“Practice Makes Perfect ”... Or Does It?

The current public focus on health care quality is mobiliz-ing payers and regulatory bodies alike to measure quality of care and to link quality with physician reimbursement through “pay for performance ” (1). For the medical profession to address the public’s concern and improve its care of pa-tients, it must understand the determinants of quality so that physicians can model and emulate predictors of good quality and recognize and remedy predictors of poor quality. To address one potential predictor of quality, in this issue Choudhry and colleagues (2) systematically reviewed data relating experience and age to physician performance. Surprisingly, 70 % of studies demonstrated a negative asso-ciation between length of time in practice and several mea-sures of good physician performance. Although the magni-tude of the association varied, this general relationship held for medical knowledge, adherence to nationally accepte