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

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.