ShareThisBy TRACY CORREA
Monday, November 13, 2006
Dr. Leo Shishmanian, a 75-year-old Fresno, Calif., radiologist, retired once, but it ended up being more like a hiatus.
In 1999, he stopped working and traveled with his wife. Three years ago, he was asked by colleagues at Saint Agnes Medical Center to interpret X-rays on a part-time basis. He now does the same for Kaiser Permanente's Fresno Medical Center, working about three days a week between the two hospitals, sometimes more.
Shishmanian said a shortage of medical specialists in Fresno - as well as the rest of the central San Joaquin Valley - is one reason he feels compelled to work.
Dr. Norman Sigel, 71, who specializes in internal medicine, is also still going strong. So is Dr. Bernard Freeburg, a 72-year-old gynecologist. Both maintain busy Fresno practices.
"I wouldn't be there if they didn't need me," Shishmanian said. "As long as you can see well and your brain is working, you can continue to work in radiology."
Increasingly, doctors are working beyond traditional retirement age - mostly because they want to and often because they feel guilty about abandoning their patients.
Figures from the American Medical Association show that more than 18 percent of licensed doctors in 2004 were 65 and older - up from 16 percent in 1993 and 13 percent in 1975.
But several studies have raised questions about whether older doctors, particularly surgeons who still take on complicated medical procedures, produce worse outcomes than their younger peers. And with no mandatory retirement age for doctors, questions are increasingly being raised about when they should retire.
A study in the September Annals of Surgery examined Medicare files on 461,000 patients who had one of eight complicated and high-risk operations, including heart bypass and partial lung removal. In five of the eight, researchers found the surgeons' age made no difference in outcome. However, in three procedures - pancreas removal, heart bypass and surgery to clear plaque from blocked arteries - patients of surgeons older than 60 had a higher rate of death within 30 days compared with patients of younger surgeons.
The study did note that the older surgeons did have a lower volume of surgeries.
Another study by researchers at Harvard Medical School that was published in the Annals of Internal Medicine last year found that older doctors may be less likely to deliver currently accepted standards of care. It found that problems are less about age than whether doctors are able to keep up with medical advances.
The Harvard study was considered significant because it countered the widely assumed notion that physicians with more experience provide better care.
Dr. Robert Wachter, professor of medicine at University of California at San Francisco and author of the book "Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes," said he would hate to see a mandatory retirement age for doctors.
But, he said patients should assume some responsibility for ensuring their doctors - no matter what their age - are competent. Ask whether surgeons are board certified, Wachter said.
But don't stop there.
"I don't only want to know if they have kept up, but that their hands are steady," he said.
Sigel, the 71-year-old internist, said that because he isn't a surgeon, he feels he can practice longer. He said he doesn't feel old or less skilled than his younger counterparts. He said he believes many of his patients, many of whom are older, find comfort in an experienced doctor.
"I like to tell my patients age is not a disease. Age is an event. It's a number," he said.
Sigel has also earned the respect of many younger patients whose elderly family members have come to him over the years.
John Nale, 37, and a farmer in nearby Kerman, credited Sigel with saving his life.
Eleven years ago, the doctor found a lump on Nale's thyroid during a routine exam. He ordered follow-up tests, which revealed cancer. Nale is healthy today and said he will continue seeing Sigel as long as he can.
"I believe his experience makes up for anything a young doctor brings to the table," Nale said.
"I pay him for his services because he does a good job," he said. "I will go to Dr. Sigel until I'm buried or he's buried."
