How Does Physician Clinical Experience Affect Quality of Care, as Measured by Length of Stay?

Introduction: Length of stay (LOS) is a widely utilized metric of hospital quality and operational efficiency. Prolonged LOS is associated with increased healthcare costs, greater risk of hospital-acquired complications and infections, and reduced bed turnover, negatively affecting patient outcomes and institutional performance. Hospitalists and internal medicine physicians play an integral role in determining a patient's readiness for discharge and facilitating timely transitions of care. Examining factors that influence LOS, including physician characteristics such as clinical experience or time since graduation of residency or licensure may inform strategies to enhance quality of care. Methods: We performed a literature search of PubMed with no restrictions on time, setting, or language to examine the relationship between physician clinical experience (measured in years since licensure or graduation) and inpatient LOS. Results: Results were mixed and inconclusive. Four out of nine included articles found that physician clinical experience was associated with shorter LOS. Two articles associated a longer LOS with more years in practice. Finally, three out of our nine studies noted no differences in LOS by physician clinical experience. Discussion: Collectively, the evidence to date suggests that physician clinical experience alone is not a consistent determinant of LOS, but this is modified by extensive heterogeneity in methodology among included studies. More precise characterization of clinical experience, encompassing factors such as duration of inpatient exposure and patient complexity, is needed. Conclusions: More research with standardized definitions of experience, adjustment for case complexity, and exploration of process-level factors is needed to determine if and how physician clinical experience affects LOS.