Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice

Am J Med. 2011 Sep;124(9):868-74. doi: 10.1016/j.amjmed.2011.04.011. Epub 2011 Jul 23.


Background: More physician years in practice have been associated with less frequent guideline adherence, but it is unknown whether years in practice are associated with patient outcomes.

Methods: We examined all inpatients on the teaching service of an urban hospital from July 1, 2002 through June 30, 2004. Admissions were assigned to attending physicians quasi-randomly. Years in practice was defined as the number of years the attending physician held a medical license. We divided physicians into 4 groups (0-5, 6-10, 11-20, and >20 years in practice), and used negative binomial and logistic regression to adjust for patient characteristics and estimate associations between years in practice and length-of-stay, readmission, and mortality.

Results: Fifty-nine physicians and 6572 admissions were examined. Although the 4 inpatient groups had similar demographic and clinical characteristics, physicians with more years in practice had longer mean lengths of stay (4.77, 5.29, 5.42, and 5.31 days for physicians with 0-5, 6-10, 11-20, and >20 years in practice, respectively, P=.001). After adjustment, inpatients of physicians with more than 20 years in practice had higher risk for both in-hospital mortality (odds ratio 1.71; 95% confidence interval, 1.06-2.76) and 30-day mortality (odds ratio 1.51, 95% confidence interval, 1.06-2.16) than inpatients of physicians with 0-5 years in practice.

Conclusion: Inpatient care by physicians with more years in practice is associated with higher risk of mortality. Quality-of-care interventions should be developed to maintain inpatient skills for physicians.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Adult
  • Aged
  • Clinical Competence / statistics & numerical data
  • Female
  • Health Services Misuse / statistics & numerical data*
  • Hospital Mortality*
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data*
  • Licensure, Medical / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • New York City
  • Odds Ratio
  • Outcome Assessment, Health Care / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality Assurance, Health Care / statistics & numerical data*