Quality/Patient Safety

Doctors who have been in practice longer may be more likely to provide lower quality of care

Doctors who have been practicing medicine for a long time are generally considered to have the skills and knowledge needed to deliver high quality care. However, the opposite may be true, according to a recent study. Although "practice makes perfect" in some situations, physicians' knowledge and performance may decline with the passage of time, suggests Stephen B. Soumerai, Sc.D., of the HMO Research Network Center for Education and Research on Therapeutics (CERT), which receives support from the Agency for Healthcare Research and Quality (HS11843). This study was led by Niteesh K. Choudhry, M.D., of Harvard Medical School.

The researchers conducted a systematic review of studies from 1966 to June 2004 relating medical knowledge and health care quality to physician age and years in practice. Of 62 published studies, more than half (52 percent) suggested that physician performance declined over time for all outcomes measured. Only one study showed improved performance for all outcomes measured. For instance, a study of mortality for 39,007 patients hospitalized for heart attack found a relative increase in mortality of 0.5 percent for every year since the treating physician (cardiologists, internists, and family practitioners) had graduated from medical school.

Another study of patients hospitalized for various conditions found that patients of physicians in practice for more years had longer hospital stays than patients of physicians in practice for fewer years. Also, 15 studies demonstrated that physicians in practice for more years were less likely to adhere to standards of diagnostic and screening tests than more recent medical school graduates. One study showed that physicians who had graduated more than 20 years prior to the survey were consistently less likely to adhere to cancer screening practices.

More details are in "Systematic review: The relationship between clinical experience and quality of health care," by Dr. Choudhry, Robert H. Fletcher, M.D., M.Sc., and Dr. Soumerai, in the February 2005 Annals of Internal Medicine 142(4), pp. 260-273.

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