AAO 2024: Alfredo Sadun on the aging ophthalmologist

Alfredo Sadun, MD, PhD, is the chief of Ophthalmology at the Doheny Eye Institute of UCLA. At this year's AAO meeting held in Chicago, Illinois, he stopped by the Eye Care Network booth to share insights from the symposium "Professional Longevity 2.0: Assessing the Ophthalmologist," which he presented during.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Alfredo Sadun, MD: Hi. My name is Alfredo Sudun. I'm chief of Ophthalmology at the Doheny Eye Institute of UCLA, and this morning, we had a really interesting session. The issue is what to do with the aging clinician?

Stephen A. Obstbaum, MD and Samuel Masket, MD chaired a session that had a number of experts from different areas dealing with what is the obvious problem of a larger and larger percentage of our population aging at the academy. Now, 40% of the academy is over the age of 60, and perhaps sometimes at the age of 70 or 80, they lose the ability to be good surgeons or clinicians. But of course, there's great variability. People age at different rates, so we can't just use an age cutoff and require things to happen at that age.

There has been an attempt by several institutions, including the Ford Hospital and also Scripps, to suggest that at age 70, people need to take exams, and they've both been sued successfully for ageism, because, after all, anything that you require a 70 year old to do that you don't require your 60 year olds is a form of ageism. So we discussed the pros and cons of different issues, including the legality, and I presented a particular vignette, just to give people the flavor of it, of an aging physician who was highly respected at his institution, and whose resident noted that twice during anterior segment surgery, he had gotten confused as to which patient he was operating on. She was afraid to confront him because she talked to her chair. Her chair asked for advice from her mentor, doing chairman of psychiatry said, "Oh, we got it now. We got a great test for Alzheimer's disease and other cognitive diseases." He took the test, and he failed it. He protested, saying he was having a bad day. He took the test another day, and he passed it, which, by the way, is typical for issues of cognitive decline, that there's good days and bad days, and then they said, sorry, it's not valid for retest, and therefore you still have to leave the faculty. Total disaster you can imagine in lawsuits.

So we discussed the various approaches that can be used with ethical considerations, legal considerations, and practical considerations. People do age, our cognitive and physical abilities go down, but they don't do so in an even predictable way. I'm sure we all know somebody who, at age 100 continues to run a little marathon, but other people are like me, who finds it hard to get across this academy once I turned 60, but even different parts of the body age at different rates. So it's just good luck if your cognitive skill is still there.

Collegiality is everything here, for 2 reasons. Number 1 is you don't believe you're losing your skills until somebody tells you. One of the things that studies show is that, with the loss of cognitive abilities is the loss of self-reflection. But your colleagues don't want you to make a fool of yourself, and they'll pull you aside, and they'll tell you. And in many cases where it works successfully is where, finally, the colleagues talk to them. Secondly, you don't lose all your skills at once, and if you can be in a situation where you can accomplish 90% of what you like to do, but there's a 10% that's missing, some colleague will probably help cover that 10%.

Well, I certainly advise people to take the MOC for the American Board of Ophthalmology for several reasons. One is studies have shown that people who have MOC certification are much less likely to be sued than those who don't. Whether this represents the actual acquisition of information, I think that's half of it, or the self-reflective nature of people who choose to voluntarily take it, it's a good thing, and it works. So constantly learning, I think, is definitely an effective strategy to staying on top.