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Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians.

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This study introduces a model for physician performance, separating decision-making from procedural skill. Better decision-making in medicine improves patient outcomes by optimizing procedure allocation and reducing unnecessary C-sections.

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Area of Science:

  • Medical expertise
  • Physician performance evaluation
  • Healthcare quality improvement

Background:

  • Expert performance is typically assessed by outcomes, but this doesn't account for skill nuances.
  • Physician expertise involves both decision-making and procedural skill, which can have differential impacts.

Purpose of the Study:

  • To develop a model differentiating physician decision-making and procedural skill.
  • To investigate how these dimensions affect healthcare utilization and patient outcomes.
  • To identify methods for detecting poor diagnosticians using administrative data.

Main Methods:

  • Developed a two-dimensional model of physician performance (decision-making and procedural skill).
  • Analyzed the impact of each dimension on the utilization of intensive procedures across different risk groups.
  • Utilized administrative data to identify physicians with poor diagnostic skills.

Main Results:

  • Enhanced procedural skill increases intensive procedure use across all risk levels.
  • Improved decision-making reallocates procedures from low-risk to high-risk cases.
  • Poor diagnosticians were identifiable via administrative data, and improving decision-making reduced C-section rates in low-risk births while increasing them in high-risk births.

Conclusions:

  • Physician performance is multidimensional, with distinct impacts from decision-making and procedural skill.
  • Administrative data can identify diagnostic deficiencies.
  • Optimizing physician decision-making can lead to significant improvements in birth outcomes.