Healthcare Labor Markets
Paper Session
Friday, Jan. 3, 2025 8:00 AM - 10:00 AM (PST)
- Chair: Joshua D. Gottlieb, University of Chicago
The Productivity of Professions: Evidence from the Emergency Department
Abstract
This paper studies the productivity of nurse practitioners (NPs) and physicians, two professions performing overlapping tasks but with stark differences in background, training, and pay. Using quasi-experimental variation in patient assignment to NPs versus physicians in 44 Veterans Health Administration emergency departments, we find that, on average, NPs use more resources but achieve worse patient outcomes relative to physicians. The costs of lower productivity surpass the pay differences between the professions. Yet even larger productivity variation exists within each profession, implying substantial productivity overlap between the two professions. Within professions, wages and assigned patient complexity vary only weakly with productivity.Gender Differences in Non-Promotable Tasks: The Case of Clinical Note-Taking
Abstract
Medicine has a reputation of being a gender-egalitarian profession, but there is also evidence of persistent differences in hours worked as well as procedures and tasks performed. We investigate gender differences on the intensive margin in detail by leveraging a unique dataset that contains granular information based on the Electronic Medical Records and Audit Log at a large teaching hospital. Our primary analysis sample contains 1,620 physicians, of which about 47% are women. In this highly standardized environment, we find that even after controlling for a detailed set of physician attributes, women spend about 10% more time on notes per shift than men. Next, we show that patients quasi-randomly assigned to female physicians upon inpatient hospital admission receive 7.6% fewer orders without any declines in quality of care (readmissions or days in the hospital). Analysis of note text reveals that women include 23% more clinical concepts in their notes. Despite meaningful improvements in clinical efficiency caused by additional note writing effort, physician salary and other measures of career advancement are not correlated with this value-adding task.The Rise of Midlevels in Healthcare Supply
Abstract
We document the growth in mid-level practitioners' role in providing healthcare in the United States and unpack the reasons for this growth using a model of task allocation. Combining medical claims with internal Census data, we consider explanations related to changing regulation, technology, and labor supply. While scope of practice deregulation increases demand for midlevels, this effect is too small to explain the change in labor markets. Technological change may have increased midlevels' relative productivity, but cannot explain their highly varied geographic patterns. Instead, we show that growth in healthcare demand, combined with doctors' increasing preference to live in urban and well-educated regions of the country, primarily drives substitution to midlevels. We use our estimates to project future demand for these occupations.Discussant(s)
Diane Alexander
,
University of Pennsylvania
JEL Classifications
- J4 - Particular Labor Markets