IDEAS home Printed from https://ideas.repec.org/a/aea/aejpol/v10y2018i1p326-56.html
   My bibliography  Save this article

The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration

Author

Listed:
  • David Molitor

Abstract

Physician treatment choices for observably similar patients vary dramatically across regions. This paper exploits cardiologist migration to disentangle the role of physician-specific factors such as preferences and learned behavior versus environment-level factors such as hospital capacity and productivity spillovers on physician behavior. Physicians starting in the same region and subsequently moving to dissimilar regions practice similarly before the move. After the move, physician behavior in the first year changes by 0.6–0.8 percentage points for each percentage point change in practice environment, with no further changes over time. This suggests environment factors explain between 60–80 percent of regional disparities in physician behavior.

Suggested Citation

  • David Molitor, 2018. "The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 326-356, February.
  • Handle: RePEc:aea:aejpol:v:10:y:2018:i:1:p:326-56
    Note: DOI: 10.1257/pol.20160319
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/articles?id=10.1257/pol.20160319
    Download Restriction: no

    File URL: https://www.aeaweb.org/content/file?id=6419
    Download Restriction: no

    File URL: https://www.aeaweb.org/articles/attachments?retrieve=h2GfEDMnOtEByiocAVS5eFF2TgE1vSLw
    Download Restriction: no

    File URL: https://www.aeaweb.org/articles/attachments?retrieve=P-kPM6zH6RB8YCnfXip9FlsXDerHCFCc
    Download Restriction: Access to full text is restricted to AEA members and institutional subscribers.
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association, vol. 50(3), pages 413-25, September.
    2. Andrea Ichino & Giovanni Maggi, 2000. "Work Environment and Individual Background: Explaining Regional Shirking Differentials in a Large Italian Firm," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(3), pages 1057-1090.
    3. Angrist, Joshua D., 2014. "The perils of peer effects," Labour Economics, Elsevier, vol. 30(C), pages 98-108.
    4. Charles F. Manski, 1993. "Identification of Endogenous Social Effects: The Reflection Problem," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 60(3), pages 531-542.
    5. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    6. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    7. Tomas J. Philipson & Seth A. Seabury & Lee M. Lockwood & Dana P. Goldman & Darius N. Lakdawalla, 2010. "Geographic Variation in Health Care: The Role of Private Markets," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 41(1 (Spring), pages 325-361.
    8. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association;National Tax Journal, vol. 50(3), pages 413-425, September.
    9. Bart J. Bronnenberg & Jean-Pierre H. Dube & Matthew Gentzkow, 2012. "The Evolution of Brand Preferences: Evidence from Consumer Migration," American Economic Review, American Economic Association, vol. 102(6), pages 2472-2508, October.
    10. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    11. Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
    12. Phelps, Charles E., 2000. "Information diffusion and best practice adoption," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 5, pages 223-264, Elsevier.
    13. Charles E. Phelps, 1992. "Diffusion of Information in Medical Care," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 23-42, Summer.
    14. Dranove David & Ramanarayanan Subramaniam & Sfekas Andrew, 2011. "Does the Market Punish Aggressive Experts? Evidence from Cesarean Sections," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(2), pages 1-33, January.
    15. Doyle Jr., Joseph J. & Ewer, Steven M. & Wagner, Todd H., 2010. "Returns to physician human capital: Evidence from patients randomized to physician teams," Journal of Health Economics, Elsevier, vol. 29(6), pages 866-882, December.
    16. McClellan, Mark & Newhouse, Joseph P., 1997. "The marginal cost-effectiveness of medical technology: A panel instrumental-variables approach," Journal of Econometrics, Elsevier, vol. 77(1), pages 39-64, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    2. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    3. Anna A. Levine Taub & Anton Kolotilin & Robert S. Gibbons & Ernst R. Berndt, 2011. "The Diversity of Concentrated Prescribing Behavior: An Application to Antipsychotics," NBER Working Papers 16823, National Bureau of Economic Research, Inc.
    4. Janet Currie & W. Bentley MacLeod & Jessica Van Parys, 2015. "Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks," NBER Working Papers 21218, National Bureau of Economic Research, Inc.
    5. David C. Chan, Jr, 2016. "Informational Frictions and Practice Variation: Evidence from Physicians in Training," NBER Working Papers 21855, National Bureau of Economic Research, Inc.
    6. Jessica Van Parys, 2016. "Variation in Physician Practice Styles within and across Emergency Departments," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-19, August.
    7. Janet M. Currie & W. Bentley MacLeod, 2018. "Understanding Doctor Decision Making: The Case of Depression," NBER Working Papers 24955, National Bureau of Economic Research, Inc.
    8. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    9. Alexander Ahammer & Thomas Schober, 2020. "Exploring variations in health‐care expenditures—What is the role of practice styles?," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 683-699, June.
    10. Peter Rønø Thingholm, 2023. "Provider Spill-Overs in Opioid Prescription Leniency and Patient – Labor Market Outcomes," Economics Working Papers 2023-05, Department of Economics and Business Economics, Aarhus University.
    11. Andrew J. Rettenmaier & Zijun Wang, 2012. "Regional variations in medical spending and utilization: a longitudinal analysis of US Medicare population," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 67-82, February.
    12. Barrenho, Eliana & Miraldo, Marisa & Propper, Carol & Walsh, Brendan, 2021. "The importance of surgeons and their peers in adoption and diffusion of innovation: An observational study of laparoscopic colectomy adoption and diffusion in England," Social Science & Medicine, Elsevier, vol. 272(C).
    13. Lundborg, Petter & James, Stefan & Lagerqvist, Bo & Vikström, Johan, 2021. "Learning-by-Doing and Productivity Growth among High-Skilled Workers: Evidence from the Treatment of Heart Attacks," IZA Discussion Papers 14744, Institute of Labor Economics (IZA).
    14. Berndt, Ernst R. & Gibbons, Robert S. & Kolotilin, Anton & Taub, Anna Levine, 2015. "The heterogeneity of concentrated prescribing behavior: Theory and evidence from antipsychotics," Journal of Health Economics, Elsevier, vol. 40(C), pages 26-39.
    15. Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43.
    16. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    17. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    18. Godøy, Anna & Dale-Olsen, Harald, 2018. "Spillovers from gatekeeping – Peer effects in absenteeism," Journal of Public Economics, Elsevier, vol. 167(C), pages 190-204.
    19. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Thingholm, Peter Rønø, 2021. "Discontinuity in care: Practice closures among primary care providers and patient health care utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    20. Semih Tumen & Tugba Zeydanli, 2016. "Social interactions in job satisfaction," International Journal of Manpower, Emerald Group Publishing Limited, vol. 37(3), pages 426-455, June.

    More about this item

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:aejpol:v:10:y:2018:i:1:p:326-56. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.