Association between physicians’ experience after training and maternal obstetrical outcomes: cohort study
Objective To assess the association between obstetricians’ years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice. Design Retrospective cohort analysis. Setting Obstetrical discharges from acute care hospitals in Flo...
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| Veröffentlicht in: | BMJ (Online) 2013-03, Vol.346 (7905), p.14-14 |
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| creator | Epstein, Andrew J Srinivas, Sindhu K Nicholson, Sean Herrin, Jeph Asch, David A |
| description | Objective To assess the association between obstetricians’ years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice. Design Retrospective cohort analysis. Setting Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009. Population 6 704 311 deliveries performed by 5175 obstetricians. Main outcome measure Three composite measures of maternal complication rates per physician year from vaginal and cesarean births separately and combined, adjusted for secular trends. Results Obstetricians’ maternal complication rates declined during the first three decades after completion of residency. The improvement was largest in the first decade and diminished thereafter. For all deliveries, the change was −0.21 (95% confidence interval −0.23 to −0.19) percentage points per year in the first decade, −0.11 (−0.13 to −0.09) percentage points per year in the second decade, and −0.05 (−0.08 to −0.01) percentage points in the third decade (P |
| doi_str_mv | 10.1136/bmj.f1596 |
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Design Retrospective cohort analysis. Setting Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009. Population 6 704 311 deliveries performed by 5175 obstetricians. Main outcome measure Three composite measures of maternal complication rates per physician year from vaginal and cesarean births separately and combined, adjusted for secular trends. Results Obstetricians’ maternal complication rates declined during the first three decades after completion of residency. The improvement was largest in the first decade and diminished thereafter. For all deliveries, the change was −0.21 (95% confidence interval −0.23 to −0.19) percentage points per year in the first decade, −0.11 (−0.13 to −0.09) percentage points per year in the second decade, and −0.05 (−0.08 to −0.01) percentage points in the third decade (P<0.001 for second to first decade comparison; P=0.001 for third to second decade comparison). The patterns were comparable for cesarean deliveries and vaginal deliveries and across several sensitivity checks. Conclusions Among obstetricians practicing in Florida and New York, those with more years of experience had fewer maternal complications. This association persisted over the first three decades of practice but diminished in magnitude.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.f1596</identifier><identifier>PMID: 23538919</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adult ; Body mass index ; Calendars ; Careers ; Cesarean section ; Clinical Competence - statistics & numerical data ; Cohort analysis ; Cohort Studies ; Confidence intervals ; Ethnicity ; Female ; Florida ; Gynecology ; Humans ; Medicaid ; Medical practice ; Mortality ; New York ; Obstetric labor complications ; Obstetric Labor Complications - etiology ; Obstetrics ; Patient Discharge - statistics & numerical data ; Patients ; Physicians ; Practice Patterns, Physicians' - statistics & numerical data ; Pregnancy ; Pregnancy complications ; Pregnancy Complications - etiology ; Pregnancy outcome ; Pregnancy Outcome - epidemiology ; Retrospective Studies ; Surgeons ; Training ; Vagina ; Young Adult</subject><ispartof>BMJ (Online), 2013-03, Vol.346 (7905), p.14-14</ispartof><rights>Epstein et al 2013</rights><rights>BMJ Publishing Group Ltd 2013</rights><rights>Copyright BMJ Publishing Group LTD Mar 28, 2013</rights><rights>Copyright: 2013 © Epstein et al 2013</rights><rights>Epstein et al 2013 2013 Epstein et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b586t-d8dadc4b67a811064a436fe92f77e231b254521ba56b1dc54196b13b9a0ea71c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/346/bmj.f1596.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/346/bmj.f1596.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,776,780,799,881,3183,23550,27901,27902,57992,58225,77569,77600</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23538919$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Epstein, Andrew J</creatorcontrib><creatorcontrib>Srinivas, Sindhu K</creatorcontrib><creatorcontrib>Nicholson, Sean</creatorcontrib><creatorcontrib>Herrin, Jeph</creatorcontrib><creatorcontrib>Asch, David A</creatorcontrib><title>Association between physicians’ experience after training and maternal obstetrical outcomes: cohort study</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To assess the association between obstetricians’ years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice. Design Retrospective cohort analysis. Setting Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009. Population 6 704 311 deliveries performed by 5175 obstetricians. Main outcome measure Three composite measures of maternal complication rates per physician year from vaginal and cesarean births separately and combined, adjusted for secular trends. Results Obstetricians’ maternal complication rates declined during the first three decades after completion of residency. The improvement was largest in the first decade and diminished thereafter. For all deliveries, the change was −0.21 (95% confidence interval −0.23 to −0.19) percentage points per year in the first decade, −0.11 (−0.13 to −0.09) percentage points per year in the second decade, and −0.05 (−0.08 to −0.01) percentage points in the third decade (P<0.001 for second to first decade comparison; P=0.001 for third to second decade comparison). The patterns were comparable for cesarean deliveries and vaginal deliveries and across several sensitivity checks. Conclusions Among obstetricians practicing in Florida and New York, those with more years of experience had fewer maternal complications. This association persisted over the first three decades of practice but diminished in magnitude.