Physicians’ use of medical technology: an analysis of the introduction and subsequent failure of drug-eluting stents

Using data on cardiac patients in Florida hospitals from 2003 to 2007, we analyse the adoption and deadoption of a major new medical technology, drug-eluting stents (DESs). The Food and Drug Administration approved DESs in April 2003 and physicians rapidly adopted the new technology. In March 2006, a presentation was made at the American Cardiology Conference which showed that patients receiving DES in real-world settings suffered higher rates of mortality and myocardial infarction than those receiving stents without drugs. We examine the utilization of DES from April 2003 to the end of 2007. Using a hospital fixed-effects model, we find that board-certified and top-trained physicians were initially quicker to adopt DES. Over time, this effect dissipated and top-trained physicians were less likely to use DES by the time new clinical trials indicated they could be problematic. After the news, board-certified and top-ranked physicians were less likely to change their behaviour. Physicians’ own experience also contributes to the use of technology and the effects are stronger for non-board-certified physicians. We conclude that even within hospitals, physician training and experience play an important role in explaining differences in rates of technology use.