The Productivity of Professions: Evidence from the Emergency Department

This paper studies the productivity of nurse practitioners (NPs) and physicians, two professions performing overlapping tasks but with starkly different backgrounds, training, and pay. Using quasi-experimental variation in patient assignment to NPs versus physicians in Veterans Health Administration emergency departments, we find that, on average, NPs use more resources and achieve less favorable patient outcomes than physicians. However, the NP-physician performance difference varies by case complexity and severity. Importantly, even larger productivity variation exists within each profession, leading to substantial overlap between the productivity distributions of the two professions; NPs perform better than physicians in 38 percent of random pairs.