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Original Investigation
January 2018

Association Between Ophthalmologist Age and Unsolicited Patient Complaints

Author Affiliations
  • 1Medical student at Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Center for Patient and Professional Advocacy, Nashville, Tennessee
  • 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
  • 4Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Ophthalmol. 2018;136(1):61-67. doi:10.1001/jamaophthalmol.2017.5154
Key Points

Question  Is physician age associated with an increased likelihood of receiving unsolicited patient complaints among ophthalmologists?

Findings  This cohort study of 1342 ophthalmologists found that increasing physician age was associated with a decreased risk of receiving an unsolicited patient complaint. Younger ophthalmologists had a significantly shorter time to first complaint and were significantly more likely to receive a patient complaint than were older physicians.

Meaning  Ophthalmologists’ patient complaints provide information that may have practical applications for patient safety, clinical education, and clinical practice management.


Importance  Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics (eg, practice setting, subspecialty) that may contribute to the likelihood of patient complaints, unsafe care, and lawsuits.

Objective  To assess the association between ophthalmologist age and the likelihood of generating unsolicited patient complaints (UPCs) among a cohort of ophthalmologists.

Design, Setting, and Participants  Retrospective cohort study with variable duration of follow-up. The study assessed time to first complaint between 2002 and 2015 in 1342 attending ophthalmologists or neuro-ophthalmologists who had graduated from medical school before 2010 and were affiliated with an organization that participates in Vanderbilt University Medical Center’s Patient Advocacy Reporting System. Participants were stratified into 5 age bands and were followed up from the time of their employment to receipt of their first complaint. Trained coders categorized UPCs into 34 specific types under 6 major categories.

Main Outcomes and Measures  Time to first recorded complaint. Multivariable Cox proportional hazards model was used to measure the association between time to first complaint and ophthalmologist age after adjustment for predetermined covariates.

Results  The median physician age was 47 years, with 9% who were 71 years or older. The cohort was 74% male, 90% held MD degrees, and 73% practiced in academic medical centers. The mean follow-up period was 9.8 years. Ophthalmologists older than 70 years had the lowest complaint rate (0.71 per 1000 follow-up days vs 1.41, 1.84, 2.02, and 1.88 in descending order of age band). By 2000 days of follow-up (or within 5.5 years), the youngest group had an estimated UPC risk of 0.523. By 4000 days (>10 years), participants in the older than 70 years age band had an estimated risk of UPC of only 0.364. The 2 youngest age bands were associated with a statistically significant shorter time to first complaint. Compared with those aged 71 years or older, the risk of incurring a UPC for those aged 41 to 50 years was 1.73-fold higher (hazard ratio [HR], 1.73; 95% CI, 1.21-2.46; P = .002). Similarly, participants aged 31 to 40 years had a 2.36 times higher risk of incurring a UPC (HR, 2.36; 95% CI, 1.64-3.40; P < .001).

Conclusions and Relevance  This study suggests that older ophthalmologists are less likely to receive UPCs than younger ones. Although limitations in the study design could affect the interpretation of these conclusions, the findings may have practical implications for patient safety, clinical education, and clinical practice management.