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More Experienced Physicians May Provide Lower Quality of Care
Medscape are reporting from Ann Intern Med. 2005:142:260-273, 302-303:
Conventional wisdom about physician expertise generally holds that the longer a physician has been in practice, the better honed his or her clinical skills become. But a new study turns that adage on its head with its conclusion that physicians who have been in practice longer may, in fact, provide lower quality of care.
The problem is not that more experienced physicians are not intelligent, well-trained or competent, and the findings "should not be used to put the blame on older physicians," said study lead author Niteesh K. Choudhry, MD, an instructor of medicine at Harvard Medical School in Boston, Massachusetts. Instead, "the problem is that we've been relying on methods that may not be very effective in requiring that physicians keep up to date."
To address that gap, the traditional methods of keeping physicians' knowledge and clinical practice current need to be reexamined and altered, according to the study. "Over the past 15 or 20 years, there has been a body of literature generated that helps to identify what techniques work and don't work," Dr. Choudhry told Medscape in an interview. "We should refocus our efforts for recertification and relicensing on that."
The study linking physician years in practice to quality of care, published in the Feb. 15 issue of the Annals of Internal Medicine, was based on a Medline review of 59 articles from 1996 through 2004 that reported data on 62 groups of outcomes. Studies were included if they were original reports that provided empirical results; measured knowledge, guideline adherence, mortality, or some other type of quality-of-care process; and included years since graduation from medical school, years since certification, or physician age as a potential variable influencing results.
Research shows that more experienced physicians are providing less effective care. But the study's authors say the problem is not about age.
Robert H. Fletcher, MD, considers himself an "older physician." A professor emeritus at Harvard Medical School and the former editor of the Annals of Internal Medicine, he graduated from Harvard in 1966.
So it was with a sympathetic heart that he co-authored a study showing that doctors in practice for longer periods of time are more likely to possess less factual knowledge, are less likely to follow appropriate standards of care and more likely to have poorer patient outcomes