Comparing age of practitioners
DEAR DOCTOR: I recently read that patients of younger doctors have a lower risk of death than patients of older doctors. How could this be? Don’t older doctors have more experience?
DEAR READER:
The study to which you’re referring was published recently in the British Medical Journal. The authors found that physicians younger than 40 had a 30-day patient death rate of 10.8 percent; those over 65 had a 12.1 percent death rate. The greatest disparity was seen among doctors who took care of fewer than 90 patients in the hospital per year; there was no age difference in the death rate among those doctors who took care of more than 201 patients per year.
Neither the 30-days readmission rate nor the cost of care was significantly different between the older and younger doctors.
The authors mentioned that patients seen by the older and younger physicians were the same. However, the oldest group of physicians had slightly more patients with congestive heart failure, lung disease, diabetes, neurologic disorders and mental illness. If you combine the higher mortality rate
for all these maladies, that small difference could explain the very slight discrepancy in the death rate seen with the oldest group of doctors.
The physicians caring for the patients in the study were hospitalists; that is, doctors who care predominantly for hospitalized patients. Hospitalist medicine is a relatively new form of practice. The older doctors in the study probably started their careers by working not only in a hospital but also in an outpatient clinic. The younger doctors in the study may have had more specialization in hospital practice and thus better outcomes in that setting. But the older doctors with busy hospital practices have comparable death rates to the younger doctors, so that potential connection isn’t clear-cut.
I wouldn’t make a huge issue regarding a hospital doctor’s age unless that doctor sees relatively few patients in the hospital each year. As my older colleagues taught me when I was starting out, experience counts.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.