Young doctor or old doctor?

In My Humble Opinion
1

If you’re like me and in the US, you probably have an employer-sponsored insurance plan to cover your medical costs. These plans typically include shared costs between you and the insurer, which are split based on the type of plan that can vary based premium, copay, co-insurance etc.

And as you age, the need for specialists grows. Whether you need an orthopedist, gastroenterologist, urologist, dermatologist, etc., the responsibility is on you to find one. Sure, your insurer will give you a list of acceptable providers you can see on their website, but how do you decide which one to book? Your primary care physician may give you a recommendation, but that would just be an extra doc visit and cost you more money.

In the past, I would look for older specialists. My thought was that they have just seen more patients, and thus a higher chance of experiencing a greater diversity of patients and issues, and so perhaps better at diagnosing conditions correctly, and prescribing better treatment.

However, through all the information available on the internet, I’ve noticed that the specialists I see are far behind in keeping up with the latest advancements, findings and treatments. Additionally, they seem quick dismiss anything new, and rely too much on their own experience.

So now I’m thinking that younger specialists might be more open to accepting and applying the latest advancements. Additionally, with the the historical data and information available immediately, they can also utilize the personal experiences of older doctors without having to actually spend the years of seeing actual patients to gain the experience.

Thoughts?

2

As you suggested, there are distinct advantages to each. Young doctors are often more up to date on the latest medical findings, but older doctors obviously have more experience. I think it comes down to what you want from your doctor, and whether they are a good fit for you.

I recently relocated and had to find a new PCP as well as two specialists. I picked a few that were in my network after reading their bios hoping they would work, and luckily they did. I can have an intelligent conversation with each of them with little or no chit chat, which I hate. I can be in and out in 15 minutes with all my questions answered. They all happen to be young doctors, and that seems to work better for me. YMMV.

3

Anecdotally, I’ve often had better luck with younger doctors as well. Not only were they more privy to recent advancements, they don’t seem to carry with them the know-it-all mentality that some older doctors seem to have (that dismissive attitude you speak of). More important than mere exposure to research and continuing education, I think, is the willingness and ability to remain open to ignorance and curiosity… and that’s not just a function of age, but personality and upbringing and training too.

The best doctors I’ve had were humble ones, because they were willing to listen and consider the patient experience before jumping to conclusions. And that isn’t just a “nice to have” matter of having good bedside manners… at least in my case, the older, been-then-done-that doctors sometimes took inappropriate diagnostic shortcuts that excluded significant variables that could’ve helped inform their diagnoses and treatments.

In my particular case, at 40 years old, I’m not particularly healthy or unhealthy, but have suffered from chronic gout since my mid-20s. Several older doctors initially (and then insistently) dismissed it as a diagnostic possibility due to my diet (vegan) and age, though more recent research has shown it to be much more prevalent in some populations (especially Asians) and possessing a big genetic, not just dietary, component. It took many attacks, and several doctors in different cities, to finally get on the right medication for that, and since then it has never recurred. None of the older white doctors considered either factor. It was a younger one who eventually suggested, “All the diagnostic criteria and training I’ve learned tells me you shouldn’t have gout, and I can’t prove that it is or isn’t gout, but I can’t think of anything else it could be. Despite the lack of certainty, I think we should put you on gout medication for a few months as a trial and see how it goes.” It worked. The older ones refused to even entertain it as a possibility, despite multiple recurring attacks in the same toes.

I’ve had similar experiences in other fields of medicine, especially psychiatry and psychology, where the older doctors were not really that interested (or perhaps even aware of) recent changes in diagnostic criteria and treatment modalities, whereas the younger ones would explicitly mention things like “Well, we used to think that ______, but lately we’ve come to realize that _____ and so we’re doing things a little differently now.” (The DSM itself has changed a lot in regards to how the field looks at things like depression, autism, ADHD, sexuality, etc.) And of course there’s the whole trans-affirming or not difference between providers, and that probably has a huge generational component.

Maybe if you’re just dealing with relatively mainstream conditions for the US and are a part of the dominant ethnicity, the older doctors (who would presumably have seen hundreds of those cases) can more quickly get you the right treatment. As someone non-white who’s just entering mid-life, though, my personal (and again, strictly anecdotal) experience strongly favors the younger ones due to their general openness and not-yet-cemented practices. Even if they don’t necessarily keep up with recent research more successfully (who can? there’s so much more that comes out than any one person can reasonably keep up with), they are at least more willing to listen and consider different factors. The older ones weren’t so much.

For many of those same reasons, I tend to prefer women doctors.

