Searching for a good MD? Research offers insights to navigate hard choices

Diverse_doctors_3-300x201Some new research studies suggest ways to find a good doctor by focusing on demographics. Older doctors who have reduced their caseloads may not be an optimal choice, one study suggests, while another finds that, for seniors sick enough to be hospitalized, women MDs excel. And doctors who are immigrants can be solid patient choices, a third study reports.

 

Let’s be clear: These studies are observational, and they focus on select measures of care. But they are based on big data, analyses of hundreds of thousands and even millions of cases. Your own individual experience with a clinician counts a ton, and must never be ignored. A doctor with a brilliant resume, golden accomplishments, and a sterling reputation can still treat you badly, even blunder with your care.

Still, after examining three years of data on more than 700,000 admissions and the outcomes of 19,000 doctors, researchers from Harvard Medical School and prominent Boston-area hospitals found that as MDs aged, mortality rates of their hospitalized patients climbed. For doctors younger than 40, the rate was 10.8 percent, while for those older than 60, it hit 12 percent.

Patients of older doctors fared worse, most notably if MDs had reduced their caseload and slowed their practice, researchers found after adjusting for various factors. This may mean experienced doctors had gotten far not only from training to deal with patients sick enough to be hospitalized, they also may have failed to stay current, including with necessary skills.

Meantime, in a study of more than 1.5 million, hospitalized Medicare patients 65 and older, researchers found that female internists had small but important and better results with patients. Their mortality and readmission rates were fractionally lower. But that difference could be significant, with researchers estimating it could save 32,000 Medicare patients’ lives annually, roughly the same number of Americans who die each year in car crashes.

In an editorial accompanying the study on female MDs and their patients, experts noted that, stereotypes and clichés aside, other research has shown that women doctors focus more on those in their care, also communicating better and spending more time with them. Women follow clinical guidelines more closely than do their male colleagues. Alas, though studies suggest their outcomes are superior, female MDs get paid less—roughly 8 percent under their male peers.

As for doctors who are immigrants, the Harvard Business Review reports they’re taking a bad rap, notably due to the Trump Administration’s negative depictions of foreigners, even those who study, then work here, and become U.S. citizens. One in four physicians practicing in America completed medical school abroad. These MDs are more willing to go to treat patients in rural and underserved areas of the country.

Based on an analysis, again, on three years of data on more than 1 million, hospitalized Medicare patients, researchers found that those treated by graduates of international medical schools had lower mortality rates as compared with seniors cared for by U.S. medical school grads. Their readmission rates were similar. But the immigrant docs’ patients tended to be sicker, and costs of their care were higher—reflecting, perhaps, that the foreign-born physicians took on more difficult or complex cases, because their skill and training levels were higher than American peers, otherwise the immigrants would not have gotten into this country to practice.

In my practice, I see the harms that patients can suffer while seeking medical services. I’ve dealt with many doctors, both excellent and atrocious. But when it comes to choosing yours, careful research and skepticism must count—not biases, whether for a silver-haired MD, or against a female or foreign-born practitioner.  On the firm’s site, I offer questions that patients may wish to use when trying to make critical choices in finding top primary care doctors or surgeons. There also are some nifty new ways to figure which practitioners might offer good care. Caveat emptor.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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