This was the lead article in Anesthesiology this past month. Very interesting and difficult subject. This retrospective review from Canada found that anesthesiologists over 65 yo are more often the subject of litigation than their younger counterparts (despite the fact that older anesthesiologists did lower acuity cases). The study is not without flaws but addresses an important issue: when is time to walk away? In my time, I've only seen 2 colleagues who were asked to leave, because we felt their clinical skills were failing. Both episodes were uncomfortable and difficult. I don't know what the best answer may be: one could consider a maximum age for mandatory retirement or some method of peer review. I think the answer may lie in between where older clinicians undergo a step down in hours and cases which is accompanied by some sort of ongoing evaluation. Any other thoughts?