Learning-by-Doing in a High-Skill Profession when Stakes are High: Evidence from Advanced Cancer Surgery

Although learning-by-doing is believed to be an important source of productivity growth there is limited evidence that production volume affects productivity in a causal sense. We document evidence of learning-by-doing in a high-skill profession where stakes are high; advanced cancer surgery. For this purpose, we introduce a novel instrument that exploits closures and openings of entire cancer clinics which has given rise to sharp and exogenous changes in cancer surgical volume performed at Swedish public sector hospitals. Using detailed register data on more than 100,000 episodes of advanced cancer surgery our results suggest positive effects of surgery volume on survival. In addition, we provide evidence on the mechanisms through which these improvements occur. We also show that results are not driven by changes in patient composition or by other changes at the hospital level.