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Physician age and outcomes in elderly patients in hospital in the US: observational study

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017) Cite this as: BMJ 2017;357:j1797
  1. Yusuke Tsugawa, research associate1 2,
  2. Joseph P Newhouse, John D MacArthur professor1 3 4 5,
  3. Alan M Zaslavsky, professor3,
  4. Daniel M Blumenthal, fellow6,
  5. Anupam B Jena, Ruth L Newhouse associate professor3 5 7
  1. 1Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
  2. 2Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
  3. 3Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
  4. 4Harvard Kennedy School, Cambridge, MA, USA
  5. 5National Bureau of Economic Research, Cambridge, MA, USA
  6. 6Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
  7. 7Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
  1. Correspondence to: Y Tsugawa, Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, 42 Church Street, Cambridge, MA 02138, USA ytsugawa{at}hsph.harvard.edu

Abstract

Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.

Design Observational study.

Setting US acute care hospitals.

Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists.

Main outcome measures 30 day mortality and readmissions and costs of care.

Results 736 537 admissions managed by 18 854 hospitalist physicians (median age 41) were included. Patients’ characteristics were similar across physician ages. After adjustment for characteristics of patients and physicians and hospital fixed effects (effectively comparing physicians within the same hospital), patients’ adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%), 11.1% for physicians aged 40-49 (11.0% to 11.3%), 11.3% for physicians aged 50-59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60 (11.6% to 12.5%). Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Readmissions did not vary with physician age, while costs of care were slightly higher among older physicians. Similar patterns were observed among general internists and in several sensitivity analyses.

Conclusions Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.

Footnotes

  • Contributors: All authors contributed to the design and conduct of the study, data collection and management, analysis interpretation of the data; and preparation, review, or approval of the manuscript. ABJ supervised the study and is guarantor.

  • Funding: YT is supported in part by the Abe Fellowship (Social Science Research Council and the Japan Foundation Center for Global Partnership). ABJ is supported by the Office of the Director, National Institutes of Health (NIH Early Independence Award, grant 1DP5OD017897-01). The research conducted was independent of any involvement from the sponsors of the study. Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: ABJ has received consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry. JPN is a director of Aetna and has received consulting fees from EMD Serono; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the institutional review board at Harvard Medical School.

  • Data sharing: No additional data available.

  • Transparency statement: The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies are disclosed.

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