Are Older Doctors Better than Younger Ones? (Yes, and No)

Many professions require lifelong learning to stay up to speed. At the same time, work experience is a valuable part of lifelong learning. I have heard middle-age tech workers complain of ageism, claiming they are laid off ahead of younger colleagues due to their age and higher pay. Likewise, I’ve heard older tech workers say it’s harder to get a new job due to ageism. I have also heard young tech workers claim their older colleagues don’t keep up with advancing technology, often specializing in older programming languages that are falling out of favor (COBOL anyone, how about Pascal or Fortran?). It’s not just computer languages that change over time, it’s also true of medicine.

The Wall Street Journal ran an article questioning whether older physicians get worse results than younger ones.

Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

Older doctors obviously had more years of experience since completing residency, with doctors under 40 having an average of 4.9 post-residency years of experience, increasing to 28.6 years for doctors over 60. Older doctors were also more likely to be male: 61% of doctors under 40 were men, compared to 84% of doctors over 60, reflecting the shift in gender makeup that has occurred in our profession in recent decades.

The study looked at hospitalists, internal medicine physicians who work in hospitals and treat hospitalized patients. The research found that patient mortality is related to physicians’ age.

Some percentage of hospitalized patients will survive or die no matter who their doctor is, but for others, their doctor’s clinical judgment, decision-making, and technical skill could be the difference between life and death.

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.

What may be the cause of this difference in mortality? Are older doctors over-confident? Do younger doctors question their own skill and seek advice from other physicians or search the recent literature? Do older physicians begin to coast a decade or so before retirement?

There are two possible explanations. The first is that there is a true age effect, wherein simply being older leads to changes in how a doctor practices, resulting in higher mortality. Perhaps older doctors are overly confident in their experience, feeling they have “seen a case like this a million times,” and thus miss tricky diagnoses.

The other, which we think is more likely, is that there are things that older doctors and younger doctors do differently simply because they were trained at different times. 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.

Experience matters, taking care of patients with different diagnoses hundreds of times over decades reduces mortality.

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.

Some tasks, such as surgery, benefit from experience. Researchers found a modest reduction in mortality that correlated with the surgeons age. Also important is keeping up with newer drugs and procedures, something older docs may or may not do.

Do older physicians coast the last few years until retirement? It all depends on the physician. Numerous studies have found that repetition and high volume is associated with better outcomes. Perhaps doctors in high volume practices also spend off-hours reading about new procedures and drugs. Or maybe they teach younger colleagues what they know and younger colleagues teach them resent discoveries. The differences appear too modest to automatically seek out younger or older physicians, although there are some areas of medicine where it may pay to do so.