Never Quit or Give Up (Churchill) (Mahomes), Commitment to succeed (Lombardi) and staying the course even when it is really hard (F. Leahy) are motivations used in numerous areas of life, including athletics, academics, survival and success. Almost certainly, neurosurgeons and neurosurgical residents pursue goals utilizing these principles. Typically, these select few demonstrate characteristics of being achievers in the educational process with academic achievements, promotion in rank, recognition, production, pursuit of power or authority and financial gain. Much attention is given to the continuous development of skills and practices focused on attainment of more goals and rewards. In contrast, neurosurgical career life expectancy receives little attention.
Neurosurgery is a unique life calling. Neurosurgeons are considered by many, including themselves, to be among the best and brightest. Most perceive neurosurgery to be the ultimate in medical specialties. It is clearly “the jealous mistress” and requires extreme dedication. Every day is filled with intensity. Participation provides the ultimate in “the thrill of victory and the agony of defeat.”
Neurosurgery Defines the Person
Neurosurgeons share many personality traits, including mental veracity, intelligence, problem solving skill, visuospatial skill and superior technical skill (read more in Henry Marsh’s Do No Harm). A common perception of these individuals is that: “Neurosurgery defines me, it is who I am, not what I do.”
Too many neurosurgeons make little time for developing interests outside neurosurgery or cultivating quality family time. Without the practice of neurosurgery, many believe they have no purpose, and most have given little attention to what it means to reach the end of their neurosurgical career. A senior neurosurgeon usually has earned the respect of his colleagues. He/She may be somewhat immune to criticisms or to others pointing out deficiencies. He/She has generally been productive and considered a “rainmaker.” Most are likely wary of the phase of life after an active clinical practice.
In 1892, Sir William Osler stated:
“There is no sadder picture than the Professor who has outgrown his usefulness, and, the only one unconscious of the fact, insists with a praiseworthy zeal, upon performance of duties for which the circumstances of the time have rendered him unfit.”
The reality is that aging brings physical and mental changes. Anticipated changes include cognitive decline, vision change, decreased stamina and dexterity loss. These developments vary among individuals; some are unaffected until later, while others experience deterioration of skills and cognition at an earlier time.
Age-related Change is Inevitable
In the last few decades, organized medicine and the lay public have posed questions regarding the competency and safety of older surgeons. Some have advocated testing the mental competence and technical skill of surgeons over the age of 65. While this has been suggested as a voluntary activity, some institutions now require it. Knowing these facts, it is worthwhile for neurosurgeons to plan their neurosurgical career life cycle. This planning can be aided by recognizing that aging is accompanied by a decline in skills. It is worth considering patient safety when planning practice culmination so that the need to protect one’s legacy is never an issue. Developing a plan for careful case selection in the later years of practice can be important to avoid declining outcomes, which force practice restrictions. Realizing that even if one cannot (or should not) continue practice at the same level, one can still contribute, particularly considering the value of experience and insight gained in a full neurosurgical career.
Options Abound
Senior neurosurgeons may continue to participate in many important roles. Among these contributions are outpatient evaluations, mentoring, teaching, surgical assistance, research, administration and participation in organized medical and neurosurgical societies. Planning appropriately for the neurosurgical career life cycle is worth the effort; reaping the rewards of a career of service is achievable. No one will care whether or not one performs one more case; back away before it is required. Realize that the goal of wealth accumulation can distort vision. Give back and receive the reward of selflessness. Develop concern for someone or something other than the self. Acknowledge and honor those, including the trusting patients, who made it possible for this incredible career. Foster the next generation.
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