23:40 GMT +324 July 2017
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    Study Suggests the Older a Doctor, the Higher the Risk Their Patients Will Die

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    The age of a doctor may impact the quality of the care they offer, and even cut their patients' chances of survival, a team of Harvard researchers have concluded – although they are unclear whether the findings point to genuine differences in abilities based on age or physicians' skills become outdated as medical practices evolve.

    The team looked at data on over 700,000 hospital admissions of patients cared for by nearly 19,000 physicians between 2011 and 2014, analyzing records for 30-day mortality, readmissions and costs of care.

    The findings were stark — for every 77 patients treated by doctors over 60, one less patient would die within 30 days of admission, if treated by a doctor under the age of 40. Patients with doctors under the age of 40 had an average 30-day mortality rate of 10.8 percent — mortality rates inched up to 11.1 percent with doctors aged 40 to 49, then to 11.3 percent with doctors 50 to 59, and 12.1 percent with doctors aged 60 or above. In short, mortality rates crept up in step with a physician's age.

    ​The stats were adjusted for a variety of variables, such as overall hospital mortality rates and severity of patient illnesses.

    However, the study is fundamentally an observational one, noting a correlation — and as correlation does not imply causation, it cannot truly determine whether age is the cause of the different mortality rates. Moreover, while the age-related mortality trend was significant overall, it ceased to assert itself when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.

    To explain the apparent connection, authors say several factors could be at play. For instance, doctors' skills may deteriorate over time — or simply become outdated, and older doctors may be more likely to rely on anecdotal rather than evidence-based practices. The obvious flip-side is younger doctors are freshly trained in the most effective practices. Furthermore, older doctors who see a lot of patients may be forced to keep up with the most up-to-date methods — or indeed attract the most patients because they keep up.

    "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.

    While the authors acknowledge that their study is "exploratory," they stress that health outcomes, like mortality, should be a key driver in the evolution of medicine. The findings, they conclude, "suggest that continuing medical education of physicians could be important and that continual assessment of outcomes might be useful."

    ​Despite these caveats, some may be concerned by the findings — particularly as medicine is an aging profession, as the baby-boom generation has started to reach retirement age. Data indicates the share of physicians who were aged 55 or over in Europe rose from 24 percent to 37 percent between 2004 — 2014. The share of physicians aged 55 or over is within the range of 40-46 percent in Bulgaria, Cyprus, Germany, Hungary, Belgium, Latvia, Estonia and France, peaking at 52 percent in Italy. By contrast, this fell to one fifth in Malta (17 percent) and the United Kingdom (13 percent). Still, in the UK's case, this amounts to 24,023 licensed doctors aged over 50 working in the UK, compared to 18,437 under 40 and 17,819 aged 40 to 49.

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    Tags:
    mortality rates, doctors, healthcare, health, British Medical Journal, Harvard University, United States
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