RESEARCH - Older Doctors Not Always Better

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Older Doctors Not Always Better

Practice Doesn't Necessarily Make Perfect, Harvard Study Shows

By Miranda Hitti

WebMD Medical News

Reviewed By Brunilda Nazario, MD

Feb. 14, 2005 -- Older doctors aren't necessarily better, new research

shows.

" Physicians who have been in practice longer may be at risk for providing

lower-quality care, " write researchers including Harvard Medical School's

Niteesh Choudhry, MD, in the Feb. 15 edition of ls of Internal Medicine.

" This subgroup of physicians may need quality improvement interventions. "

The finding is a " wake-up call to the medical profession, " write

Weinberger, MD, and colleagues in a journal editorial. Weinberger is with

the American College of Physicians.

" Practice does not make perfect, but it must be accompanied by an ongoing

active effort to maintain competence and quality of care, " says the

editorial.

Choudhry and colleagues reached that conclusion after reviewing 62 studies

on doctors' performance. The studies looked at a physician's age and

experience, which often went hand in hand.

Overall, more than half (52%) of the studies reported that doctors'

performance declined with increasing years in practice for all categories

examined. Doctors' performance was based on how well doctors stuck to

medical care guidelines as well as patient outcomes, such as death rates.

Conclusions varied somewhat. Thirteen studies -- 21% -- showed that doctors'

performance decreased over time in some, but not all, areas. Another 21%

found no link between doctors' performance and length of time in practice.

Finally, 3% of the studies showed that doctors' performance first increased,

then peaked, and eventually declined over time.

Older Doctors Keeping Pace?

The findings indicate " physicians who have been in practice for more years

and older physicians possess less factual knowledge, are less likely to

adhere to appropriate standards of care, and may also have poorer patient

outcomes, " write the researchers.

" Our results are troubling, " they write. Part of the challenge may be

keeping up with medical advancements. Many experienced doctors are exempt

from recertification requirements, and lectures and printed materials don't

always fill in the gaps, say the researchers.

Perhaps doctors' " tool kits " -- their core knowledge and techniques -- " are

created during training and may not be updated regularly, " write Choudhry

and colleagues. That could make it hard to accommodate new information and

approaches.

Open-Minded or Set in Their Ways?

" Older physicians seem less likely to adopt newly proven therapies, and may

be less receptive to new standards of care, " write the researchers. When

major changes arise -- like using less aggressive surgery for early stage

breast cancer -- long-time doctors may find it harder to discard their old

practices.

The researchers don't discount experience. " Older physicians may be more

effective at delivering the humanistic, rather than the technical, aspects

of medical care, " they write, noting that some studies have shown greater

patient satisfaction with older doctors.

Experienced doctors might also have better clinical judgment, providing

better care in complex cases or doing a better job of diagnosing problems,

but those outcomes haven't been rigorously studied, say the researchers.

Ideally, doctors' performance would be tracked over a long time in one group

of MDs, but that's not practical, say the researchers. They call for more

work on the topic and added attention to older doctors who may need to

upgrade their skills.

SOURCES: Choudhry, N. ls of Internal Medicine, Feb. 15, 2005; vol 142:

pp 260-273. Weinberger, S., ls of Internal Medicine, Feb. 15, 2005; vol

142: pp 302-303. News release, Harvard Medical School.

http://my.webmd.com/content/article/100/105846.htm

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org