Physicians Less Likely to Die in Hospital Than Other Patients

Diana Phillips

January 20, 2016

Disparities in end-of-life care between physicians and the general patient population suggest a gap between what physicians choose for themselves and the care provided to most patients.

New research examining the intensity of end-of-life care and the locations of death for physicians and nonphysicians indicate that physicians receive less aggressive care before death. They are also less likely to die in the hospital and are more likely to receive hospice care than similar nonphysician patients.

The findings, reported in two research letters published January 19 in JAMA, may add credence to the view expressed by some experts that physicians die in a manner that is more consistent with their end-of-life preferences than does the general population.

In one of the studies, Joel S. Weissman, PhD, from the Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, and colleagues examined whether physicians receive higher- or lower-intensity end-of-life treatments compared with nonphysicians.

The investigators analyzed end-of-life resource use among Medicare beneficiaries across four states who died between 2004 and 2011. Looking specifically at measures of surgery, hospice care, intensive care unit admission, in-hospital death, and expenditures during the last 6 months of life, they compared outcomes among physicians (2396), lawyers (2081), and the general population (665,579).

In adjusted analyses, physicians were significantly less likely to die in a hospital compared with the general population (27.9% vs 32.0%; P < .001). They were also significantly less likely to have surgery (25.1% vs 27.4%; P = .01) and less likely to be admitted to the intensive care unit (25.8% vs 27.6%; P = .04).

Compared with lawyers, who are considered socioeconomically and educationally similar, physicians were significantly less likely to die in a hospital (27.9% vs 32.7%; P < .001). Physicians and lawyers did not differ, however, on other measures of care.

Although moderate, the differences for three of the five end-of-life care intensity measures "suggest less aggressive care for physicians," the authors write. They note that physicians' insight into the "burdens and futility" of intense end-of-life care, "as well as the benefits and the financial resources to pay for other treatment options" may partially explain the difference.

That only one measure differed between physicians and lawyers (the likelihood of in-hospital death) suggests that "actual experience with hospital deaths may differentially motivate physicians to avoid them," the authors hypothesize.

"These findings could inform how health professionals communicate with patients about end-of-life care choices," the authors write. "For example, family members of critically ill patients sometimes seek reassurance from physicians that their loved one is receiving the same type of care that a physician would receive."

Less Likely to Die in Any Facility

In the second study, Saul Blecker, MD, from the New York University School of Medicine, New York City, and colleagues examined records for approximately 500,000 individuals who died from 1979 to 2011, based on data from the National Longitudinal Mortality Study, comparing the location of death for physicians (815) with that of other clinicians (2635), other professionals (15,308) with similar education levels, and the general population (452,485).

In the total study population, 40.3% of patients died in an inpatient hospital and 72.1% died in any facility. Compared with physicians, patients from the general population were significantly more likely to die in a hospital (40.4% vs 38.3%; adjusted odds ratio [aOR], 1.10; 95% confidence interval [CI], 1.08 - 1.12). Nonphysician patients were also significantly more likely to die in any facility (72.4% vs 63.3%; aOR, 1.34; 95% CI, 1.32 - 1.37).

In addition, other healthcare professionals and other highly educated patients were also more likely to die in any facility compared with physicians (aOR, 1.14 [95% CI, 1.12 - 1.17] and aOR, 1.12 [95% CI, 1.11 - 1.14, respectively). There was no significant difference between these groups and physicians in terms of likelihood of an in-hospital death, however.

"Our results suggest that familiarity with health care (supported by the subgroup results) and educational attainment may have a small association with experience of death," the authors write. "These results may also be related to socioeconomic differences besides education, which we could not measure, or to differential treatment by clinicians."

Dr Blecker was supported by a grant from the Agency for Healthcare Research and Quality. The authors have disclosed no other relevant financial relationships.

JAMA. 2016;315:303-305. Weissman extract, Blecker extract

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