We all grow old. Even surgeons. We slow down, we weaken and our skills diminish. Although individuals differ and chronological age may not be an accurate guide to biological age, we cannot hold back the advancing years. How long should we allow surgeons to keep operating? If public safety is the priority, as it must be, should there be a mandatory retirement age, as there is for pilots in the airline industry? Or is there a fair and equitable way of assessing those nearing the end of their career to ensure their competency is maintained? The ageing surgeon poses daunting challenges. For the individuals concerned, the idea of ageing may trigger fears about loss of status, identity and livelihood. Patients may worry about the quality of their care. For healthcare systems struggling to meet growing demand, this issue raises questions about capacity. Medical regulators in Australia and Canada are implementing additional checks on doctors from the age of 70 years,1 2 but most countries have no mandatory retirement age for surgeons and those where it once existed have moved away from such a prescribed approach.3 Globally, the surgical workforce is ageing, with figures of those above 65 years ranging from as high as 25% in the USA,4 and 19% in Australia and New Zealand,5 to 9% in the UK.6 Cognitive decline is evident in older surgeons, as in ageing adults generally. The 2008 Cognitive Changes and Retirement among Senior Surgeons study found a deterioration in attention, reaction time, memory and sensory changes in vision, visual processing speed and hearing.7 A further study, however, found the decline was slower in surgeons than in age-matched controls.8 Importantly though, the assessment in that study did not encompass all surgical skills. Some studies have shown that older …