The Formation and Evolution of Physician Treatment Styles: An Application to Cesarean Sections

42 Pages Posted: 21 Sep 2005 Last revised: 24 Jul 2021

See all articles by Andrew Joel Epstein

Andrew Joel Epstein

Yale University - School of Public Health

Sean Nicholson

Cornell University - Department of Policy Analysis & Management (PAM); National Bureau of Economic Research (NBER)

Date Written: August 2005

Abstract

Small-area-variation studies have shown that physician treatment styles differ substantially both between and within markets, controlling for patient characteristics. Using a data set containing the universe of deliveries in Florida over a 12-year period with consistent physician identifiers and a rich set of patient characteristics, we examine why treatment styles differ across obstetricians at a point in time, and why styles change over time. We find that the variation in c-section rates across physicians within a market is two to three times greater than the variation between markets. Surprisingly, residency programs explain less than four percent of the variation between physicians in their risk-adjusted c-section rates, even among newly-trained physicians. Although we find evidence that physicians, especially relatively inexperienced ones, learn from their peers, they do not substantially revise their prior beliefs regarding how patients should be treated due to the local exchange of information. Our results indicate that physicians are not likely to converge over time to a community standard; thus, within-market variation in treatment styles is likely to persist.

Suggested Citation

Epstein, Andrew Joel and Nicholson, Sean, The Formation and Evolution of Physician Treatment Styles: An Application to Cesarean Sections (August 2005). NBER Working Paper No. w11549, Available at SSRN: https://ssrn.com/abstract=785007

Andrew Joel Epstein

Yale University - School of Public Health

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Sean Nicholson (Contact Author)

Cornell University - Department of Policy Analysis & Management (PAM) ( email )

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National Bureau of Economic Research (NBER)

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