Are patients worse off with more seasoned doctors?
In a surprising finding published in the American Journal of Medicine, patients who were more sick fared worse off with more experienced doctors than with those who were newer to the profession. The trend flies in the face of common sense and asks some hard – and interesting – questions about the durability of medical training.
It turns out that patients whose doctors had practiced for at least 20 years stayed longer in the hospital and were more likely to die compared to those whose doctors got their medical license in the past five years.
Dr. William Southern and colleagues looked at records of more than 6,500 patients who'd been hospitalized between 2002 and 2004 at New York City's Montefiore Medical Center in the Bronx. Montefiore is a teaching hospital where patients are first seen by a junior doctor who randomly assigns them to one of the hospital's six medical teams. Each team has a medical student, recent medical school graduates, and at the top, a senior doctor known as the attending physician.
Over the course of the study, there were 59 different attending physicians. The researchers divided them up based on how long they were practicing: five years or less, six to 10 years, 11 to 20 years, or more than 20 years.
In comparing the most and least experienced doctors, researchers saw the most-experienced group had more patients die in the hospital. In fact, compared to patients with the newest doctors, those with the most experienced physicians had more than a 70 percent increase in their odds of dying in the hospital and a 50 percent increase in their odds of dying within 30 days, but this risk only applied to the sickest patients.
The study also found that more experienced doctors were implicated in longer hospital stays, which are also a risk factor for developing complications.
Previous research has found similar results across a variety of physician specialties.
So how to account for this seemingly paradoxical trend? It would seem that the more a doctor practices the better he or she gets at his profession. No amount of coursework and supervised practice can substitute for the years of hands-on experience one gets while practicing one’s trade. It cannot simply be that quality of care goes down the further one is away from training.
The problem, says Dr. Niteesh Choudhry of Harvard Medical School, who was not involved in the new study, is not with the loss of capability of the more experienced doctors, but rather, their familiarity with more current guidelines and practices. The results suggest the need to rethink the way doctors are continually educated in the years after completing their certification.
The authors of the study suggest that physicians with more than 20 years in practice be required to recertify periodically. Most of the older doctors in the current study are presently exempt from having to take recertification tests, they say.
Doctors, like most licensed health care practitioners, do participate in required continuing education programs, but most of these consist primarily in attending brief lectures, accompanied by readings in the professional literature. The current recommendation would augment the scope of keeping one’s credentials up-to-date.