You walk into the room, your patient looks at you and says “How old are you anyway?” So much for confidence and credibility when trying to treat them. The older the patient the older they want the doctor to be. After all, the more experience the better the doctor, right? Not necessarily. A study by Harvard researchers found that in this data-driven age, younger doctors have better patient outcomes than older ones do.
The observational study published May 2017 looked at a random sample of hospitalized Medicare patients aged 65 and over. The patients were managed by hospitalists with a mean age of 41. The study’s primary outcome as patients’ 30-day mortality rate and the secondary outcome was 30-day readmission rates and costs of care. The study concluded that patients treated by older physicians “had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.” The study found no association between physician age and the patient 30-day readmission rate.
Here is what appears to be the core issue: As physicians gain more experience, the clinical skills and knowledge they accumulate can improve the quality of patient care. However, those same skills can become outdated, especially today when science, technology and research advance at supersonic speed. As the authors state, “It is possible that physicians further from training are less likely to adhere to evidence-based guidelines, might use newly proved treatments less often, and might more often rely on clinical evidence that is not up to date.”
On the other hand, younger doctors who grew up processing multiple sources of information and recently graduated from medical school are more up-to-date on clinical information, standards of care, treatment pathways, quality measures and best practices in diagnosis, screenings and preventive care.
The authors of the study do admit that there is one more variable at play here, and that is the training of hospitalists. Before formalized training for hospitalists was available, the positions were filled by physicians who began their careers as internists or primary care physicians. They were not specifically trained as hospitalists. Younger physicians begin their careers as hospitalists and are trained specifically as such. The authors state accurately that hospitalist training now includes 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”. That difference in training could significantly impact patient care and outcomes.
The study is an interesting read. One physician wrote about in the New York Times Sunday Review with his own reflections on why, in his experience, the findings are true. Dr. Haider Javed Warraich said that younger doctors are more likely to adopt innovative practices, prescribe newer medications, or learn new medical procedures “such as performing cardiac catheterization from the wrist rather than the groins that are safer for patients”.
He closes by saying, “As a young doctor, I constantly look to my mentors for guidance. Yet, at the same time, I also believe that experienced physicians need to look to younger doctors to bring a fresh perspective to health care’s most vexing questions, like developing new patient-focused models of care, disentangling the role corporate interests play in the development of medical norms and guidelines and incorporating patients’ values in medical treatment.”
We are running out of primary care physicians. The population is aging and retiring out of health care just as they are entering that very same system with increased needs for care. We need young physicians. We also need older patients to accept and respect them. The pendulum is swinging and we need to catch it in the middle so that young physicians can use their knowledge and enthusiasm for science and medicine to the benefit of older patients who need it.
