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Physicians under Pressure: Evidence from Antibiotics Prescribing in England

Author

Listed:
  • Thomas Allen

    (Manchester Centre for Health Economics, University of Manchester, Manchester, UK
    Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark)

  • Dorte Gyrd-Hansen

    (Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark)

  • Søren Rud Kristensen

    (Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
    Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK)

  • Anne Sophie Oxholm

    (Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark)

  • Line Bjørnskov Pedersen

    (Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
    Research Unit for General Practice, University of Southern Denmark, J..B, Odense C, Denmark)

  • Mario Pezzino

    (School of Social Sciences, University of Manchester, Manchester, UK)

Abstract

Background Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians’ decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. Setting We test our prediction on general practitioners’ antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. Methods We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs’ prescribing. Results We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. Conclusions Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians’ work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45 Highlights Many physicians are working under increasing pressure. We test the importance of pressure on physicians’ prescribing of antibiotics. The prescribed rate of broad-spectrum antibiotics increases with pressure. Policy makers should be aware of the societal costs of pressured physicians.

Suggested Citation

  • Thomas Allen & Dorte Gyrd-Hansen & Søren Rud Kristensen & Anne Sophie Oxholm & Line Bjørnskov Pedersen & Mario Pezzino, 2022. "Physicians under Pressure: Evidence from Antibiotics Prescribing in England," Medical Decision Making, , vol. 42(3), pages 303-312, April.
    • Handle: RePEc:sae:medema:v:42:y:2022:i:3:p:303-312
    DOI: 10.1177/0272989X211069931
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    References listed on IDEAS

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    Cited by:

    1. Andrews, Brendon P., 2024. "Medical ethics and physician motivations," Journal of Health Economics, Elsevier, vol. 98(C).
    2. Anne Sophie Oxholm & Dorte Gyrd-Hansen & Christian Bøtcher Jacobsen & Ulrich Thy Jensen & Line Bjørnskov Pedersen, 2024. "The link between physician motivation and care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(3), pages 525-537, April.
    3. Souček, Claudia & Reggiani, Tommaso & Kairies-Schwarz, Nadja, 2025. "Physicians’ responses to time pressure: Experimental evidence on treatment quality and documentation behaviour," Health Policy, Elsevier, vol. 155(C).

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    Keywords

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J28 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Safety; Job Satisfaction; Related Public Policy
    • J45 - Labor and Demographic Economics - - Particular Labor Markets - - - Public Sector Labor Markets

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