Patients more likely to die under care from 1st-year hospitalists

An extra year of experience for a physician can make an impact on patient mortality in a hospital, according to a study published in JAMA Internal Medicine that found 30-day and hospital mortality rates were higher for hospitalists in the first year of practice than their second.

The study, led by James Goodwin, MD of the University of Texas Medical Branch in Galveston, Texas, looked at more at Medicare data from between Jan. 2007 and Dec. 2013 for more than 3,800 first-year hospitalists. Only physicians who continued to practice as hospitalists four or more years after their initial year of experience were included.

Goodwin and his coauthors found there was a "significant association" between hospitalist experience and mortality rates. Compared to second-year hospitalists, patients of first-year hospitalists had higher observed 30-day mortality (10.5 percent vs. 9.97 percent) and observed hospital mortality (3.33 percent vs. 2.96 percent).

After that first year, however, the improvement dropped off, as the study authors found little change in the odds of mortality when comparing second-year hospitalists to those with additional years of experience. 

“There are potential explanations of our findings other than lack of experience producing increased deaths,” Goodwin and his coauthors wrote. “Less experienced hospitalists might be assigned less stable patients. Working in a new hospital with an unfamiliar environment might contribute to the excess mortality associated with first year hospitalists. Hospitalists might become better at coding diagnoses with experience, resulting in artificially lower adjusted mortality for their patients. To reduce this possibility, we did not include discharge diagnoses from the incident admission in assessing comorbidity.”

More research is needed, the authors concluded, to figure out more specific reasons behind their findings. In the short term, they recommended hospitals offer additional support, like mentoring programs, and lighter caseloads to first-year hospitalists. Changes may also be needed in residency programs.

“For example, involving more hospitalist faculty in residency training and creation of hospitalist tracks in residency or hospitalist fellowship programs may prepare individuals better for the challenges early in their hospitalist career,” Goodwin and his coauthors wrote.