Anesthesiology:
doi: 10.1097/ALN.0b013e31826e0ef9
Correspondence

In Reply

Tessler, Michael J. M.D.*; Shrier, Ian M.D., Ph.D.; Steele, Russell J. Ph.D.

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We thank Haddad, Gilmour, Katz, and Eger for their interest in our article.1
We agree with Haddad that there is a growing body of literature looking at the quality of care delivered by older physicians.2,3 However, our study looked at the relative risk of litigation for three different ages of anesthesiologists and did not address the quality of care delivered by anesthesiologists who either did or did not take the Maintenance of Certification Exam. As a comment, we wish to highlight, despite Haddad’s assurances the literature is “replete with studies” and “abundant data” regarding “declines in both knowledge and skill in the aging physician,” the most recent cited papers in all of the letters to the editor are from 2006,4,5 and Haddad and Gilmour quote the same two papers in support of their contentions.6,7 We think more work is essential.
Regarding Gilmour’s comments, we studied the experiences of specialist anesthesiologists, as determined by each provincial billing authority, exclusively (see also the response to Eger). It is true that there is a 1-to-1 ratio between anesthesiologist and patient in Canada, unlike the practice south of the border. It remains to be determined whether the Canadian or American model leads to a higher relative risk of litigation as anesthesiologists age.
Katz raises a valid point. We had tried to explore, as best we could, confounding variables, such as the complexity level of the various interventions performed by the anesthesiologists studied. However, there were so few moderate or high complexity procedures performed by the oldest age group that we think older anesthesiologists are probably already systematically limiting their work to their “comfort zone.” Still, we agree that it remains possible some of these litigations could be because of the oldest group providing anesthesia for low complexity procedures in unfamiliar contexts or populations, and we hope our study stimulates more research in this area.
Eger raises an interesting point. It is possible that some of the older anesthesiologists in our database did not receive a similar quality of anesthesia training as is available today, and that the standards of the specialty have improved since the oldest group of anesthesiologists finished their residencies. We agree that factors affecting the quality of care provided by anesthesiologists need to be further investigated.
Michael J. Tessler, M.D.,* Ian Shrier, M.D., Ph.D., Russell J. Steele, Ph.D.
*Jewish General Hospital, Montreal, Quebec, Canada. mtessler@ana.jgh.mcgill.ca
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References

1. Tessler MJ, Shrier I, Steele RJ. Association between anesthesiologist age and litigation. Anesthesiology. 2012;116:574–9

2. Southern WN, Bellin EY, Arnsten JH. Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice. Am J Med. 2011;124:868–74

3. Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: The relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73

4. 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. 2006;296:1094–102

5. Waljee JF, Greenfield LJ, Dimick JB, Birkmeyer JD. Surgeon age and operative mortality in the United States. Ann Surg. 2006;244:353–62

6. Day SC, Norcini JJ, Webster GD, Viner ED, Chirico AM. The effect of changes in medical knowledge on examination performance at the time of recertification. Res Med Educ. 1988;27:139–44

7. Eva KW. The aging physician: Changes in cognitive processing and their impact on medical practice. Acad Med. 2002;77:S1–6

© 2012 American Society of Anesthesiologists, Inc.

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