Correspondence  |   November 2012
In Reply
Author Affiliations & Notes
  • Michael J. Tessler, M.D.
  • *Jewish General Hospital, Montreal, Quebec, Canada.
Article Information
Correspondence   |   November 2012
In Reply
Anesthesiology 11 2012, Vol.117, 1139. doi:
Anesthesiology 11 2012, Vol.117, 1139. doi:
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.
*Jewish General Hospital, Montreal, Quebec, Canada.
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