Do younger doctors outperform older physicians?

Do patients prefer Marcus Welby, MD, or Derek Shepherd, McDreamy, for their physician? The former, a well-seasoned veteran of medical science, the latter, a recently educated young doctor?

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Your patient’s preferences may make more of a difference than your bedside manners. Or not.

Researchers at Harvard found that the patients of older physicians have a higher mortality rate than those of their younger colleagues.

The observational study, which was published in the British Medical Journal, looked at 700,000 patients treated by 19,000 doctors from 2011 to 2014 and found a rise in the mortality rates of the patients as the age of their doctors increased.[1]

All patients in the study were 65 and older and on Medicare. Patients with doctors under 40 had a 30-day mortality rate of 10.8% while patients of docs aged 41-49 had a mortality rate of 11.1%. Physicians aged 50-59 had a patient mortality rate of 11.3%, and once doctors were older than 60, their patient’s mortality rate rose to 12.1%.

Adjustments were made for patient’s age, sex, race, comorbidities, household income and day of admission.

What would account for the jump in mortality rates from doctors under 40 to those over 60? Technology? Training? Continuing education?

“There are so many obvious and not so obvious reasons why the conclusions may be completely false-even the opposite-of what was observed that perhaps a real study of the question may give a better answer,” says Stuart Spitalnic, MD, an emergency medicine physician at Newport Hospital and clinical assistant professor of Emergency Medicine at Brown University.

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Spitalnic says, “The authors themselves point out this could, if any relationship existed at all, be explained by a cohort effect.” Cohort effect commonly occurs in research when the similarities among study participants effect the study results.

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Since the 2014 census of registered American physicians shows that 26.3% of doctors in the country are over 60, with 9% over 70, should their patients be concerned? [2]

Spitalnic has serious doubts that Medicare data, the kind used in this study, can accurately determine who cared for patients when and how old they were. 

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What’s more, older doctors with large numbers of patients did not see their patients' mortality rates increase. Researchers attributed that to the fact that busier docs may stay current on the latest medical developments and attract more patients to their practice due to their advances.

Similiarly, another Harvard study found elderly patients treated by women had lower mortality rates than those treated by men.[3] That study concluded that potential differences in practice patterns between male and female physicians could be responsible for the clinical implications. Differences in practicing habits among older and younger doctors could also be called into question in the observational study.

Interestingly, the study found no association between physician age and patient’s 30-day readmission rate or cost of care.

“If the relationship exists at all, you would not expect it to disappear in doctors that took care of high volumes of patients,” says Spitalnic. “If care was somehow subpar, readmission rates should have been higher as well.” Spitalnic has been practicing over 25 years.

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The study excluded patients whose death dates were not validated. However, the researchers don't think that as doctors get older their quality of care gets worse.

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So why the difference in mortality? One observation is that older physicians might perform worse due to decreased clinical knowledge, not rigidly adhering to standards of appropriate treatment and may not be up to date in regards to quality issues like diagnosis, screening and preventive care.

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Also, perhaps as older physicians move further from training they are less likely to adhere to evidence-based guidelines, not use newly proven treatments as often as younger doctors and might more often rely on out-of-date clinical evidence, making a case for continued medical education and certification.

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“I believe patients need to be more mindful on how up to date their physicians are with the technology we have at hand,” says Berry Pierre, DO, MPH, an internist in South Florida and clinical associate professor for Nova Southeastern University College of Osteopathic Medicine and Florida State University College of Medicine, who has been practicing less than a decade.

Yet whether quality of care differs between younger and older physicians remains largely unknown. Researchers note this study was purely “observational” and more analysis is needed before any conclusion on the age of the physician influencing their patient’s mortality can be reached.

For now, whether patients prefer older and wiser versus younger and hipper remains no more than a personal preference.

[1] https://www.healthgrades.com/physician/dr-stuart-spitalnic-xyxxh

[2]https://www.fsmb.org/Media/Default/PDF/Census/2014census.pdf

[3]https://www.hsph.harvard.edu/news/press-releases/hospitalized-patients-female-physicians-lower-mortality-readmission/