title: Patients of doctors further from medical school graduation have poorer outcomes.
abstract: BACKGROUND
  There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume.
  
  
  OBJECTIVE
  This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes.
  
  
  METHODS
  This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed.
  
  
  RESULTS
  After adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality.
  
  
  CONCLUSIONS
  Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning.
authors.affiliation: Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Norcini
authors.affiliation: Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
authors.affiliation: Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
authors.forename: Amy
authors.identifier: http://orcid.org/0000-0003-2832-4835
authors.initials: A
authors.lastname: Opalek
authors.affiliation: Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
authors.forename: W Dale
authors.initials: WD
authors.lastname: Dauphinee
mesh_terms: D002568:Certification; D003695:Delivery of Health Care; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D010820:Physicians; D012189:Retrospective Studies; D012577:Schools, Medical; D013997:Time Factors