Physician age and outcomes in elderly patients in hospital in the US
1–10 of 43 posts
Re: Physician age and outcomes in elderly patients in hospital in the US
#2The actual results are not quite as dire as the headline suggests:
"patients’ adjusted 30 day mortality rates were 10.8% for physicians aged "
All of the patients were 65 or older with a medical condition. Perhaps the oldest and sickest are regularly routed to older doctors? As ever, correlation does not imply causation:
Re: Physician age and outcomes in elderly patients in hospital in the US
#3Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions?
(I don't mean to state the obvious but this wasn't made explicitly clear enough to me.)
Edit: My initial comment here is probably wrong based on the detailed section "Adjustment variables":
> Patient characteristics included age in five year increments, sex, race or ethnic group (non-Hispanic white, non-Hispanic black, Hispanic, other), primary diagnosis (diagnosis related group), 27 comorbidities (Elixhauser comorbidity index22), median household income of zip code (in 10ths), an indicator for dual Medicare-Medicaid coverage, day of the week of the admission date (to account for the possibility that severity of illness of patients could be higher on specific days of the week), and year indicators.
Re: Physician age and outcomes in elderly patients in hospital in the US
#4Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions? (I don't mean to state the obvious but this wasn't made explicitly clear enough to me.) Edit: My initial comment here is probably wrong based on the detailed section "Adjustment variables": > Patient characteristics included age in five year increments, sex, race or ethnic group (n…
They do say that they adjust for "patient characteristics", although they don't go into much detail. Also it's important to note that physicians that have a large volume of patients don't have a higher mortality rate on their patients. It looks like a real effect, maybe from "staying behind" or maybe simply not being on the "top of their game".
Re: Physician age and outcomes in elderly patients in hospital in the US
#5The news here (Japan) was talking the other day about cases of TB slipping through diagnosis because younger physicians had no experience with it. Older doctors knew what it was right away.
Re: Physician age and outcomes in elderly patients in hospital in the US
#6Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions? (I don't mean to state the obvious but this wasn't made explicitly clear enough to me.) Edit: My initial comment here is probably wrong based on the detailed section "Adjustment variables": > Patient characteristics included age in five year increments, sex, race or ethnic group (n…
They do say that they adjust for "patient characteristics", although they don't go into much detail. Also it's important to note that physicians that have a large volume of patients don't have a higher mortality rate on their patients. It looks like a real effect, maybe from "staying behind" or maybe simply not being on the "top of their game".
It's difficult to really say for certain what's going on. The adjustments I'm sure are very crude compared to what case assignment decisions are actually based on, for example, so I'm sure they're adjustments wouldn't really account very well for patient illness severity or other subtleties along those lines.
Another possibility is that younger staff are more likely to be questioned about things. "Have you thought about X?" causes them to rethink something and make a revision. If older staff are just assumed to know what they're doing, they might be questioned less.
The fact that differences weren't present among physicians with a large volume also makes me wonder if this is just a fishing expedition that wouldn't replicate. Not to cast aspersions on the authors; just to say that if you slice up any dataset enough you can find something.
Finally, the differences aren't huge...
Re: Physician age and outcomes in elderly patients in hospital in the US
#7The news here (Japan) was talking the other day about cases of TB slipping through diagnosis because younger physicians had no experience with it. Older doctors knew what it was right away.
Older doctors can probably diagnose TB better, but I would wonder if that can be used as a core competency measure of a doctor. Also, I believe there are cases younger doctors diagnose a lesser-known disease when older ones could not.
There can be all different sorts of anecdotes, but the link was about a study with more than 100k doctors, which would be a stronger evidence that the probability of survival is better for patients with younger doctors.
Re: Physician age and outcomes in elderly patients in hospital in the US
#8The title should be "hospital patients treated by low volume physicians are more likely to die". But that would have been less likely to get published. The "high volume" group was also really NOT high volume: 200 patients per year is around 4 patients per week. So the study really tells us about very 'low volume' providers compared to slightly higher volume providers, it's interesting that that was enough to get rid of any age-related effect. That in turn suggests the effect was pretty small.
Similarly, I'm pretty sure that "code written by programmers who don't program often is more likely to have bugs", and "pilots who don't fly often are more likely to crash".
(Strictly speaking, you'd want to normalize the risk of bugs / crashes per some unit of output e.g. per hour flown for pilots.)
Re: Physician age and outcomes in elderly patients in hospital in the US
#9The title should be "hospital patients treated by low volume physicians are more likely to die". But that would have been less likely to get published. The "high volume" group was also really NOT high volume: 200 patients per year is around 4 patients per week. So the study really tells us about very 'low volume' providers compared to slightly higher volume providers, it's interesting that that was enough to get rid…
Older docs don't have to take board exams every ten years. Incoming doctors all have to take board exams every 10 years for the rest of their working life. This may account for why high volume doctors don't have the higher mortality rate even for older physicians. Perhaps the higher volume makes them more likely to be current in their field.
Re: Physician age and outcomes in elderly patients in hospital in the US
#10I always find it concerning when authors dichotomize a variable without an extremely solid basis for doing so. It reduces statistical power, and it hints of over-mining the data to dredge out an effect.
This group of authors is well respected and known for doing studies like this. However, if their chief interest is observing the effect of physician age on patient outcome, physician age should clearly be treated as a continuous or truncated variable here.
Edit: In the supplement [1. Table B], they do perform the calculation with physician age as a continuous variable, and the effect stands. Good on them for doing the math in this way.
1 = http://www.bmj.com/content/bmj/suppl/2017/05/15/bmj.j1797.DC...