Patients of older physicians have a higher 30-day mortality rate than those treated by younger physicians—unless the older physician has high patient volumes, according to an "exploratory" new study in BMJ.  

As people live longer, meet your new Medicare patient

Methods

For the study, researchers at Harvard T.H. Chan School of Public Health assessed the 30-day mortality rate of Medicare beneficiaries receiving inpatient care at about 737,000 acute-care hospitals between 2011 and 2014.

The study examined 18,854 hospitalists who had an average age of 41. When broken down by age group:

• About 10,000 physicians were younger than 40 years old;
• About 8,000 physicians were ages 40-49;
• About 3,000 physicians were ages 50-59; and
• About 1,000 physicians were ages 60 and older.

Findings

After controlling for physician characteristics, patient characteristics, and hospital-specific fixed effects, the researchers found that the overall 30-day mortality rate was 11.1 percent—but the rate varied with physician age. Specifically, the mortality rate for patients treated by:

Geriatrics implementation strategy guide

• Physicians under age 40 was 10.8 percent;
• Physicians between ages 40 and 49 was 11.1 percent;
• Physicians between ages 50 and 59 was 11.3 percent; and
• Physicians age 60 and older was 12.1 percent.

However, the researchers also found that there was no age-related difference in the mortality rate for older physicians who treated high volumes of patients (defined as 200 or more per year). In addition, the researchers found no difference across doctor age groups for 30-day readmission rates, which were about 15 percent across the board.  

The researchers also found a significant but small increase in Medicare Part B spending by physician age, with each decade of age correlating to a cost increase of 2.4 percent.

Discussion

Yusuke Tsugawa—the study's lead author and a research associate at Harvard T.H. Chan School of Public Health—and colleagues emphasized that the findings were "exploratory." If confirmed, however, they would suggest that for every 77 patients treated by a physician aged 60 years or older who maintains a low patient volume, one fewer patient would die if treated by a physician younger than 40.

In other words, a patient treated by a physician age 40 or younger would have an 11 percent lower probability of dying than a patient treated at the same hospital by a low-patient-volume physician age 60 or older, if controlling for all other factors, Tsugawa said.

The researchers hypothesized that while "clinical skills and knowledge accumulated by more experienced physicians could lead to improved quality of care," it's possible that "physicians' skills might become outdated as scientific knowledge, technology, and clinical guidelines change."

Linda Aiken, the director of the University of Pennsylvania's Center for Health Outcomes and Policy Research, co-authored a related editorial that called the study a "fresh and informative look at the association between physician age and patient outcomes." In the editorial, Aiken wrote that the study, in her opinion, suggests a need to reevaluate requirements for continuing physician education and establish interventions for improvement.

But Tsugawa cautioned that the study doesn't mean patients should look for younger doctors. "There are many other factors patients should take into account when selecting their doctors that may be more important than their age," he said (Swift, Medscape, 5/16; Tsugawa et. al, BMJ, 5/16; Aiken et. al, BMJ, 5/16; Mozes, U.S. News & World Report, 5/16).

As people live longer, meet your new Medicare patient

From 2011 to 2030, an average of 10,000 baby boomers will age into Medicare each day. With this shift, Medicare patients will comprise more than half of inpatient volumes and be the primary source of volume growth.

Your new Medicare patients approach health care decisions differently—which means you have to approach them differently. Read the five distinctions that matter most.

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