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Death Rates Higher When Older Hospitalists Provide Care

CAMBRIDGE, MA — Patients treated by older hospitalists are more likely to die within a month after inpatient admission than those seen by younger physicians — but only when patient loads were lower, according to a new report.

The study, published in BMJ, determined the biggest disparity between hospitalists older than 60 and those younger than 40.

Researchers from Harvard Medical School and Harvard T.H. Chan School of Public Health pointed out that, while the difference in death rates was small — 10.8% for patients treated by younger physicians vs. 12.1% in those cared for by older ones — it was of clinical significance. They calculate that one additional patient death occurs, on average, for every 77 patients treated by over-60 doctors compared to the younger cohort.

“This difference is not merely statistically significant, but clinically important — it is comparable to the difference in death rates observed between patients at high risk for heart disease who are treated with proper heart medications, and those who receive none,” suggested senior investigator Anupam Jena, MD, PhD, the Ruth L. Newhouse associate professor of Health Care Policy at Harvard Medical School and an internal medicine physician at Massachusetts General Hospital.

However, no differences were detected when older physicians were managing large numbers of patients.

“Residency training sharpens the clinical skills of newly minted physicians because it exposes them to a great number of cases, but as physicians get farther away from residency their clinical skill may begin to decline somewhat,” explained first author Yusuke Tsugawa, MD, PhD, MPH, a researcher in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health. “Our observation that physicians’ age is inconsequential so long as they treat a high volume of patients supports that notion.”

As for physicians in their 40s and 50s, death rates were not much different than for younger clinicians — 11.1% and 11.3%, respectively.

The study team reviewed 30,000 hospital admission records of Medicare patients, ages 65 and older, treated between 2011 and 2014 by more than 18,800 hospitalists.

Cautioning that their study was observational, researchers urged more investigation to improve understanding of the factors contributing to the higher mortality seen among patients treated by older physicians.

“Older physicians bring invaluable richness of knowledge and depth of experience, yet their clinical skills may begin to lag behind over time,” Jena said. “The results of our study suggest the critical importance of continuing medical education throughout a doctor’s entire career, regardless of age and experience.”