To the Editor:

The report by Tessler et al.  1and the accompanying editorial by Warner2cautiously examine the possibility that senior anesthesiologists, by virtue of age, pose a greater risk to patients. This natural concern is prompted by Tessler et al. ’s finding that anesthesiologists older than 65 in the period between 1993 and 2002 incurred a greater risk of litigation than anesthesiologists younger than 51 yr.

Both the report and the editorial kindly avoided mentioning an explanation that did not rely upon the debilities of aging. If we assume that the 65-yr-old anesthesiologists entered training at age 25, they would have begun residency between 1953 and 1962, just before anesthesia programs began to attract the best and brightest, as they do today. Regarding recruitment into the specialty, in 1946 John Lundy noted,3“There was a tendency for only those physicians who were incompetent in general practice or in other branches to limit themselves to the practice of anesthesia.”

Although they examine other factors, both Tessler et al.  and Warner appear to assume that the prime factor differentiating their three groups was aging, and probably it was. But perhaps a confounding factor was that the older anesthesiologists were less competent to begin with. This might be revealed by repeating Tessler et al. ’s study in 10 yr.

, University of California, San Francisco, San Francisco, California.


Tessler MJ, Shrier I, Steele RJ. Association between anesthesiologist age and litigation. Anesthesiology. 2012;116:574–9
Warner MA. More than just taking the keys away …. ANESTHESIOLOGY. 2012;116:501–3
Lundy JS. Factors that influenced the development of anesthesiology. Anesth Analg. 1946;25:38–43