Patients of doctors further from medical school graduation have poorer outcomes.

Context: There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume.

Objectives: This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes.

Methods: This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed.

Results: After adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality.

Conclusions: Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning.