Mortality higher for patients treated by inexperienced hospitalists, study finds

Experience matters when it comes to hospitalists and patient outcomes—at least during that critical first year of practice.

A recent study published in JAMA Internal Medicine found that patients cared for by hospitalists in their first year of experience had higher mortality rates than patients cared for by more experienced doctors.

The researchers said that the findings suggest that hospitalists who are very early in their medical careers may need additional support to ensure optimal outcomes for patients.

The study, from researchers based at the University of Texas Medical Branch in Galveston and the Medical College of Wisconsin, reviewed a 5% national sample of data from July 1, 2003, through June 30, 2014 for Medicare patients and found a “significant association” between hospitalist experience and patient mortality both during hospitalization and in a 30-day follow-up.

An extra year of experience impacted patient mortality, as mortality rates were higher for hospitalists in their first year of practice than their second. The study looked at data for 3,860 first-year hospitalists who continued to practice hospital medicine for at least four years.  

Compared to second-year hospitalists, patients of those doctors in their first year had a higher observed 30-day mortality rate (10.5% vs. 9.97%) as well as an observed hospital mortality (3.33% vs. 2.96%). After that first year, however, the study found little change from comparing second-year hospitalists to those with additional years of experience.

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That is an important finding given that substantial numbers of hospitalists are fresh graduates of residency training programs. While the study did not look at reasons for the higher mortality rates, the researchers speculated that many new hospitalists may experience a dramatic change in their work environment as they transition from their residencies. They may also be challenged by the faster pace and new systems of those hospitals, making it difficult to transition from primary care to hospital medicine.

Hospitals may need to provide additional support and reduced caseloads to hospitalists just starting their careers, the study suggested. The findings should prompt interventions to bolster support systems for new hospitalists, such as mentoring and coaching programs, researchers said.

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,” the study said.

A previous study, also published in JAMA Internal Medicine, found that inpatients who are cared for by their primary care physicians have lower mortality rates than those treated by hospitalists.