My pet theory is that whether they’re younger and/or female, they’ve had to work harder in their educations and careers, and have probably had to put up with some of the same dismissive attitudes from their peers and superiors and are thus (hopefully) less likely to want to inflict the same on their own patients. What they lack in clinical experience, they seem to make up for in empathy and willingness to learn. Knowledge can be gained and research can be read… it’s much harder to convince someone with decades of experience that they maybe don’t know everything. Especially when that suggestion comes from someone younger and less educated than them.

4

One other factor: Some completely incompetent people somehow manage to make it past all of the tests and residencies to become doctors (see, for instance, the surgeon who thought the liver was the spleen). Such doctors will reveal themselves sooner or later, and generally cease to be doctors. A young incompetent doctor might not have been weeded out yet that way, but an older incompetent doctor probably would have.

Though this is probably rare enough to be only a minor consideration.

5

To me this is like asking if men or women make better firefighters. Statistically there will be differences between the groups, but those statistics tell you nothing about the person standing in front of you. Until you’ve evaluated the individual, the statistics simply bias your expectations.

If your doctor doesn’t feel right and you have a choice, try another one.

6

My selection process for picking a specialist includes checking multiple reviews (hopefully finding many of them, as ratings can be skewed by a few wildly negative or positive ones) and doing a medical license lookup. The latter feature is offered on all state medical board websites that I’ve looked into. You can find out whether any disciplinary actions have been taken and usually, details of what they were for. A Google search should turn up any spectacular incidents like mistaking the liver for the spleen.

Beyond that, it’s good to ask the physician at an initial appointment about their experience treating your condition and if contemplating a surgical procedure, how many of them they’ve performed (and how recently).

As far as age goes, I’m inclined toward someone who’s been in practice for awhile, rather than being freshly minted out of residency/fellowship or getting close to retirement age. I’m not especially concerned that an older surgeon isn’t “up to date”, as mastering newer procedures is an essential part of continuing medical education if they want to stay competitive in their field. Just as long as they seem knowledgeable and vigorous, and unlikely to fall asleep during surgery.

7

This. My PCP is old. Old enough that two years ago i asked him if he was thinking of retiring any time soon. But he’s also an academic doctor, and his field is literally “evidence based changes in standard treatment”. He’s very in top of changes in diagnosis and treatment.

8

I don’t know if it matters. I’ve thought about this too, but I think it more comes down to the doctor’s personality. Do they have critical thinking skills? Are they willing to admit they can be wrong? Are they looking for the actual solution, or just the easiest solution so they can push you out the door?

Those are the big things I look for, and they don’t seem correlated with age. Some young doctors are dogmatic and don’t listen, and some older doctors are constantly learning new things and actually listen to their patients.

9

At my age, every doctor is a young doctor.

But it never mattered to me. I figured they were competent until shown otherwise.

10

I think the last time I actually got to choose a doctor was back in the 1990s.

Every time we’ve had to choose doctors (my wife, kid and me) in the last 20 years, you have to take whoever is accepting patients. For specialists we’ve had 3-4 month waits to get an appointment, so we have almost always relied on going to whoever had a cancellation.

My daughter’s pediatrician was literally a guy starting out that month (he’d finished his residency a month after she was born) in the same practice as his father. Not a family practice, a group with dozens of doctors in three locations. We thought we were getting Dr. John Brown MD, respected and experienced pediatrician. We got Dr. John Brown OD, a guy who looked like he couldn’t possibly be a doctor. Regardless he’s still her doctor and she’s not looking forward to aging out of his care soon.

11

It’s fascinating to me that the typical healthcare consumer has way, way easier access to reliable information about a $20 Target toaster, or the local ice cream shops, than the doctor making their life-or-death decisions.

Between the complexities of private healthcare insurance (where only some doctors in your area are in-network and accepting new patients), the low number and quality of reviews for many doctors, and the lack of understanding of how medical boards & licensing works (I’d have no idea what gets reported or not, and what would cause a publicly viewable mark on their permanent record)… finding a good doctor seems mostly a matter of luck and possibly institutional prestige, unless they also happen to be active in research as a lecturer or scholar.

RateMyProfessor.com used to be really popular for college professors, and was quite helpful. RateMDs.com also exists for doctors, but it never seemed to have gotten much use (at least in the towns I’ve been in).

So we’re left with Google Maps and Yelp reviews of individual doctors, which typically only works if they have their own practice (as opposed to being one of many doctors in a hospital/HMO type environment).

Where else can you find good crowdsourced reviews of doctors?

12

I never found it to be such. Most of the reviews were just based on the grade the individual reviewer got, and there were never enough of them to draw any meaningful conclusions from.

