Variation in Physician Practice Styles within and across Emergency Departments

Abstract

Despite the significant responsibility that physicians have in healthcare delivery, we know surprisingly little about why physician practice styles vary within or across institutions. Estimating variation in physician practice styles is complicated by the fact that patients are rarely randomly assigned to physicians. This paper uses the quasi-random assignment of patients to physicians in emergency departments (EDs) to show how physicians vary in their treatment of patients with minor injuries. The results reveal a considerable degree of variation in practice styles within EDs; physicians at the 75th percentile of the spending distribution spend 20% more than physicians at the 25th percentile. Observable physician characteristics do not explain much of the variation across physicians, but there is a significant degree of sorting between physicians and EDs over time, with high-cost physicians sorting into high-cost EDs as they gain experience. The results may shed light on why some EDs remain persistently higher-cost than others.

What Drives Risky Prescription Opioid Use? Evidence from Migration

“…These include policies such as opioid prescribing limits specifically targeted to the opioid naive(Sacks et al 2021) as well as policies designed to increase access to treatment facilities (Corredor-Waldron and Currie 2022).The feasibility and desirability of policies targeting these place-based channels remains an important open question. In terms of the feasibility of targeting the addiction channel, recent work has documented substantial variation in physician propensity to prescribe opioids for what they believe to be legitimate reasons (e.g.,Barnett, Olenski, and Jena 2017;Schnell and Currie 2018; Eichmeyer and Zhang, forthcoming), which is consistent with the broader evidence of substantial variation across individual physicians in other aspects of practice style (e.g Epstein and Nicholson 2009;Van Parys 2016;Currie and MacLeod 2020;Fadlon and Van Parys 2020;Chan, Gentzkow, and Yu 2022)…”

Association of hospital and community factors on the attainment of Baby‐Friendly designation: A breastfeeding health promotion

“…For example, one study found that Magnet hospitals were predominately located in the northeastern region of the United States (Tai & Bame, 2017 ). Additionally, studies have shown that significant local and regional variations in cost, quality, and types of clinical services exist (Van Parys, 2016 ). Geographical differences included in the model help us control for confounding biases shaped by similar market and economic conditions and account for regional practice pattern variation (Van Parys, 2016 ).…”

“…Additionally, studies have shown that significant local and regional variations in cost, quality, and types of clinical services exist (Van Parys, 2016 ). Geographical differences included in the model help us control for confounding biases shaped by similar market and economic conditions and account for regional practice pattern variation (Van Parys, 2016 ). However, the variation may not be due to demographic or geographic influences but to the local environment (Molitor, 2018 ).…”

Probabilistic Machine Learning for Healthcare

“…First, there is inherent randomness in how patients are treated as well as in healthcare data-collection. For example, dosages can differ across hospital practices; so can reporting standards and practices (133,134). There may also be some uncertainty between when a drug was administered versus when the intervention was recorded.…”