Physician Productivity: Doing More with Less

This projects tests how physicians respond to negative shocks to their daily appointment schedule, employing costly or clinically inappropriate inputs as a substitute for time. To deal with the unobservable differences between patients scheduled for appointments of differing durations, I exploit a natural experiment in which a “flowbuster” patient – one whose observed appointment duration dramatically exceeds scheduled duration – exogenously increases a physician’s private cost of time spent with subsequently scheduled patients.

Preliminary results indicate that physicians catch up following a flowbuster patient by significantly shortening the appointments immediately following a schedule disruption. The appointment immediately following a flowbuster is an average of seven minutes shorter than the elapsed time for similar appointments prior to a schedule disruption. Orders for prescription drugs, lab tests, imaging tests, or specialty referrals may substitute or complement time in the physician’s production function. I examine patients with the most common diagnoses and find that, following a schedule disruption, the likelihood of prescription drug orders increases one to three percent among patients with acute respiratory infections (antibiotics) and those reporting back or joint pain (opioids).  Among patients scheduled for a routine check-up, those who see the physician following a schedule disruption receive fewer diagnoses and lab orders, and have a shorter duration to next appointment.

With more than 11 million newly insured individuals and a largely unchanged physician workforce, increased demand for physician services may result in longer workdays and/or shorter appointments. Results of this research will inform expectations regarding spending growth and quality of care provided by office-based physicians.