“In addition to crashes, older drivers are over­represented in the frequency of trafc violations such as failure to yield, failure to stop, inatten­tion, and safe-movement violations. However, they are underrepresented in recklessness, fol­lowing too closely, and alcohol violations. The federal highway safety standard for driver licens­ing requires that reexamination occur at least every four years and tests of knowledge and visual acuity are done. It also calls for driver de­ciencies and limitations to be identied and that remedial measures or termination of licensure occur for individuals failing to meet the stan­dards. There is great variation in how the states handle this responsibility, but most require vision testing at some age threshold, whereas only a few require knowledge or road testing. Authorities in the eld suggest that vision testing be expanded to include both acuity under reduced illumination and dynamic visual acuity [15]. The data also suggest that the frequency of examination be increased to every 2years when the driver reaches age 70–75 years and consideration be given to issuance of restricted licenses to avoid high-risk trafc areas” [3].

end of the spectrum, individuals are not permit­ted to drive until age 16years and are not legally able to purchase or consume alcoholic beverages until 21years of age. These choices are obviously based on administrative expediency because it would be much more costly to make individual assessments. However, state administrators nd themselves subject to liability for failing to iden­tify the disabilities of drivers who subsequently cause death or damages. So we can begin to see some similarities here to the responsibilities we face in the credentialing of older surgeons. The public can quite legitimately ask why it is that the older person must take an examination to drive but not to be an operating surgeon. If we respond that we monitor for adverse outcomes, the question becomes why it is necessary for an adverse outcome to occur before something is done. Acting on a single adverse outcome would surely be challenged in court, but to wait for multiple adverse outcomes invites the plaintiff’s attorney to include the Chief of Surgery in the suit. The concept of calculated risk would cer­tainly not be acceptable when there is a group at risk, such as in a commercial airplane. In fact, the Federal Aviation Administration has been able to withstand a number of legal challenges to its requirement that commercial pilots ying larger planes retire at age 60years. It is less comforting to realize that the rule does not apply to smaller commuter ights and private pilots. However, there are no data to suggest that older commercial pilots have more accidents. Indeed, the defense to the rule has been the legal technicality that the older pilot challenging the rule must show that his performance is as good as that of any other older pilot and because there are no other older pilots, it is a catch 22. The Ofce of Aviation Medicine within the Federal Aviation Administration has initiated a research project to look at the relation­ship between aging and accidents and develop a battery of tests to select individuals capable of ying beyond age 60years. That may be difcult, however, because pilots as a group have a much higher death rate than the general population, peaking at the 55–59year age group for reasons that are unclear. However, pilots who retire early have a longer life expectancy” [3].

More recently, Whitehead [27], in a short com­munication on the internet entitled, “When Should Surgeons Stop Operating” highlighted a two-day series of assessments for older surgeons to evaluate physical and cognitive function, a program offered at Sinai Hospital in Baltimore. She noted that some of the declines that accompany aging include increasing fatigue, forgetfulness, and reduced eyesight. She then pointed out that other profes­sions maintain a close watch for such changes in order to protect the public, and some even have a rm age cut-off. For example, airline pilots are required to retire at age 65, and some reghters must step down by age 57, however, no nation­wide age-related cut-offs, required assessments, or guidelines currently exist to ensure that physicians provide their services safely and competently. She added that we all know octogenarians who can play a respectable game of tennis, and others in the same age group who cannot even walk to the mail­box. The same can be said for surgeons; many still do great work in their 70s, but others should not even be allowed in the operating room [27].