</description><subject>Adult</subject><subject>Body mass index</subject><subject>Calendars</subject><subject>Careers</subject><subject>Cesarean section</subject><subject>Clinical Competence - statistics & numerical data</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Florida</subject><subject>Gynecology</subject><subject>Humans</subject><subject>Medicaid</subject><subject>Medical practice</subject><subject>Mortality</subject><subject>New York</subject><subject>Obstetric labor complications</subject><subject>Obstetric Labor Complications - etiology</subject><subject>Obstetrics</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patients</subject><subject>Physicians</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Pregnancy Complications - etiology</subject><subject>Pregnancy outcome</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Training</subject><subject>Vagina</subject><subject>Young Adult</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ks1u1DAUhS0EoqOhCx4AFAkWsEjxjeO_LpCqEb9qQUiA2FlO4nQ8ndiD7UBnx2vwejwJHlJGBQlWvrrn09GxjxG6C_gIgLAnzbA66oFKdgPNgFNWgiDkJpphSWUpgIgDdBjjCmNcES4ko7fRQUUoERLkDF2cxOhbq5P1rmhM-mqMKzbLbbR56eKPb98Lc7kxwRrXmkL3yYQiBW2ddeeFdl0x6Lxyel34JiaTgm1385haP5h4XLR-6UMqYhq77R10q9fraA6vzjn68PzZ-8XL8vTti1eLk9OyoYKlshOd7tq6YVwLAMxqXRPWG1n1nJuKQFPRmlbQaMoa6Fpag8wDaaTGRnNoyRw9nXw3YzOYrjUuJ16rTbCDDlvltVV_Ks4u1bn_oggDTKnIBo-uDIL_PJqY1GBja9Zr7YwfowJSAZcMRJXRB3-hKz_u3iNTsqaMAK7kfynOBWYcw456PFFt8DEG0-8jA1a7rlXuWv3qOrP3r99xT_5uNgP3JmAVkw_X9DrHyt9ijspJt7m2y72uw4VinHCq3nxcKDj79Lqm784Uz_zDid9l-Heun6uMy7g</recordid><startdate>20130328</startdate><enddate>20130328</enddate><creator>Epstein, Andrew J</creator><creator>Srinivas, Sindhu K</creator><creator>Nicholson, Sean</creator><creator>Herrin, Jeph</creator><creator>Asch, David A</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130328</creationdate><title>Association between physicians’ experience after training and maternal obstetrical outcomes: cohort study</title><author>Epstein, Andrew J ; Srinivas, Sindhu K ; Nicholson, Sean ; Herrin, Jeph ; Asch, David A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b586t-d8dadc4b67a811064a436fe92f77e231b254521ba56b1dc54196b13b9a0ea71c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Body mass index</topic><topic>Calendars</topic><topic>Careers</topic><topic>Cesarean section</topic><topic>Clinical Competence - statistics & numerical data</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Florida</topic><topic>Gynecology</topic><topic>Humans</topic><topic>Medicaid</topic><topic>Medical practice</topic><topic>Mortality</topic><topic>New York</topic><topic>Obstetric labor complications</topic><topic>Obstetric Labor Complications - etiology</topic><topic>Obstetrics</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patients</topic><topic>Physicians</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Pregnancy</topic><topic>Pregnancy complications</topic><topic>Pregnancy Complications - etiology</topic><topic>Pregnancy outcome</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Training</topic><topic>Vagina</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Epstein, Andrew J</creatorcontrib><creatorcontrib>Srinivas, Sindhu K</creatorcontrib><creatorcontrib>Nicholson, Sean</creatorcontrib><creatorcontrib>Herrin, Jeph</creatorcontrib><creatorcontrib>Asch, David A</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied & Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Epstein, Andrew J</au><au>Srinivas, Sindhu K</au><au>Nicholson, Sean</au><au>Herrin, Jeph</au><au>Asch, David A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between physicians’ experience after training and maternal obstetrical outcomes: cohort study</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2013-03-28</date><risdate>2013</risdate><volume>346</volume><issue>7905</issue><spage>14</spage><epage>14</epage><pages>14-14</pages><issn>0959-8138</issn><issn>1756-1833</issn><eissn>1756-1833</eissn><abstract>Objective To assess the association between obstetricians’ years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice. Design Retrospective cohort analysis. Setting Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009. Population 6 704 311 deliveries performed by 5175 obstetricians. Main outcome measure Three composite measures of maternal complication rates per physician year from vaginal and cesarean births separately and combined, adjusted for secular trends. Results Obstetricians’ maternal complication rates declined during the first three decades after completion of residency. The improvement was largest in the first decade and diminished thereafter. For all deliveries, the change was −0.21 (95% confidence interval −0.23 to −0.19) percentage points per year in the first decade, −0.11 (−0.13 to −0.09) percentage points per year in the second decade, and −0.05 (−0.08 to −0.01) percentage points in the third decade (P<0.001 for second to first decade comparison; P=0.001 for third to second decade comparison). The patterns were comparable for cesarean deliveries and vaginal deliveries and across several sensitivity checks. Conclusions Among obstetricians practicing in Florida and New York, those with more years of experience had fewer maternal complications. This association persisted over the first three decades of practice but diminished in magnitude.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>23538919</pmid><doi>10.1136/bmj.f1596</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Body mass index Calendars Careers Cesarean section Clinical Competence - statistics & numerical data Cohort analysis Cohort Studies Confidence intervals Ethnicity Female Florida Gynecology Humans Medicaid Medical practice Mortality New York Obstetric labor complications Obstetric Labor Complications - etiology Obstetrics Patient Discharge - statistics & numerical data Patients Physicians Practice Patterns, Physicians' - statistics & numerical data Pregnancy Pregnancy complications Pregnancy Complications - etiology Pregnancy outcome Pregnancy Outcome - epidemiology Retrospective Studies Surgeons Training Vagina Young Adult |
| title | Association between physicians’ experience after training and maternal obstetrical outcomes: cohort study |
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