Safety · Thought Provoking

Physician age affects patient mortality — unless volume is high

Written by Emily Rappleye (Twitter | Google+)  | May 17, 2017 
 Older physicians may increase patient mortality risk, according to a recent study published in The BMJ.

The study sought to determine the effect of a physician’s age on cost, 30-day mortality and 30-day readmission rates. It was based on Medicare fee-for-service data for more than 735,000 hospital admissions between 2011 and 2014 and included more than 18,850 hospitalists. Researchers adjusted for physician and patient characteristics as well as hospital fixed effects, so data essentially compared physicians within the same hospital.

They found 30-day adjusted mortality rate increased with physician age. For physicians below age 40, the mortality rate was 10.8 percent. Physicians over age 60 had a 30-day adjusted mortality rate of 12.1 percent.

The difference in mortality was statistically significant, and the authors suggest it may be clinically significant too. Patients treated by physicians younger than 40 years old are 11 percent less likely to die than those treated by physicians over age 60, according to their findings. The age effect has the same clinical significance as the use of beta blockers to prevent death in heart attack patients, the authors wrote.

However, the risk disappeared with higher patient volume. The researchers found no association between physician age and increased patient mortality rates among physicians who treat more than 200 patient admissions per year.

“[W]e found that the positive association between physician age and patient mortality was driven primarily by physicians treating a low to medium volumes of patients, suggesting that high volumes could be ‘protective’ of clinical skills,” the authors wrote. “The association between practice volume and skills, however, could be bidirectional — physicians whose skills are declining might either self select, or be encouraged by others to leave, positions in which they are responsible for clinical management of large numbers of patients and could, therefore, treat fewer patients over time.”

They also found the cost of care increased slightly with physician age, but determined it was not statistically significant.

Read more here.