is long.
What should I bring?
Accommodations such as eyeglasses, hearing aids, and braces should be worn. Cell-phones and pagers must be turned off during the tests but may be used during the lunch breaks.
What determines the cost of the program?
The greatest cost of the program is clinician time, particularly the neuropsychology component. Some sophisticated equipment is employed in the Physical/Occupational Medicine area.
Other Questions
What if I have other questions?
Please feel free to contact us with any other questions. You may complete the contact form or call us at 410-601-9927.
Program References
Aging Surgeon Program References
- Hartz AJ, Kuhn EM, Pulido J. Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates. Med Care. Jan 1999;37(1):93-103.
- O'Neill L, Lanska DJ, Hartz A. Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology. Sep 26 2000;55(6):773-781.
- Neumayer LA, Gawande AA, Wang J, et al. Proficiency of surgeons in inguinal hernia repair: effect of experience and age. Ann Surg. Sep 2005;242(3):344-348; discussion 348-352.
- Waljee JF, Greenfield LJ, Dimick JB, Birkmeyer JD. Surgeon age and operative mortality in the United States. Ann Surg. Sep 2006;244(3):353-362.
- Lee HJ, Drag LL, Bieliauskas LA, et al. Results from the cognitive changes and retirement among senior surgeons self-report survey. J Am Coll Surg. Nov 2009;209(5):668-671 e662.
- Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. Jama. Sep 6 2006;296(9):1094-1102.
- Powell DH. Profiles in Cognitive Aging. London: Harvard University Press; 1994,p. 87.
- Eva KW. The aging physician: changes in cognitive processing and their impact on medical practice. Acad Med. Oct 2002;77(10 Suppl):S1-6.
- Bieliauskas LA, Langenecker S, Graver C, Lee HJ, O'Neill J, Greenfield LJ. Cognitive changes and retirement among senior surgeons (CCRASS): results from the CCRASS Study. J Am Coll Surg. Jul 2008;207(1):69-78; discussion 78-69.
- Drag LL, Bieliauskas LA, Langenecker SA, Greenfield LJ. Cognitive functioning, retirement status, and age: results from the Cognitive Changes and Retirement among Senior Surgeons study. J Am Coll Surg. Sep 2010;211(3):303-307.
- Hyde G, Miscall B. Impairment Due to Aging. The Impaired Surgeon: Diagnosis, Treatment, and Reentry. Chicago: American College of Surgeons; 1992:5.
- Greenfield LJ. Farewell to surgery. J Vasc Surg. Jan 1994;19(1):6-14.