The formation and evolution of physician treatment styles: An application to cesarean sections

Abstract

Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using data on the universe of deliveries in Florida and New York over a 15-year period, we examine why treatment styles differ across obstetricians at a point in time and why styles change over time. We find that variation in c-section rates across physicians within a market is about twice as large as variation between markets. Surprisingly, residency programs explain no more than four percent of the variation in physicians' risk-adjusted c-section rates, even among newly trained physicians. Although we find evidence that physicians learn from their peers, they do not substantially revise their prior beliefs regarding treatment due to the local exchange of information. Our results indicate that physicians are not likely to converge over time to a community standard; thus, within-market variation in treatment styles is likely to persist.

Addressing the Opioid Epidemic: Is There a Role for Physician Education?

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Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians

“…Both Epstein and Nicholson (2009) and Dranove, Ramanarayanan, and Sfekas (2011) investigate the prevalence of spillovers in the case of C-sections, and neither find much evidence for them: there is no convergence in practice styles among physicians in the same hospitals over time. Similarly, Chan (2015) looks at how doctors’ practice style develops early in their careers and finds that the practice styles of attending physicians have little impact on those junior to them.…”

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“…However, physician-specific factors such as preferences, training, and experience may cause physicians to treat patients differently even under similar environments. Consistent with this possibility, physicians practicing in the same local health care market often exhibit large and persistent “style” differences in their tendency to prescribe certain treatments and utilize medical resources (Phelps 2000, Grytten and Sørensen 2003, and Epstein and Nicholson 2009). These styles exist even when physicians have access to the same hospital facilities and ancillary staff and when the patients are randomized to physician teams (Doyle, Ewer, and Wagner 2010).…”