Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians

51 Pages Posted: 8 May 2013

See all articles by Janet Currie

Janet Currie

Princeton University; National Bureau of Economic Research (NBER); Institute for the Study of Labor (IZA)

W. Bentley MacLeod

Columbia University - Department of Economics; National Bureau of Economic Research (NBER); IZA Institute of Labor Economics

Date Written: April 2013

Abstract

Expert performance is often evaluated in a one dimensional way by assuming that good experts have good outcomes. We examine the example of expertise in medicine and develop a model that allows for two dimensions of physician performance: Procedural decision making and skill performing procedures. Higher procedural skill increases the use of intensive procedures across the board, while better decision making results in fewer intensive procedures for the low risk, but more for the high risk. Deriving empirical analogues to our theoretical measures for the case of C-section, we show that poor diagnosticians can be identified using administrative data and that improving decision making would reduce C-section rates by 15.5% in the bottom half of the risk distribution, and increase them by 5.5% in the top half. Because there are many more C-sections in the high risk, these numbers imply that the overall rate of C-section is too low rather than too high and that reallocating C-sections from low risk to high risk women could improve health outcomes among mothers and babies. Our results suggest that focusing on the choices of experts as well as the outcomes achieved could contribute to evaluating expert performance in other settings.

Suggested Citation

Currie, Janet and MacLeod, William Bentley, Diagnosing Expertise: Human Capital, Decision Making and Performance Among Physicians (April 2013). NBER Working Paper No. w18977. Available at SSRN: https://ssrn.com/abstract=2262170

Janet Currie (Contact Author)

Princeton University ( email )

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HOME PAGE: http://www.princeton.edu/~jcurrie

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Institute for the Study of Labor (IZA)

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William Bentley MacLeod

Columbia University - Department of Economics ( email )

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United States

National Bureau of Economic Research (NBER)

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Cambridge, MA 02138
United States

IZA Institute of Labor Economics ( email )

P.O. Box 7240
Bonn, D-53072
Germany

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