OT? Younger vs. older doctors

Do Younger or Older Doctors Get Better Results?

A physician’s effectiveness has less to do with age than with how many patients they see and how well they keep up to date on new research.

By Anupam B. Jena and Christopher Worsham, The Wall Street Journal, July 8, 2023

n a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems…

Using data from Medicare on patients over age 65 and a database containing doctors’ ages, we identified about 737,000 non-elective hospitalizations managed by about 19,000 different hospitalists from 2011-13. We divided patients into four different groups based on the age of the doctor who treated them: doctors aged less than 40, 40-49, 50-59, and 60 and above…

The next step was to compare 30-day mortality rates between the four age different groups. Our statistical model found that as doctors got older, their patients had higher mortality rates. The rate for under-40 doctors was 10.8%, increasing to 11.1% in the 40-49 group, 11.3% in the 50-59 group, and 12.1% in the over-60 group… We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers…

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers…

We found that for “low volume” doctors, older doctors had higher mortality. For “medium volume” doctors, the pattern was less pronounced. And for “high-volume” doctors, the pattern went away altogether. In practical terms, as long as a doctor is seeing a sufficiently large number of patients, the doctor’s age is irrelevant to the care they give

A separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age. … The results showed that unlike hospitalists, surgeons got better with age. …[end quote]

Bottom line: The most relevant question for any doctor or surgeon is, “Do you have a lot of experience caring for patients in my situation?” The surgeons I chose for my hysterectomy and bilateral mastectomy both answered, “Over 10 years of experience, hundreds of similar surgeries.” (These were specialist women’s health practices in Seattle, 2.5 hours away from home.)



Well, one reason younger doctors might have better outcomes than their more senior peers is that the more senior/more experienced guys have the tougher cases referred to them.

When dh had his aortic aneurysm start to dissect he was admitted to our local hospital with a good reputation (part of the hospital group he worked for at the time) Cardiothoracic surgeon was a peppy young thing…probably a few years out of his fellowship with a lovely bedside manner. Reassured my husband (or so he thought) that “he hadn’t had a problem yet” A huge Red Flag for anyone somewhat in the know. Long story short, he arranged a transfer for the University hospital…where, next day, the reassurances came by way of a statement that the whole team was so experienced that there wasn’t a problem they hadn’t encountered and handled smoothly


Do you see the glaring problem with the patient sample?

The older a doctor is often the older the patient load is. Patients stay with their doctors.

A 40 year old doctor is seeing a 65 y/o patient as the person retires and leaves his or her employer insurance coverage. Medicare is taken more widely. While doctors might not take Medicare the more common part of it is how many Medicare patients a doctor will see.

The doctor-patient relationship in a standard medical practice (where patients stay with their doctors…if they ever do these days) isn’t what’s under review in this essay…but rather the outcomes of Medicare beneficiaries who were admitted to hospital and treated by hospitalists for non elective procedures. I think this patient demographic was chosen simply because of the ease of getting the statistics for review than anything else.

I think this is the study that one of the authors must’ve been referring to. Per the opening paragraph, the setting is in US acute care hospitals.


Yes. That was the study quoted. Being the BMJ and this is open access, the responses are available for reading also.

I think the rationale for this essay (since it’s obviously not a press release from time of publication) has more to do with promoting the authors’ new book than the merits of the original paper. Book promotion rather than science by press release.


I guess i need to put a finer point on this.

An older doctor has older patients on average. This means the mortality rate should shift higher. As younger doctor would have younger seniors in his or her care on average and the mortality rate would shift a bit downwards. Now this does not have to be true for each and every doctor but on the whole would hold some water. The differences in mortality rates in the study would be explained.