I ran across a recently published web article that originated from the Wall Street Journal (WSJ), to which I don’t have access because I’m not a subscriber. The title is “Do Younger or Older Doctors Get Better Results?” and it’s in the form of an essay by Pete Ryan.
It’s been picked up by over 130 news outlets and is actually based on an open access study published in the British Medical Journal (BMJ) in 2017, (BMJ 2017;357:j1797): Tsugawa Y, Newhouse J P, Zaslavsky A M, Blumenthal D M, Jena A B. Physician age and outcomes in elderly patients in hospital in the US: observational study BMJ 2017; 357:j1797 doi:10.1136/bmj. j1797.
I had a quick look at the rapid response comments. A couple resonated with me. One was from a retired person:
“I did not see specific patient age statistics vs physician age groupings. Wouldn’t older patients, whose risk of dying soon was higher, want to see their own older doctors? Lots of uncontrolled variables in this study… I also agree with one of the other comments that a patient who knew the end of their life was near would seek care from an older physician that would tend to be more empathetic with a patient of their own age.”
Another was from an emergency room physician, Dr. Cloyd B. Gatrell, who entered the comment on June 8, 2017. Part of it echoed my sentiments exactly:
“The authors’ own statements call their conclusion into question: “Our findings might just as likely reflect cohort effects rather than declining clinical performance associated with greater age….”
I suspect most of the web articles spawned by the study didn’t really talk about the study itself. They probably were mainly about your attitude if the doctor who entered the exam room had gray hair or not.
The study involved internal medicine hospitalists and measured mortality rates comparing physicians were in different age ranges from less than 40 years to over 60.
It got me wondering if you could do a similar study of younger and older psychiatrists. Maybe something like it has been done. I’m not sure what an appropriate outcome measure might be. If you focus on bad outcomes, completed suicides are probably too rare and can involve psychiatrists of any age. The quote that comes to mind:
“There are two kinds of psychiatrists—those who have had a patient die by suicide, and those who will.”
Robert Simon, MD, forensic psychiatrist
I doubt they would fall into any particular age category more often than any other.
Anyway, on the subject of physicians who are getting older and required to retire at a specific age, recent news revealed that Scripps Clinical Medical Group agreed to pay almost $7 million to physicians to settle an age and disability discrimination charge filed with the U.S. Equal Opportunity Commission over a policy requiring them to retire at age 75.
And this reminds me of an article in Hektoen International A Journal of Medical Humanities: Jean Astruc, the “compleat physician.” He was a doctor in the Age of Enlightenment and was a geriatrician. An excerpt from the article:
Jean Astruc had a special interest in geriatrics and in 1762 gave a series of lectures that were taken down by one of his students. He described how in old age the skin becomes thick and hard, the hair and teeth fall out, there becomes need for glasses, respiration becomes labored, urine escapes, there is insomnia, and people forget what they have done during the day but remember every detail of what they have done in the distant past. He recommended diet, some wine to help the circulation, exercise, long sleep, and “a life from bed to table and back to bed.”
I think there is a contradiction in Astruc’s recommendations.
I retired voluntarily a little over 3 years ago. It just so happens that one of the reasons was the Maintenance of Certification (MOC) program, which the BMJ study authors mentioned in the first paragraph of the introduction:
“Interest in how quality of care evolves over a physician’s career has revived in recent years, with debates over how best to structure programs for continuing medical education, including recent controversy in the US regarding maintenance of certification programs.”
That reminds me that I got an email a few days ago from Jeffrey M. Lyness, MD, the new President and CEO of the American Board of Psychiatry and Neurology (ABPN) in January of 2023, replacing Larry Faulkner, MD. It was a letter explaining how I could recertify. I decided not to renew several years ago and I’m not thinking of coming out of retirement. I have always been an opponent of the MOC.
Maybe he sent me the letter because he found the Clinical Chart Review Module on delirium that a resident and I made in 2018. As of January 24, 2024 you can still find the module on the web site just by typing in the word “delirium” in the search field. It could be the only document about delirium on the ABPN web site, although that’s difficult to believe.
On the other hand, it’s one of two modules that are labeled as approved although valid through December 31, 2023. Maybe it’s headed for retirement.
Go Retire Psychiatrist 