Live data from Hacker News

Physician age and outcomes in elderly patients in hospital in the US

bmj.com

31–40 of 43 posts

Re: Physician age and outcomes in elderly patients in hospital in the US

#31
Re: ". Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians."

So it's not just age per se, but age plus lack of case quantity.

Which now raises the questions:

1) How are patients assigned to doctors? Is there something else that effects outcomes?

2) Why are some docs carrying less patients? Is that the cause, and age the correlation?

Re: Physician age and outcomes in elderly patients in hospital in the US

#32
This does not relate to the physician population studied, but I've seen older attendings in certain specialties use political clout to score more exciting rotations in critical care units after rarely practicing while younger attendings who don't often practice generally are forced to maintain a clinic. I would be interested in seeing if that had any general impact in care.

Re: Physician age and outcomes in elderly patients in hospital in the US

#33

I listened to a podcast on this, Freakenomics Radio Bad Medicine Part 3. The takeaway was that newer doctors had better outcomes than older doctors with the exceptions of surgeons. "JENA: Exactly. So patients more or less end up getting quasi-randomized to physicians with different characteristics. So for example if you happen to get hospitalized in the first week of May, you may be treated by a group of doctors who…

In my experience older physicians (internists in American lingo) and pediatricians trump younger ones any day.

At lot of doctors work in teams now. I think this could help to mitigate these issues.

Re: Physician age and outcomes in elderly patients in hospital in the US

#34
A little off-topic, but I get the feeling that these studies won't be so important in the coming decades. AI is going to be better than both young and old doctors when it comes to diagnosis, or recommending drugs and treatments. I've tried to have some discussions about this on Quora and Reddit, but I quickly get shot down by people (sometimes doctors) who refuse to accept this. I think there are even a lot of skeptical people on Hacker News, which I don't understand. It just feels obvious and inevitable.

Re: Physician age and outcomes in elderly patients in hospital in the US

#35

The 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…

> So the study really tells us about very 'low volume' providers compared to slightly higher volume providers

I don't think 'slightly higher' is accurate. The report says, "We classified physicians into thirds of patient volume: low (estimated number of total admissions 201 admissions)". So you have two-thirds of doctors whose median volume is 90 per year, and one third of doctors whose median volume is well above 201 per year. That seems to be a significant difference.

> That in turn suggests the effect was pretty small.

For two-thirds of doctors the effect is: "adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%)...and 12.1% for physicians aged ≥60 (11.6% to 12.5%)". I'd say that's a significant effect - certainly something that should be included in the title.

Re: Physician age and outcomes in elderly patients in hospital in the US

#36
From their conclusions, I wonder if there is some kind of "use-it-or-lose-it" effect going on in the sample of older physicians, which does not affect the sample of younger physicians as severely due to their age. That is, the high volume physicians are kept sharp by the high patient workload regardless of age.

Authors' conclusions reproduced below:

"Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients."

Re: Physician age and outcomes in elderly patients in hospital in the US

#38

The 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…

[deleted]

Re: Physician age and outcomes in elderly patients in hospital in the US

#39

I 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…

great point. they mention the same thing here: Physician age was modeled both as a continuous linear variable and as a categorical variable (in categories of can you explain what it means? Specificially, how does making it categorical allow for it, and keeping it continuous prevent it? Any ideas?

Probably because when treating it as continuous they only look for linear regression.

When categorizing in buckets, they probably do an ANOVA. This technique posits that the average does vary per category exactly as measured, and asks the question: If I tell you the category, how much is the variance of your data reduced? If the variance falls a lot (relatively to what it was), it means there's a statistically significant effect between the category and your variable.

And, in their defense, they can't really go fishing for different continuous relationships once they have the data, as that'd reduce their statistical power.

Of interest too is the number of adjustable parameters of the model:

If instead of four age categories you use, say, four hundred, you end up splitting each doctor into one category. The predictive power of that model is greatest, with very good statistical significance, but you have achieved no insight at all.

Similarly when taking age as continuous; if instead of a straight line you fit a curve with four hundred free parameters, you overfit it to the point of destroying any insight.

So in that sense it's "unfair" that they used four age categories, vs two free parameters of a linear regression. And there would need to be some explanation as to the age ranges they used for each category.

Re: Physician age and outcomes in elderly patients in hospital in the US

#40
post #16

Earlier quoted context omitted.

Funny, this reminded me of my own surgery that had complications. My surgeon said that he has done over 200 similar surgeries and I was his first complication. The first thing that came out of my mouth was no wonder you don't know how to handle complications because you have been running around like a headless chicken. In the end, postop complications were addressed by a surgeon half way around the world than the ope…

> The first thing that came out of my mouth was no wonder you don't know how to handle complications because you have been running around like a headless chicken. I daresay you drew the wrong conclusions from this incident. All things being equal, a doctor with more experience and a lower rate of complications should be your preferred choice for any medical procedure.

"Lower rate of complications" is much better than "ZERO rate of complications". When you had zero problems, you have no experience handling problems. When you had some problems, you know how to handle problems. When you had too many problems, you are careless.
Post reply on HN