13

A lot of ratings sites exist for M.D.s, including Healthgrades, Vitals and U.S. News and World Report, usually citing their years or experience and where they trained. The number of reviews varies, and as I mentioned, if there are few reviews the outcome can be skewed by someone with a grudge (fair or not) or who knows, the doc’s mama putting in a good word for them. But it doesn’t matter if they’re members of a group; ratings for individuals are commonplace.*

We could get into a whole separate discussion on whether the National Practitioner Data Bank which lists malpractice cases should be available to the public.

Regardless, there is a certain amount of helpful information available for anyone doing online checks and more importantly, evaluating a doc up close and personal.

  • I sometimes look at physician ratings sites to check my listed profile. I don’t expect personal reviews as a pathologist, though as I have a certain online presence that possibility exists.** The last time I checked I was surprised to find a five-star rating from someone whose name I didn’t recognize - no review, just five stars. Did I crank out an entertaining and revelatory surgical pathology report? Who knows?
    **Physicians who take controversial stands on public health issues have sometimes been targeted by malefactors leaving phony negative reviews.
14

I’d want a young physician and an old surgeon.

Young physician for the reasons noted above - more up-to-date, more open minded, and better bedside manner. But as far as surgeons go, I’d rather be operated on by an old one. That’s because surgery is a lot more cutthroat and result-oriented, so someone who’s still slicing and dicing in his 60s has to be good, and will also be highly respected, which means that they’ll have a lot more resources at their disposal, not to mention the most talented young surgeons to assist them in their work.

15

I want a surgeon who has done a lot of exactly the procedure I’m having in the past year.

16

My sense is the ratemyprof ratings did reflect grades and personalities and tastes. Some people love the math prof who teaches with a guitar–“logarythm and blues”–and some hate it. Some like traditional authoritarian profs, some prefer different styles. I think the same is true of doctor reviews–it’s often personal, subjective feelings rather than objective analysis of skill. And even the best doctor will whiff sometimes.

Also, a lot of great reviews for toasters are “came on time, 5 stars” or “package was damaged, 1 star,” and so you may learn nothing you want to know about the product. Ditto profs and doctors.

17

Yeah ratings are really tricky. I know some docs who are like the auto dealer repair reminding people to answer the request for giving them a perfect review. Most don’t. Problem is that then few respond … That said someone really low should be a red flag.

I’ve had no need for any specialists yet but after my last PCP retired on me I intentionally chose someone on the younger side. Just so I have more of a chance of them staying around until I … have no more need of their services.

18

I don’t think age matters when it comes to how good a doctor is. Having been in practice for 20 years now, I’ve noticed that good older doctors almost always started out as good younger doctors.

As far as experience and how up to date one’s knowledge is, the sword cuts both ways. The younger doctor naturally has more recent training, but a lot of it will be in areas that don’t apply to their area of focus / specialty. An older say, psychiatrist, will probably be out of date on how to best treat a hip fracture in a frail elderly patient compared to the young psychiatrist fresh out of residency who just did an ortho rotation a year ago. But that also means that younger psychiatrist was spending some of their learning time studying things that don’t apply directly, while the older one most likely focused on areas pertinent to their practice.

19

Yes, when my doctor finally retires, i will be looking for a new PCP whose expected professional lifespan exceeds my expected total lifespan. Shopping for doctors is difficult, and doesn’t get easier with age.

Of course, my mother tried this, and then her PCP decided to have babies and be a stay at home mom!

20

It’s kind of funny… for our kids, we chose a very old pediatrician. Largely because we absolutely love his ability to calm and comfort apprehensive or uncomfortable children and because he’s got a lot of experience. But at the same time, the other doctors in his practice are all considerably younger- in fact his daughter works in the same practice, and she’s probably early 40s.

My doctor is about my age. I picked him because I had been going to one who wouldn’t listen to the questions I’d ask and didn’t like explaining her diagnosis and treatment rationales, and would get peeved if I pressed. Current doctor is very open to explaining why he’s thinking a certain way, what the differential diagnostic criteria are, and what the treatments are, and why he’s choosing the one he is. And he’s open about the next steps if he gets it wrong.

I once made an off-hand comment about him having seen something like what I was experiencing a million times, and he replied that no, what he’s seen a miliion times are allergies, sinus infections, flu, and high blood pressure maintenance. But, about once every couple of weeks a patient presents with something interesting and he’s got to go look it up and do real doctor stuff, and that’s what he really enjoys and why he became a doctor in the first place. I felt very comforted by that, in that if it’s something outside his experience, he’s going to dig in because that’s what interests him.

Now his office has got a PA who handles the routine visits. I really like her actually, although I’m not sure how it works with her and Dr. K- when is it past her expertise, does he just act in a consulting role, or what? I probably should ask the next time I’m in.