It Makes Sense, but Do I Really Need to Participate?

With increasing life expectancy and improved quality of life, functional age no longer necessarily corresponds to chronological age. Surgeons are working longer, a trend further reinforced by the shortage of healthcare professionals. Consequently, the age pyramid of surgeons is shifting upwards worldwide. In Switzerland, almost 22% of surgeons are over 60 years old (1). At the same time, the relative number of young physicians choosing surgery is declining, with some leaving the profession prematurely. These trends suggest that the number of older surgeons will continue to rise in the future.

Although surgeons are also subject to the natural aging process, the experience they acquire over the years can compensate for age-related changes to some extent, sometimes even providing an advantage over less experienced colleagues. However, at a certain point, experience alone is no longer sufficient to ensure high-quality patient care across all areas of practice. Against this backdrop, the Swiss Society of Surgery (SGC) launched the "Senior Surgeon Assessment" (SSA) project. The goal is to maintain acquired competencies at the highest level and support surgeons in their ongoing professional development. Ultimately, the tool is also intended to encourage critical self-reflection (2,3).

Methodology and Pilot Phase

The SSA is an assessment tool designed by surgeons for surgeons. It serves not only to evaluate surgical skills but also to provide insights into potential future career paths. Ultimately, the SSA is intended to function as a coaching tool (2,3). A pilot phase involving seven assessments confirmed the feasibility of the project and was well received by both participants and experts. These findings attracted international attention from organizations such as the German Society of Surgery (DGCH), the European Union of Medical Specialists (UEMS), and the American College of Surgeons.

However, participation following the pilot phase remained limited, prompting the SGC to conduct a survey among its members in Switzerland. The goal was to understand the reasons for the low participation and identify ways to improve the acceptance and implementation of the SSA.

Results

A total of 1,106 questionnaires were sent out, with 310 responses (28.02%) received: 256 in German, 51 in French, and 3 in Italian.

The key findings are summarized in the following table:

Analysis and Discussion of the Results

Awareness and Perception of the SSA
A total of 62% of respondents reported being aware of the SSA. The publications and conference presentations appear to have contributed to general awareness; however, there is room for improvement regarding a deeper understanding of the SSA. Enhanced communication through various channels could help further increase awareness and knowledge of the assessment tool.

Necessity of an Assessment
Two-thirds (66%) of respondents consider such an assessment necessary. Nevertheless, concerns remain regarding external evaluations of one’s own skills. Further clarification is needed to position the SSA as a support measure rather than a form of oversight.

Responsibility of Other Institutions
A significant proportion (44%) believe that other institutions should take responsibility for the assessment. Some respondents also emphasized the need for legal regulations to mandate such evaluations and entrust them to professional societies. The concept of using the SSA as a "quality seal" to define continued surgical practice beyond the standard retirement age could be considered.

Cost Concerns
A majority (82%) perceive the cost of the SSA as too high. It should be noted that nearly all fees go toward compensating the expert evaluators. Potential solutions to reduce the financial burden include subsidies or cost-sharing by professional societies or hospitals. However, external funding could risk compromising the autonomy of the assessment process and its outcomes.

Confidentiality Issues
A total of 67% expressed concerns regarding data protection. In reality, all collected information is stored exclusively on a secure SGC server. Providing more detailed explanations of the data security measures could help build trust among potential participants.

Recognition for Continuing Education Credits
A significant 63% of respondents support the recognition of the SSA for CME credits. This indicates that many surgeons perceive the assessment as a valuable learning opportunity that could also provide guidance for future professional development.

Additional Comments and Insights

Minimum Age for the Assessment
Most respondents consider a minimum age of 55 years too early, preferring thresholds of 60 or 65 years instead.

Expert Qualifications
Some respondents questioned whether younger experts could objectively assess older surgeons. During the pilot phase, careful attention was given to selecting evaluators with outstanding professional qualifications and recognition within the surgical community. Additionally, assessed surgeons had the option to reject specific evaluators.

Involvement of Anesthesiologists and OR Staff
The participation of anesthesiologists and OR staff is primarily intended to provide insights into behavioral changes over recent months and years rather than evaluating technical skills, thereby enabling a more comprehensive assessment.

Acceptance Challenges
Some respondents perceive the SSA as an additional bureaucratic burden ("Not another exam at 65!"). This underscores the need to frame the assessment primarily as a career development and self-reflection tool rather than an examination.

Conclusion

The survey indicates an overall positive response to the SSA but also highlights challenges in perception and acceptance. Establishing the SSA as a supportive and coaching measure that helps surgeons shape their professional careers meaningfully will be key. Possible strategies include recognizing the tool as a quality certification or a seal of approval for surgeons wishing to continue practicing beyond retirement age. A modified approach emphasizing its benefits, coupled with potential financial relief for participants, could enhance acceptance.

The SSA represents a forward-thinking initiative to maintain surgical quality at the highest level while ensuring patient safety. At the same time, it serves as a model for individual, self-critical quality assurance. A cultural shift within the surgical community toward a positive perception of this evaluation will be essential for its long-term success.