"Patients cared for by physicians in their first year as hospitalists have worse 30-day and hospital mortality when compared with more experienced hospitalists. Hospitalists very early in their careers may benefit from additional support and reduced caseloads."
Recently reported in JAMA was that the 30-day mortality rate for patients cared for by a physician hospitalist in their first year of practice was 10.51% compared to 9.97% for the second year of practice, and OR of 0.90. These rates stabilized after the second year of practice.
It is a humbling statistic for all providers to consider mortality rates for care, and while this study addresses only our physician colleagues, the concern can easily be extrapolated to NP practice. It does raise the question of what the profession can do to help stabilize novice providers during their transition/role socialization especially given that while physicians have completed essentially 2-3+ years of supervised practice (residency) there are now states where this is not required of novice NPs.
In light of these data, are there ways that active NPs can help address support novices in the first year of practice?
One proposed solution is active mentorship that extends beyond formal training into clinical practice. Mentorship has been shown in the literature to be a significant factor in both in terms of role socialization and novice clinical practice. Should the impetus fall on the novice provider to establish one or more clinical mentors? Should it fall on NP programs to foster mentorship? Should it fall on the BON to require it int he first year of practice?
Residency/fellowship programs are often suggested as well, however, if the physician residency program still result in a higher mortality in the first year of practice would these program do anything to combat that ultimate transition?
Other thoughts?
Hope there is a constructive discussion on the issue.
Goodwin, J. S., Salameh, H., Zhou, J., Singh, S., Kuo, Y. F., & Nattinger, A. B. (2017). Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA internal medicine.
