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The Older the Doctor, the Higher the Patient Mortality Rate, Study Finds (arstechnica.com)
An anonymous reader quotes a report from Ars Technica: The age of your doctor may impact the quality of the care you receive -- and even cut your chances of survival -- researchers report in the British Medical Journal. Harvard researchers looked over data on more than 700,000 hospital admissions of elderly patients cared for by nearly 19,000 physicians between 2011 and 2014. They found that mortality rates crept up in step with physician age. Patients with doctors under the age of 40 had a 30-day mortality rate of 10.8 percent. With doctors aged 40 to 49, mortality rates inched up to 11.1 percent, then to 11.3 percent with doctors 50 to 59, and 12.1 percent with doctors aged 60 or above. The stats are adjusted for a variety of variables, such as hospital mortality rates and severity of patients' illnesses. All the patients were aged 65 or older and on Medicare. Though the age-related mortality trend was significant overall, it broke down when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.
How do we know that older patients don't just like going to older doctors?
I run a Help Desk. The reps who do the most tickets are not the best. That's because the best reps can fix issues without escalating, but that takes time. Do doctors who take many patients mostly do the easy stuff? Are the doctors who take fewer patients specialists in their field, or handling more difficult cases that take more attention per patient?
Does seniority mean they take more difficult cases? Does seniority mean they care less about their malpractice insurance (because they are more secure financially)? Does seniority change which patients seek you out?
There are so many potential confounding reasons for this correlation that do not depend on the doctor being less capable or providing worse care in some manner. I'm not saying that there is no cause for concern... I'm saying that the study has potential confounds that its statistical groupings did not eliminate.
"I will trust Google to 'do no evil' until the founders no longer run it." Hello Alphabet.
Which Doctor though? Did they say it mattered in terms of total age, or solely the age of that particular incarnation of the Doctor?
You seem to presuppose that a longer time between admission and death is necessarily a good thing, and that doctors who don't score high on that has "lost ther edge".
I'm not sure your premise is correct. A doctor who resorts to induced coma will score very well for that premise, but that does not mean he's a good doctor. A doctor that can't explain that a person is brain dead and that life support should end is not doing a good job either. And a doctor who prescribes expensive treatments that patients and families can ill afford, while it only prolongs life in agony is IMHO a worse doctor than one who sees where palliative care is a better solution.
Doctors over 60 are disproportionately male. The gender ratio for young doctors is relatively balanced.
It has been shown that female doctors have slightly better statistics for outcomes than male doctors.
http://jamanetwork.com/journal...
The JAMA study uses the same patient group as the old-vs-young study, that is hospitalized Medicare patients.
And they both looked at performance of hospitalists.
As near as I can tell, the gender ratio for hospitalists is more balanced than the all-doctors gender ratio, but I can't easily find numbers of age vs sex for hospitalists.
Another factor might be that hospitalists can migrate to be a specialist (waaaay more money), but that's not an option if you're not a very good hospitalist, so perhaps the old ones are a combination of dedicated hospitalists (the ones with large patient loads and good outcomes), and the ones that didn't advance (who may be just marking time).
So, I got curious and looked at both studies (but only the abstract for the JAMA). The difference in outcome between male and female hospitalists is smaller than the difference between young and the over 60 year old doctors. If I read correctly, the female vs male patient death difference was 11.07% vs 11.49%, but the young vs old was 10.8% vs 12.1%.
So it appears that age is a much greater factor than sex.
The older the doctor the more specialized they are and the more complicated the patient they receive.... because the easy patients are treated by the junior doctors.
Seven puppies were harmed during the making of this post.
... the study says in its very own conclusions:
Patients in hospital treated by older hospitalists have higher mortality than patients cared for by younger hospitalists, except for hospitalist physicians with high volumes of patients.
In other words: It's not the age, it's caseload.
In surgery, high volume has often been associated with better outcomes. The Veterans Affairs system studied outcomes in all their hospitals for colon cancer. They found that the best results were in hospitals with higher volume, and doctors with higher volume (as I recall from the article). One of the factors associated with better surgical outcomes is having teams regularly working together. It was a convincing study because for everything they found, you could understand why it would affect quality. (I.e., no black boxes.)
There is a debate in surgery about whether we should limit surgery to high-volume hospitals. Interestingly, there were a few small VA hospitals that were "islands of excellence," with good outcomes even though they were small. So there's no substitute for empirical data.
Of course the main factor that affects outcomes is the patient's "fitness for surgery." There are better outcomes with better cardiovascular, lung and kidney function. A good proxy for that is the patient's age. A British doctor told me, "I could very easily get better outcomes. Just operate on healthier patients." Conversely, in the U.S., a lot of surgeons get good results because they operate on patients who are actually healthy and don't need surgery in the first place. Some studies of surgery like coronary bypass or endarterectomies find that 30% of cases don't meet the guidelines for surgery.
Notice that the colon cancer study I read was by the VA. Contrary to what the Koch brothers are trying to get you to believe, the VA system actually has very good outcomes. They're about as good as the best hospitals in their area, and better than the mediocre ones. When the Koch brothers tried to sell the traditional veterans' organizations on privatization, the organizations knew how good the VA hospitals were, and wouldn't buy it. The Koch brothers had to create their own astroturf veterans' organization to testify before congress.
My guess is that older doctors with a larger caseload is a sign that they enjoy their job and are staying current in medicine and engaged with their patients. Those with a lower caseload are burned out and getting ready to retire.
That's your guess. Mine is that older doctors with a larger caseload have less time to talk to each patient, and will more likely go for the standard life-prolonging treatments by default.
We could both be right or both be wrong, of course.