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The Production of and Market for New Physicians' Skill

Author

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  • Andrew J. Epstein
  • Sean Nicholson
  • David A. Asch

Abstract

Our understanding of the determinants of physician skill and the extent to which skill is valued in the marketplace is superficial. Using a large, detailed panel of new obstetricians, we find that, even though physicians' maternal complication rates improve steadily with years of practice, initial skill (as measured by performance in a physician's first year of practice) explains most of the variation in physician performance over time. At the same time, we find that the trajectories of new physicians' delivery volume develop in a way partially consistent with Bayesian learning about physician quality. In particular, as physicians gain experience, their volume becomes increasingly sensitive to the information in their accumulated prior.

Suggested Citation

  • Andrew J. Epstein & Sean Nicholson & David A. Asch, 2013. "The Production of and Market for New Physicians' Skill," NBER Working Papers 18678, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:18678
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    File URL: http://www.nber.org/papers/w18678.pdf
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    References listed on IDEAS

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    1. Amol Navathe & Guy David, 2009. "The Formation of Peer Reputation among Physicians and Its Effect on Technology Adoption," Journal of Human Capital, University of Chicago Press, vol. 3(4), pages 289-322.
    2. Epstein, Andrew J., 2010. "Effects of report cards on referral patterns to cardiac surgeons," Journal of Health Economics, Elsevier, vol. 29(5), pages 718-731, September.
    3. Paul Oyer, 2006. "Initial Labor Market Conditions and Long-Term Outcomes for Economists," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 143-160, Summer.
    4. James H. Stock & Mark W. Watson, 2008. "Heteroskedasticity-Robust Standard Errors for Fixed Effects Panel Data Regression," Econometrica, Econometric Society, vol. 76(1), pages 155-174, January.
    5. Fournier, Gary M & McInnes, Melayne Morgan, 2002. "The Effects of Managed Care on Medical Referrals and the Quality of Specialty Care," Journal of Industrial Economics, Wiley Blackwell, vol. 50(4), pages 457-473, December.
    6. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    7. Andrew J. Epstein & Jonathan D. Ketcham & Sean Nicholson, 2010. "Specialization and matching in professional services firms," RAND Journal of Economics, RAND Corporation, vol. 41(4), pages 811-834.
    8. Dranove, David & Wehner, Paul, 1994. "Physician-induced demand for childbirths," Journal of Health Economics, Elsevier, vol. 13(1), pages 61-73, March.
    9. Stock, James H. & Watson, Mark, 2008. "Heteroskedasticity-Robust Standard Errors for Fixed Effects Panel Data Regression," Scholarly Articles 28461843, Harvard University Department of Economics.
    10. Norman K Thurston & Anne M. Libby, 2002. "A Production Function For Physician Services Revisited," The Review of Economics and Statistics, MIT Press, vol. 84(1), pages 184-191, February.
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    Cited by:

    1. Jeffrey E. Harris & Beatriz G. López-Valcárcel & Patricia Barber & Vicente Ortún, 2014. "Efficiency versus Equity in the Allocation of Medical Specialty Training Positions in Spain: A Health Policy Simulation Based on a Discrete Choice Model," NBER Working Papers 19896, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • D83 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Search; Learning; Information and Knowledge; Communication; Belief; Unawareness
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J24 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Human Capital; Skills; Occupational Choice; Labor Productivity
    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality

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