TY  - JOUR
AU  - Epstein,Andrew
AU  - Nicholson,Sean
TI  - The Formation and Evolution of Physician Treatment Styles: An Application to Cesarean Sections
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 11549
PY  - 2005
Y2  - August 2005
UR  - http://www.nber.org/papers/w11549
L1  - http://www.nber.org/papers/w11549.pdf
N1  - Author contact info:
Andrew Epstein
Division of General Internal Medicine
University of Pennsylvania School of Medicine
423 Guardian Dr
1001 Blockley Hall
Philadelphia, PA 19104
Tel: 215-746-7992
E-Mail: eandrew@mail.med.upenn.edu

Sean Nicholson
Professor
Department of Policy Analysis and Management
Cornell University
102 Martha Van Rensselaer Hall
Ithaca, NY 14853
Tel: 607/254-6498
Fax: 607/255-4071
E-Mail: sn243@cornell.edu
AB  - 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.
ER  -