Physician experience and outcomes among patients admitted to general internal medicine teaching wards.
BACKGROUND
Physician scores on examinations decline with time after graduation. However, whether this translates into declining quality of care is unknown. Our objective was to determine how physician experience is associated with negative outcomes for patients admitted to hospital.


METHODS
We conducted a retrospective cohort study involving all patients admitted to general internal medicine wards over a 2-year period at all 7 teaching hospitals in Alberta, Canada. We used files from the Alberta College of Physicians and Surgeons to determine the number of years since medical school graduation for each patient's most responsible physician. Our primary outcome was the composite of in-hospital death, or readmission or death within 30 days postdischarge.


RESULTS
We identified 10 046 patients who were cared for by 149 physicians. Patient characteristics were similar across physician experience strata, as were primary outcome rates (17.4% for patients whose care was managed by physicians in the highest quartile of experience, compared with 18.8% in those receiving care from the least experienced physicians; adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.72-1.06). Outcomes were similar between experience quartiles when further stratified by physician volume, most responsible diagnosis or complexity of the patient's condition. Although we found substantial variability in length of stay between individual physicians, there were no significant differences between physician experience quartiles (mean adjusted for patient covariates and accounting for intraphysician clustering: 7.90 [95% CI 7.39-8.42] d for most experienced quartile; 7.63 [95% CI 7.13-8.14] d for least experienced quartile).


CONCLUSIONS
For patients admitted to general internal medicine teaching wards, we saw no negative association between physician experience and outcomes commonly used as proxies for quality of inpatient care.
Division of General Internal Medicine (McAlister, Kassam); Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Youngson, Bakal), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Bakal), Alberta Health Services, Calgary, Alta.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta. Finlay.McAlister@ualberta.ca.
Finlay A
FA
McAlister
Division of General Internal Medicine (McAlister, Kassam); Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Youngson, Bakal), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Bakal), Alberta Health Services, Calgary, Alta.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.
Erik
E
Youngson
Division of General Internal Medicine (McAlister, Kassam); Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Youngson, Bakal), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Bakal), Alberta Health Services, Calgary, Alta.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.
Jeffrey A
JA
Bakal
Division of General Internal Medicine (McAlister, Kassam); Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Youngson, Bakal), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Bakal), Alberta Health Services, Calgary, Alta.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.
Jayna
J
Holroyd-Leduc
Division of General Internal Medicine (McAlister, Kassam); Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Youngson, Bakal), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Bakal), Alberta Health Services, Calgary, Alta.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.
Narmin
N
Kassam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000706:statistics & numerical data*; D020445:Hospitalists / Q000592:standards*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies