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Healthcare Labor Markets

Paper Session

Friday, Jan. 3, 2025 8:00 AM - 10:00 AM (PST)

Hilton San Francisco Union Square, Union Square 24
Hosted By: Econometric Society
  • Chair: Joshua D. Gottlieb, University of Chicago

Gender Differences in Non-Promotable Tasks: The Case of Clinical Note-Taking

Bryan Chu
,
University of California-Berkeley
Benjamin Handel
,
University of California-Berkeley
Jonathan Kolstad
,
University of California-Berkeley
Ulrike Malmendier
,
University of California-Berkeley

Abstract

Medicine has a reputation of being a gender-egalitarian profession, but there is also evidence of persistent differences in hours worked as well as procedures and tasks performed. We investigate gender differences on the intensive margin in detail by leveraging a unique dataset that contains granular information based on the Electronic Medical Records and Audit Log at a large teaching hospital. Our primary analysis sample contains 1,620 physicians, of which about 47% are women. In this highly standardized environment, we find that even after controlling for a detailed set of physician attributes, women spend about 10% more time on notes per shift than men. Next, we show that patients quasi-randomly assigned to female physicians upon inpatient hospital admission receive 7.6% fewer orders without any declines in quality of care (readmissions or days in the hospital). Analysis of note text reveals that women include 23% more clinical concepts in their notes. Despite meaningful improvements in clinical efficiency caused by additional note writing effort, physician salary and other measures of career advancement are not correlated with this value-adding task.

Should Top Surgeons Practice at Top Hospitals? Sorting and Complementarities in Healthcare

Pauline Mourot
,
Boston University

Abstract

How does the existence of complementarities between surgeon and hospital quality impact aggregate patient outcomes? Using Medicare data, I examine the joint production function of patient survival between surgeons and hospitals in the context of coronary artery bypass graft (CABG) surgery. Cardiac surgeons tend to be independent from hospitals; they perform surgeries at multiple hospitals within the same year. I leverage this variation in a two-way fixed-effects strategy with interactions between hospital and surgeon quality. I address high-dimensionality issues in a model with two-sided heterogeneity and potential selection of patients into providers using a two-step grouped fixed-effects approach with partial endogenization of network formation. I find that cardiac surgeons engage in positive assortative matching, where higher-survival surgeons practice at higher-survival hospitals. However, this matching does not maximize aggregate survival: low-survival surgeons have much higher returns from practicing at a high-survival hospital than high-survival surgeons do. Partial equilibrium exercises suggest that 30-day mortality from CABG could be reduced by 20% by reallocating low-survival surgeons to high-survival hospitals. Half the gains from these national reallocations can be achieved by reallocating surgeons within regions.

The Productivity of Professions: Evidence from the Emergency Department

David C. Chan
,
Stanford University
Yiqun Chen
,
University of Illinois-Chicago

Abstract

This paper studies the productivity of nurse practitioners (NPs) and physicians, two professions performing overlapping tasks but with stark differences in background, training, and pay. Using quasi-experimental variation in patient assignment to NPs versus physicians in 44 Veterans Health Administration emergency departments, we find that, on average, NPs use more resources but achieve worse patient outcomes relative to physicians. The costs of lower productivity surpass the pay differences between the professions. Yet even larger productivity variation exists within each profession, implying substantial productivity overlap between the two professions. Within professions, wages and assigned patient complexity vary only weakly with productivity.

The Rise of Healthcare Jobs

Joshua D. Gottlieb
,
University of Chicago
Neale Mahoney
,
Stanford University
Victoria Udalova
,
U.S. Census Bureau

Abstract

We document the rise of healthcare employment from 1980 to 2022, becoming the largest sector in the U.S. labor market. Healthcare became a middle-class jobs engine,
expanding from 8.7% to 11.0% of the labor force. Employment and earnings grew fastest for middle-skilled occupations like nurses and midlevel practitioners, especially among women and immigrants. We investigate the role of healthcare employment in stabilizing regional economics in areas where manufacturing declined. Healthcare job growth has offset only 11% of manufacturing job losses, commensurate with its overall labor force share. This suggests that pivoting “from manufacturing to meds” is not the Rust Belt’s salvation.

Discussant(s)
Jonathan Zhang
,
Duke University
Raffaele Saggio
,
University of British Columbia
Diane Alexander
,
University of Pennsylvania
Abigail Adams
,
University of Oxford
JEL Classifications
  • J4 - Particular Labor Markets