Decoding "Moneyball" Metrics in Medicine: How Much Does the Age of Your Doctor Matter

TL;DR

This article offers a perspective on the debate around doctors' age and effectiveness, suggesting that experience and current knowledge are vital for patient outcomes. Drawing from my 30 years of experience in the digital health technology field and personal observations from three generations of doctors in my family, I argue that data and technology should supplement, not trivialize, the role of physicians. Triggered by the recent headline in the Wall Street Journal, I caution against generalizing the findings from narrow fields to the entirety of medicine, particularly when dealing with specialties requiring long-term patient management. Furthermore, I emphasize that technologists should work closely with doctors to utilize AI to streamline their duties, not use headlines to marginalize or diminish their critical role. The heart of medicine, I believe, lies in the blend of human connection, the wisdom of experience, and the appropriate use of technology.

Background

In a recent Wall Street Journal article by Dr. Jena, "Do Younger or Older Doctors Get Better Results? ", the authors linked the age of physicians to patient mortality rates. The study shows younger doctors have lower mortality rates than their older counterparts. However, the trend seems to reverse in the surgical field, favoring older, more experienced surgeons. As intriguing as these results seem, they raise questions that merit further exploration.

The article, based on a study conducted by Dr. Jena, presents an intriguing association between the age of physicians and patient mortality rates. While the statistical findings of this study are thought-provoking, they raise several questions about their broader applicability and the underlying assumptions driving the research.

The article cited a study that revealed a slightly higher mortality rate among patients treated by older doctors than those cared for by younger physicians. This pattern persisted even when accounting for doctor volume and case severity. The article proposed two possible explanations for this trend: either the aging process directly impacts doctors' performance, or differing practices between generations due to variations in training and familiarity with newer medical advancements may be responsible. Interestingly, the trend reversed when considering surgeons, with older surgeons demonstrating slightly lower patient mortality rates. The article concluded that while age isn't the sole determinant of a doctor's competency, it does have a noticeable impact that one can't ignore.

Digging Deeper

While the authors of the article and those who expressed opinions in the subsequent letters to the WSJ editors ("Age Before Beauty, but What About Surgery? "), are all physicians or surgeons, it will be great to get a complementary perspective from someone not deeply rooted in medicine (although you can read through comments therein, and gain the appreciation of what I am talking about!)

The study uses a relatively narrow slice of the medical field - hospitalists and surgeons - to represent the entire profession. What about cardiovascular medicine, endocrinology, oncology, and many others where long-term patient management is far more significant than 30-day mortality rates?

With nearly three decades of experience in the digital health technology field and a personal connection to medicine through three generations of physicians in my immediate family, I have a distinct vantage point from which to explore the complex interplay of age, experience, technology, and patient outcomes in healthcare. This blend of personal and professional insights has enabled me to witness the dramatic transformations technology has brought to patient care. Consequently, it offers me a unique perspective to critically examine and interpret studies that dissect these elements, such as the one discussed in the Wall Street Journal article.

Firstly, it's crucial to note that not all technology and data are created equal. Context matters in 'Moneyball Medicine,' where we leverage vast data to uncover patterns and make healthcare more effective and efficient. For instance, while the study found statistical differences in mortality rates across different age groups of doctors, the practical implications may be less pronounced. The differences in mortality rates are marginal and should be contextualized with other critical factors such as the doctor's specific skill set, their commitment to continuous learning, their team dynamics, and more.

Secondly, the study implicitly implies that younger doctors possess more up-to-date knowledge. However, in my observation, many older doctors remain on the cutting edge of medical advancements. They maintain their knowledge not just through years of hands-on experience but also through continuous medical education, active participation in professional communities, and exposure to a wide variety of complex cases.

The study also uses a relatively narrow slice of the medical field - hospitalists and surgeons - to represent the entire profession. However, areas like cardiovascular medicine, metabolic diseases, oncology, and many more are defined by long-term management and relationships between doctors and patients, where measures like 30-day mortality rates may not apply.

Beware of the Weapons of Math Destruction in Healthcare

In her thought-provoking and influential book, "Weapons of Math Destruction ," Cathy O'Neil raises caution against the misuse of large-scale data algorithms. This theme resonates strongly with our discussion here. The study in the Wall Street Journal article, with its reductionist view on patient mortality and doctor's age, exemplifies O'Neil's concern about oversimplified algorithms leading to misleading conclusions. Medicine is an intrinsically human field, layered with complexity, and drawing direct correlations without considering contextual nuances might reinforce biases and perpetuate inequalities. For instance, the focus on doctors' age and patient mortality, without substantial consideration of factors like doctor's expertise, specialty, patient demographics, or the role of multidisciplinary care teams, risks a "Weapons of Math Destruction" scenario in healthcare.?

As we embrace the digital era in medicine, we must apply data and algorithms responsibly, considering the full spectrum of medical practice and avoiding one-size-fits-all conclusions that can do more harm than good. In that vein, the older article "When Are Doctors Too Old to Practice? " should serve as a caution related to the polarization of doctors based on their age.??

Focus on the Continuum of Care

In our current healthcare model, we often compartmentalize care into discrete segments - hospital stays, clinic visits, home care - instead of considering the continuum of a patient's journey. This approach is particularly true in the study under discussion, which primarily focuses on 30-day outcomes within the confines of a hospital.

As healthcare systems evolve, we slowly acknowledge the need for integrated, patient-centric care that extends beyond hospital walls and into the home, leveraging care coordination technologies can bridge the gaps in traditional care models, significantly improving decision-making and patient outcomes.

As healthcare systems evolve, we slowly acknowledge the need for integrated, patient-centric care that extends beyond hospital walls and into the home. A shift towards "hospital at home" models can allow for more personalized, convenient, and cost-effective care. However, this also demands innovative solutions for seamless care coordination across different stages and settings of a patient's journey. Here, the role of digital health technology becomes even more crucial.

We can bridge the gaps in traditional care models by leveraging care coordination technologies. These technologies can facilitate clear communication between healthcare providers, enable smooth transitions of care, and ensure that each patient's unique needs are met throughout their medical journey. More importantly, these digital tools can provide healthcare professionals with holistic, real-time insights into a patient's health status on-demand, significantly improving decision-making and patient outcomes.

This is not to say that technology alone can solve all challenges in healthcare. Technology is a tool; like any tool, it's only as effective as the person wielding it. A critical component of any care model, digital or otherwise, is the human element - doctors, nurses, therapists, and caregivers who, beyond their expertise, also demonstrate their compassion, empathy, and commitment to their patients.

Staying Relevant

In this context, the age of a physician becomes even less relevant. Whether a doctor is young or old, what is more relevant is their ability to stay abreast of medical advances, their commitment to lifelong learning, their dedication to their patients, and their proficiency in navigating and integrating digital health solutions into their practice.

Ultimately, we should remember that technology, data, and AI should enhance the physician-patient relationship and the continuum of care, not reduce it to simplistic metrics or transactional interactions. As we shape the future of healthcare, we need to ensure that we are not just delivering care but, more importantly, caring.