Association between physicians' experience after training and maternal obstetrical outcomes: cohort study

Area of Science:

• Obstetrics and Gynecology
• Maternal Health Outcomes
• Healthcare Quality Improvement

Background:

• Physician experience is often linked to improved patient outcomes.
• Understanding the learning curve and experience effect in obstetrics is crucial for patient safety.

Purpose of the Study:

• To investigate the association between obstetricians' post-residency experience and maternal complication rates.
• To quantify the decline in maternal complications over the initial decades of an obstetrician's practice.

Main Methods:

• Retrospective cohort analysis of 6,704,311 deliveries in Florida and New York (1992-2009).
• Examined 5175 obstetricians, analyzing maternal complication rates per physician year.
• Complication rates were assessed for vaginal and cesarean births, adjusted for secular trends.

Main Results:

• Maternal complication rates decreased with increasing obstetrician experience over the first three decades post-residency.
• The rate of improvement was highest in the first decade and diminished in subsequent decades.
• Significant declines were observed: -0.21%/year (decade 1), -0.11%/year (decade 2), and -0.05%/year (decade 3).

Conclusions:

• Increased years of experience among obstetricians are associated with reduced maternal complications.
• This beneficial association is evident throughout the first three decades of practice, though the magnitude of improvement lessens over time.
• Findings highlight the continued development of surgical skills and clinical judgment with practice in obstetrics.