Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

With Respect to Clinical Excellence, Age is Only a Number


With respect to clinical excellence, compassion, knowledge, diagnostic reasoning, and clinical skill are far more important than age—age is only a number.

When considering clinical excellence, it matters if a physician is caring. It matters if a physician is curious…and skillful…and knowledgeable. These and other things matter. What doesn’t matter is a physician’s age.

This is clearly not the position taken in the recent NY Times article, For Doctors, Age May Be More Than Just a Number. This article points to evidence of “a consistent, positive relationship between lack of experience and better quality of clinical care.”

Age and experience

Although at first startling, the possibility actually sounds reasonable. Perhaps the skills of doctors decline as they age or perhaps older doctors fail to keep up with evolving medical knowledge or advances in clinical care. Although there is some evidence this may be the case, there is also evidence that greater experience caring for a particular condition is associated with better patient outcomes.

Patient volume

An important aspect of clinical excellence not discussed in the article is patient volume. There is a well-known inverse relationship between surgeon volume and operative mortality such that surgeons who perform an operation more frequently have the best patient outcomes. 

Not surprisingly, if you do something regularly, you can get very good at it and–conversely–if you do something only rarely, it is hard to maintain high proficiency. Sometimes as physicians get older they cut back on their clinical activity, and if this happens it stands to reason that their skills may decline.

The NY Times article claims that, “Younger, less experienced physicians are also less likely to order unnecessary tests…” In fact, there is evidence that the opposite is true. For example, one study of emergency department physicians showed that more experienced doctors order fewer electrocardiograms and imaging studies than those with less experience. This study also showed that, adjusting for age, sex, disease acuity, and medical setting, patients treated by less experienced physicians had higher mortality in the emergency department than those treated by more experienced physicians. Another study examined cost profiles for Massachusetts physicians and found that those with fewer than ten years of experience had 13.2% higher overall costs than physicians with forty or more years of experience.

Compassion, knowledge, clinical wisdom, and skill

In the end, while the NY Times article briefly touches on the difference between age and experience, the two are really lumped together…and age literally and figuratively grabs the headline. In fact, clinical excellence can be found in both younger and older physicians, as can poor clinical skill. I don’t personally care about a doctor’s age. I care about compassion, knowledge, clinical wisdom, and skill, and it is these–rather than age–that should grab the headline.