Choosing Doctors: Older vs Younger: Who Will Treat You Better?
If you have the chance to pick your own doctor and not many of us have such a chance in this HMO world, who would you pick to manage your health? Who would treat you better, an older doctor or the younger one who is a few years out from final training? And what does “treat” mean? Does that mean more humanistic and sensitive to your concerns or does that mean able to make the diagnosis and begin the treatment more promptly and effectively---or both? Does the additional years of experience which the older doctor includes in his or her medical armamentarium make up for any of the more recent formal medical education which the younger doctor carries?
Researchers have studied this issue and a summary review of the studies was published in the Annals of Internal Medicine 15 February 2005 Volume 142 Issue 4 Pages 260-273. The article titled “Systematic Review: The Relationship between Clinical Experience and Quality of Health Care” by Niteesh K. Choudhry, MD; Robert H. Fletcher, MD, MSc; and Stephen B. Soumerai, ScD. Go to the above link to read the full article, however here is the abstract:
Background: Physicians with more experience are generally believed to have accumulated knowledge and skills during years in practice and therefore to deliver high-quality care. However, evidence suggests that there is an inverse relationship between the number of years that a physician has been in practice and the quality of care that the physician provides.
Purpose: To systematically review studies relating medical knowledge and health care quality to years in practice and physician age.
Data Sources: English-language articles in MEDLINE from 1966 to June 2004 and reference lists of retrieved articles.
Study Selection: Studies that provided empirical results about knowledge or a quality-of-care outcome and included years since graduation or physician age as explanatory variables.
Data Extraction: We categorized studies on the basis of the nature of the association between years in practice or age and performance.
Data Synthesis: Overall, 32 of the 62 (52%) evaluations reported decreasing performance with increasing years in practice for all outcomes assessed; 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association for others; 2 (3%) reported that performance initially increased with increasing experience, peaked, and then decreased (concave relationship); 13 (21%) reported no association; 1 (2%) reported increasing performance with increasing years in practice for some outcomes but no association for others; and 1 (2%) reported increasing performance with increasing years in practice for all outcomes. Results did not change substantially when the analysis was restricted to studies that used the most objective outcome measures.
Limitations: Because of the lack of reliable search terms for physician experience, reports that provided relevant data may have been missed.
Conclusions: Physicians who have been in practice longer may be at risk for providing lower-quality care. Therefore, this subgroup of physicians may need quality improvement interventions.
Worrisome is the following extract from the full article:
Seven studies present data on the relationship between number of years in practice and actual health outcomes. The strongest of these was conducted by Norcini and colleagues, who analyzed mortality for 39 007 hospitalized patients with acute myocardial infarction managed by 4546 cardiologists, internists, and family practitioners. After controlling for a patient's probability of death, hospital location and practice environment, physician specialty, board certification, and the volume of patients seen, these researchers observed a 0.5% (SE, 0.27%) increase in mortality for every year since the treating physician had graduated from medical school.
So there you are with either taking what you get or having a chance to choose. And if you had that chance to choose, what criteria, to you, would be most important? Would the doctor’s age be most important or if not, what? Write about your own experiences in this regard but please don’t name names. ..Maurice.
Graphic: Classic illustrations of physicians, cropped by me for this thread.