Are older doctors wiser? Not necessarily
Key Takeaways
Limited research shows that younger physicians are more inclined to meet certain key competencies, such as evidence-based practice, compared with older doctors.
One study found that patient mortality rates increase with the physician's age: 10.8% for physicians aged <40 years, 11.1% for those 40-49 years, 11.3% for those 50-59 years, and 12.1% for physicians ≥60 years.
Higher patient volumes and maintenance of certification may mitigate any age-related differences in care.
Age and wisdom are often conflated. But, in the evidence-driven environment of modern healthcare, this relationship may not always hold. Indeed, the data on associations between age and clinical practice outcomes are limited. Nevertheless, a literature review reveals some interesting findings.
Research on patient outcomes per physician age
In a cross-sectional study, investigators hailing from the University of North Florida compared how younger physicians, specialists, and other HCPs employed core competencies vs older colleagues.[]
They found that younger HCPs were more likely to use key competencies, including evidence-based practice, health informatics, and quality improvement.
They also found that evidence-based practice was positively associated with quality improvement, thus indicating that a “focus on job performance has a stronger outcome for overall patient experience.” The most commonly employed competencies were patient-centered care and working in interdisciplinary teams.
“The current practice setting has strong demands for interprofessional teamwork, and health policies at the state and federal level have pushed for patient-centered care. This means that both patient-centered care and interdisciplinary teamwork are important for health professionals in their daily work and provide substantial benefit,” the authors wrote.
In another study, conducted by Harvard researchers and published in BMJ, patient mortality rates broken down by hospitalist age were determined based on a 20% random sampling of Medicare fee-for-service beneficiaries aged 65 years or older.[]
After considering potential confounders, the researchers found that the adjusted 30-day mortality rates were progressively higher as the physician’s age increased: 10.8% for physicians aged <40 years, 11.1% for those 40-49 years, 11.3% for those 50-59 years, and 12.1% for physicians ≥60 years.
This difference was not present among physicians with high patient volumes, nor did readmissions vary by the practitioner’s age. Costs of care were slightly higher among older docs. As well, similar patterns were noted among general internists.
Possible explanations
The Harvard researchers hypothesized that the results in their study regarding mortality could be secondary to either “age effects” or “cohort effects.”
Age effects can occur when physicians further distanced from residency training become less aware of, and less likely to adhere to, evidence-based guidelines, and less likely to use new treatments.
During residency, physicians are intensely exposed to a high volume of patients, and this close association may facilitate higher quality care. However, these benefits may flag during subsequent years of practice. Supporting this hypothesis is the finding that physicians at any age who serve a high patient census demonstrated similar mortality rates among patients.
As for the “cohort effects” hypothesis, hospital medicine is a rapidly evolving specialty, with younger cohorts more likely to be trained in a multi-professional team-based tradition as hospitalists. These physicians may be better instructed on adhering to clinical guidelines, they may be more familiar with shift work and patient handoffs, and they may be better versed in hospital safety. Before hospital medicine was established as a separate specialty in the 1990s, the earlier hospitalists had previously trained as PCPs.
"Thus, cohort differences in physician training, as well as declines in skill with aging, could explain our findings."
— Authors, BMJ
“Under this hypothesis, the cohort of physicians entering hospital medicine today might experience no reduction in patient outcomes with aging or possibly improved outcomes,” the authors continued.
“Although our study did not analyze the effects of current such policies in the US, it suggests that continuing medical education of physicians could be important and that continual assessment of outcomes might be useful,” they wrote.
The researchers also noted that quality-of-care initiatives have typically focused on system-level measures, but there is an increasing emphasis on the role of individual physicians in influencing costs and quality of care.
However, they said that these findings are merely exploratory and in no way can be used to expand or limit the roles of younger or older physicians, respectively.
Contributions of more-established physicians
The pandemic saw unprecedented numbers of physicians emerging from retirement to shore up access to high-quality care. In a 2023 AMA Update, former AMA President Gerald Harmon, MD, highlights the valuable perspective offered by physicians who have decades of experience under their belt.[]
“We have, despite all the efforts at providing health care to the underserved, marginalized communities, economically disadvantaged communities, there are opportunities to share your learned experiences and your breadth and depth of knowledge with folks that are not able to pay for it," Dr. Harmon said. "So volunteer. It's very rewarding. It serves an incredible amount of value to the state, community and the nation. All kinds of opportunities exist. Be a volunteer lecturer, perhaps. Any manner of opportunities to tell the world and train new doctors and other doctors in your lived experiences."
Dr. Harmon also recommended that older physicians who may be concerned about their capabilities speak with a colleague.They should not be afraid to consult and ask advice about new skill sets and procedural knowledge, or even cut back on work hours.
What this means for you
Due to staffing shortages, some retired physicians rejoined the workforce following unprecedented demand due to the pandemic. While physicians with decades of experience offer invaluable perspective to the practice of medicine, some studies show that younger physicians are more likely to meet certain key competencies compared with older physicians, partially due to their proximity to residency and training, which can result in better patient outcomes.