Forty-two percent of U.S. physicians are older than 55, and 21 percent are senior citizens. As doctors get older, some are calling for periodic screening for dementia or loss of competence. Are older doctors really worse than their young colleagues?
On average, they are. Large-scale studies strongly suggest that the average surgeon reaches the peak of his or her powers during middle age. A group of University of Michigan doctors documented the results of more than 460,000 complex surgical procedures between 1998 and 1999 to determine whether patients with older surgeons were more likely to die during or shortly after surgery. In five of the eight surgical procedures examined, the older surgeons did not perform significantly worse than their younger colleagues. However, in the three categories in which there was a statistically significant difference—coronary artery bypass, pancreatectomy, and carotid endarterectomy—surgeons between the ages of 41 and 60 were more likely to keep their patients alive than were surgeons older than 60. Several other studies have reached a similar conclusion: As surgeons age, there is a small but detectable diminishment in the quality of their work.
It’s important to note that studies of thousands of doctors don’t say anything about the skills of any individual. Plenty of older surgeons outperformed younger colleagues in the study. The data also suggested that older surgeons who continue to carry a full caseload, rather than going into semiretirement and seeing a few patients per week, experienced no loss in skill.
It’s tempting to attribute the general decline in performance among older surgeons to a loss of fine-motor control, and that likely plays a role. As the authors of the University of Michigan study pointed out, the procedures that showed the greatest difference between old and young surgeons required a high degree of coordination. (Coronary artery bypass, for example, requires the stitching together of very small blood vessels.)
Studies of primary care doctors, who rely more on their wits than their dexterity, suggest that the problem runs deeper than their fingers. In 2005, a trio of Harvard researchers analyzed existing studies on the relationship between the age of a physician and the quality of care he or she provides. All 12 of the studies that surveyed physicians for knowledge found that younger doctors were more up-to-date on clinical developments and current standards of care. Sixty-three percent of studies that reviewed the actual performance of doctors in a clinical setting found that older doctors were more likely to order unnecessary tests, fail to order necessary tests, or fail to counsel patients appropriately on preventive health strategies.
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