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

Janet Currie, W. Bentley MacLeod

NBER Working Paper No. 18977
Issued in April 2013, Revised in February 2016
NBER Program(s):Children, Health Care, Health Economics, Labor Studies

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.

download in pdf format
   (650 K)

email paper

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w18977

Published: Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43. citation courtesy of

Users who downloaded this paper also downloaded* these:
Currie, MacLeod, and Van Parys w21218 Physician Practice Style and Patient Health Outcomes: The Case of Heart Attacks
Philipson and Zanjani w19005 Economic Analysis of Risk and Uncertainty induced by Health Shocks: A Review and Extension
Johnson and Rehavi w19242 Physicians Treating Physicians: Information and Incentives in Childbirth
Currie, Stabile, and Jones w19105 Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD?
Gruber and Owings w4933 Physician Financial Incentives and Cesarean Section Delivery
NBER Videos

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email:

Contact Us