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 starkly different backgrounds, training, and pay. Using quasi-experimental variation in patient assignment to NPs versus physicians in Veterans Health Administration emergency departments, we find that, on average, NPs use more resources and exhibit a higher 30-day preventable hospitalization rate than physicians. However, the NP-physician performance difference varies by case complexity and severity. Importantly, even larger productivity variation exists within each profession, leading to substantial overlap between the productivity distributions of the two professions; NPs outperform physicians in 38 percent of random pairs.