May 26, 2017

High mortality rate seen in patients with older doctors

18 May 2017, 08:10 | Winifred Adams

GETTYGender issue A previous study found female doctors provided better care

GETTYGender issue A previous study found female doctors provided better care

A 2014 census of registered physicians found that 26.3 percent of doctors in the USA are 60 years or older, with nine percent of those over 70 - the study's data graph ends at 70 years old and has a mortality rate slightly below 13.5 percent.

The team looked at data on over 700,000 hospital admissions of patients cared for by almost 19,000 physicians between 2011 and 2014, analyzing records for 30-day mortality, readmissions and costs of care. "And above 60 years old, every 10 years of increase in physician age was associated with around a 20 percent increase in patient mortality", Tsugawa says. Mortality rates for inpatients within a month of admission were 12.1% compared to 10.8%, which accounted for one additional patient death per 77 treated for the older docs.

Among physicians with a high volume of patients, however, there was no associationbetween physician age and patient mortality, suggesting that high volumes could be "protective" of clinical skills, say the authors. "Our observation that physicians' age is inconsequential so long as they treat a high volume of patients supports that notion". Conversely, age made no difference in mortality outcomes for doctors who managed large numbers of patients.

The researchers stress that this study is purely observational and that it doesn't prove a cause and effect relationship between physician age and patient outcomes. Moreover, while the age-related mortality trend was significant overall, it ceased to assert itself when researchers sorted doctors by caseloads.

The findings, published May 16 in BMJ, reveal the largest gap in patient mortality-1.3 percentage points-between hospitalists 40 and younger and those 60 and older. However, patient death rates crept up at a regular pace as physicians got older. Additionally, the analysis focused on one subspecialty-hospitalists-and the findings may not apply to other specialists.

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"Hospital medicine is among the most rapidly evolving specialties within medicine, with dramatic changes in the training of recent cohorts of physicians who now work as hospitalists, including greater emphasis on multi-professional team based practice, adherence to clinical guidelines, training on patient handoffs, familiarity with shift work during residency training, and an improved hospital safety culture", said lead researcher Dr. Yusuke Tsugawa.

"Older physicians bring invaluable richness of knowledge and depth of experience, yet their clinical skills may begin to lag behind over time", said study co-author, Professor Anupam Jena.

Linda Aiken, director of the University of Pennsylvania's Center for Health Outcomes and Policy Research, noted in an accompanying journal editorial that "patients should be more-informed consumers in selecting a hospital" rather than a specific doctor. Conversely, they may get more patients because they keep up.

Researchers do, however, suggest that findings should not deter people from seeing old physicians.

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