Inside the Institutional Black-box: A Closer Look at Physicians
The literature on patient outcomes such as re-admissions, length of stay, and mortality has mainly focused on traditional hospital, physician and patient characteristics in explaining variations in these outcomes. In most modern circumstances, physicians are key agents in delivering care but do so in a broader institutional context. This suggests that understanding the forces that affect the evolution of physician practice styles within a hospital as well as physician-hospital interactions are critical to addressing these hospital outcomes. In this session, we present three papers (several of which are by physician-economists) that investigate previously unexplored physician-level characteristics that relate to the dynamics of physician practice styles within hospitals. In the first paper, David Chan focuses on physicians in training and examines the importance of learning and authority on the development of practice styles. In the second paper, Anupam Jena, Lena Schoemaker and Jay Bhattacharya focus on physicians after their completion of residency and investigate whether physician quality is associated with recent major reforms that have reduce resident work hours (i.e. the new ’80 hour work week’). In the third paper, Andrew Wilcock and Pinar Karaca-Mandic study cardiologists, and investigate the role of physician-hospital integration on patient mortality following percutaneous coronary interventions.