Comparing younger doctors with older practitioners
Q: 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?
A: I was fortunate when I started my practice in internal medicine to be surrounded by seasoned, experienced doctors.
After I saw patients, the medical questions abounded in my mind. Did I make the right decision about a complicated case? Was this the correct medication for this patient's illness? What lab tests should I order? Should I do an imaging study?
I brought my uncertainties to these older doctors, and they gave me sage advice in return.
The study to which you're referring was published recently in the British Medical Journal. The authors analyzed data on Medicare patients over 65 who were hospitalized between Jan. 1, 2011, and Dec. 31, 2014.
The physicians caring for them were hospitalists; that is, doctors who care predominantly for hospitalized patients. The authors divided these physicians into four age groups and studied the mortality rates of their patients in the first 30 days after hospital admission. They also assessed the cost of care and whether patients were readmitted after discharge.
The youngest group of physicians had an average age of 35. The oldest group of physicians had an average age of about 64. The study included 10,177 physicians younger than 40, and 1,086 older than 65.
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.
Also, consider that 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.
In any case, this study was conducted among in-hospital physicians, so the findings wouldn't apply to doctors who practice in an outpatient setting.
Overall, 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, experience counts.
• Dr. Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles. Send your questions to askthedoctors@mednet.ucla.edu.