Older doctors may provide lower quality of care than younger doctors, according to a study published in the February 15 issue of Annals of Internal Medicine.

Researchers at Harvard Medical School reviewed 59 previously published papers that comprised 62 studies with a large sample size of doctors. The studies included measures of physician knowledge or quality of care and the time since the doctors graduated medical school or their age.

Some 73% of the studies (45 of 62) showed that doctors performance declines over time. According to Stephen Soumerai, Sc.D., one of the researchers, the findings may be indicative of changes that have occurred in medicine. Evidence-based medicine has been widely adopted and quality assurance techniques, such as disease management and performance evaluation, are frequently used, Dr. Soumerai says. More experienced doctors may have less familiarity with these strategies and may be less accepting of them.

However, Alden N. Haffner, O.D., Ph.D., president of SUNY College of Optometry in New York, doesnt believe that older practitioners cannot or do not keep up with newer technologies and knowledge in the field of eye care because required continuing professional education fosters older practitioners ability to have access to newer technologies and newer types of therapeutic care.

Dr. Haffner believes that one problem with this study, and all similar attempts at this very difficult subject, is that the older practitioner has a wealth of experience based on his or her years of clinical practice, he says. This must be measured against more modern technologies and a knowledge base that is constantly being infused into the ability to deliver up-to-date care and services.

Dr. Haffner also discusses the issue of re-licensure and recredentialing: Although it has been suggested many times in the past, a relicensure system for practitioners has not yet come about. On the other hand, there is a re-examination process for practitioners with credentialed certification in the medical specialties.

He adds, We must always remember that a license is an obligation on the part of the practitioner to maintain current knowledge and skills for the benefit of the public that will be served. This statement applies to practitioners of all disciplines.

Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 2005 Feb 15;142(4):260-73.