title: Association between physicians' experience after training and maternal obstetrical outcomes: cohort study.
abstract: OBJECTIVE
  To assess the association between obstetricians' years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009.
  
  
  METHODS
  6,704,311 deliveries performed by 5175 obstetricians.
  
  
  METHODS
  Three composite measures of maternal complication rates per physician year from vaginal and cesarean births separately and combined, adjusted for secular trends.
  
  
  RESULTS
  Obstetricians' maternal complication rates declined during the first three decades after completion of residency. The improvement was largest in the first decade and diminished thereafter. For all deliveries, the change was -0.21 (95% confidence interval -0.23 to -0.19) percentage points per year in the first decade, -0.11 (-0.13 to -0.09) percentage points per year in the second decade, and -0.05 (-0.08 to -0.01) percentage points in the third decade (P<0.001 for second to first decade comparison; P=0.001 for third to second decade comparison). The patterns were comparable for cesarean deliveries and vaginal deliveries and across several sensitivity checks.
  
  
  CONCLUSIONS
  Among obstetricians practicing in Florida and New York, those with more years of experience had fewer maternal complications. This association persisted over the first three decades of practice but diminished in magnitude.
authors.affiliation: Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA. eandrew@mail.med.upenn.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
authors.forename: Sean
authors.initials: S
authors.lastname: Nicholson
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005431:Florida; D006801:Humans; D009518:New York; D007744:Obstetric Labor Complications / Q000209:etiology*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
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