The Oxford Dictionary defines the term retirement as ‘the act of stopping working permanently’. This is generally considered to be when a person is so old or sick as to be unable to carry out the responsibility of a particular employment. For the person concerned, it is easy to understand the physical illness or debility that makes him/her unable to work. But if it is a psychological disability, will he/she perceive it? Even more difficult to perceive is the subtle process of ageing with its impact on cognitive and psychomotor disabilities. The dilemma becomes more acute as it is well known that ‘age is but a number’! Several studies have shown that the performance capabilities of many surgeons older than 65 years compare favourably with those of younger surgeons [1]. Hence to expect someone to retire based on age alone would be incorrect.

Society should not be deprived of the wealth of experience that older surgeons possess. This experience helps the trainees and younger surgeons in decision making in difficult clinical situations. With the advent of laparoscopic surgery and restrictions on working hours of trainees seen in some western countries, training and mentoring have taken on a new meaning [2]. It is well recognised that the newer trainees need support during open surgery, particularly when conversion has to be carried out for complications of laparoscopic surgery.

At the same time, society cannot be exposed to possible complications that may occur when older surgeons operate. But is it true that older surgeons are likely to have a higher morbidity and mortality in their patients when they operate? In an analysis of a large cohort, outcomes when older surgeons operate are similar to those of younger surgeons. The increased mortality seen for a selected procedure like Whipple’s resection was attributed to smaller numbers of surgery performed rather than to age [3].

It should be noted that seniors not retiring at an ‘appropriate’ time deprives youngsters of career opportunities.

How does one solve this conundrum and strike a balance where the experience of older surgeons is harnessed for the good of society while ensuring patient safety and ‘growth’ for younger surgeons? The solution lies in bringing a degree of objectivity to assessing the performance status of surgeons.

It is documented that several cognitive skills like attention, reaction time, memory and visual learning decline with age [1]. While most of us recognise this, this recognition is subjective. Objective, validated measurement tools for these aspects of performance are available.

Psychomotor skills can also be assessed objectively. Many other professions like aviation and firefighting have these programmes of regular psychomotor testing. Many types of assessment like subjective performance testing, peer assessment, dexterity testing and Objective Structured Assessment of Technical Skills (OSATS) have been tried to measure performance. Of these, OSATS has shown to be reliable [4].

How Do We Use All This Information and Put Together an Efficient and ‘Pleasant’ Retirement Plan?

It is best to start retirement plans early. It is also preferable to make retirement a process—spread over a period of time, maybe years—and not an event—an abrupt happening [5]. Recognise that cognitive and psychomotor blunting is inevitable with age. More importantly, recognise that the individual may not be aware that this is happening. Hence one must be open to others—peers and administrators—deciding one’s competence. It is preferable that this assessment of competence is carried out by voluntary submission of the individual to the tests. If this is not forthcoming, administrators have a responsibility to society to ensure that all surgeons of whatever age are competent to undertake surgery. To this end, they must insist on surgeons undergoing objective cognitive and psychomotor testing [6].

Surgical mentorship by the presence of senior and elderly surgeons is a win–win situation—the trainee surgeon is perhaps faster with better reflexes and coordination and the senior mentor can guide him to make the proper moves and attain a degree of safety and efficiency.

Also, when it comes to counseling the family, the senior surgeon of the team becomes handy. In case of adverse outcome, the young surgeons can safely stay behind the senior member of the team. There are also theoretical surgeons in Germany who after retirement become paper tigers—they would assiduously examine the case sheet and do the gap analysis or determine the algorithmic action. Teaching art and science of surgery is an important duty of all surgeons which sees no age bar. Even while giving up active surgery, senior surgeons can keep themselves academically performing and help youngsters through mentoring involving career planning and networking [7, 8].

This would be a good legacy to leave behind.