"When I was selected to become CEO of The Permanente Medical Group, the Permanente half of Kaiser Permanente, the time required for my responsibilities forced me to give up doing surgery on a regular basis. But every year since then, during the week between Christmas and New Year’s Day, I have returned to the operating room. The timing works, as the leadership demands become minimal and it’s unlikely I’ll suddenly be needed to fly to another part of the country. It’s a magical time for me, contrasting dramatically with my world as CEO. For several hours each day, my focus is not on millions of Kaiser Permanente members—or, for that matter, on all the complexities of healthcare policy, politics and strategy—but, rather, on a single patient at a time."
Dr. Pearl is a Yale medical school graduate who trained at Stanford and has been board-certified in plastic surgery since 1979. The American Board of Plastic Surgery did not start requiring maintenance of certification every 10 years until 1995.
We do not know what specific surgical procedures he does during his magical time. Is he removing moles, performing reconstructive surgery, or doing facelifts and nose jobs? Do his patients know that he only operates a few days per year? What happens if a wound complication requiring revision surgery arises? Who follows up his patients?
How does he maintain his skills if he only operates one week per year?
The literature does not address Dr. Pearl's unique situation.
A database mining paper claimed cardiac surgeon performance deteriorated after even one day of not doing surgery. I blogged that I didn’t believe it citing many concerns including that a number of unmeasured confounders could have accounted for the small differences in outcomes.
A report prepared for the UK's General Medical Council referenced “return to practice guidelines” from the Academy of Royal Medical Colleges which found few studies about how quickly and why medical skills decline and concluded that an absence of less than three months from practice was probably not significant.
In 2014, Braun et al published a survey of deployed US Army pediatricians, half of whom were away for 6 months or more during which they "infrequently practiced the full range of their pediatric skills." Such deployments led to "a significant decline in perceived comfort with both routine and acute pediatric care."
From the UK GMC report: "Regarding surgical and clinical skills, the disparate evidence on specific skills shows that the majority of subjects assessed for retention of learned skills did not totally [emphasis added] lose the new skill after a set time period."
Notwithstanding the cardiac surgery study mentioned above, surgical skills probably do not fade after a few days or even a few months of inactivity. But operating only one week per year for several years? Quite possible.
When I was a chief of surgery, I would not have given privileges to a surgeon who operates 1.9% of every year.
Would you want the occasional surgeon to perform your operation?