Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

We study the impact of physician workload on hospital reimbursement utilizing a detailed data set from the trauma department of a major urban hospital. We find that the proportion of patients assigned a "high-severity" status for reimbursement purposes, which maps, on average, to a 47.8% higher payment for the hospital, is substantially reduced as the workload of the discharging physician increases. This effect persists after we control for a number of systematic differences in patient characteristics, condition, and time of discharge. Furthermore, we show that it is unlikely to be caused by selection bias or endogeneity in either discharge timing or allocation of discharges to physicians. We attribute this phenomenon to a workload-induced reduction in diligence of paperwork execution. We estimate the associated monetary loss to be approximately 1.1% (95% confidence interval, 0.4%-1.9%) of the department's annual revenue.