It may seem intuitive that the longer a physician has been practicing, the better they would be at their job. But a new study published in The BMJ casts doubt on that assumption, finding that physicians aged 60 or older see a higher mortality rate among their patients -- a slightly higher rate, but one that's clinically significant.
Using nationally representative data on Medicare beneficiaries admitted to a hospital with a medical condition between 2011-2014, the study found that patients treated by physicians aged 40 and younger had an 11 percent lower probability of dying compared to patients treated by a physician aged 60 or older.
To put that into perspective, that's about the same impact on mortality as statins for the primary prevention of cardiovascular death, or beta blockers for myocardial infarction.
At first glance, the prognosis for older physicians seems bleak. The report found that they often have decreased clinical knowledge, adhere less often to standards of appropriate treatment and perform worse on measures of quality with respect to diagnosis, screening and preventative care.
Age may not be the primary cause of this discrepancy in mortality, as numbers point to patient volume as potentially causational. Older physicians with a high volume of patients didn't show any statistically significant difference when it came to their patients' mortality rates. The discrepancy occurred in older physicians with low and medium volumes of patients, suggesting that it may be the amount of practice an older physician has sustained, rather than just their age, that makes the difference, the study said.
It's possible, the authors said, that physicians further removed from training are less likely to adhere to evidence-based guidelines, might use newly-proven treatments less often, and might occasionally lean on clinical evidence that's not up-to-date.
Moreover, while intense exposure to a large number of patients during residency training might enable younger physicians to provide high-quality care, the benefits of this training experience could wane if physicians care for fewer inpatients after residency.
The study notes that hospital medicine is among the most rapidly evolving specialties within the broader practice of medicine. There are dramatic changes in training among 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.
The authors caution that the findings should be considered exploratory, but say that the gap could be bridged by continuing education and more frequent re-training or certification.