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Updated: Jun 23, 2025

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Fitting in? Physician practice style after forced relocation.

Alice J Chen1, Michael R Richards2, Rachel Shriver3

  • 1Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.

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|June 17, 2024
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Summary
This summary is machine-generated.

Physician treatment decisions for newborn deliveries are highly influenced by hospital norms. When obstetricians moved to hospitals with less invasive practices, their own approach to newborn deliveries became less aggressive, improving outcomes.

Keywords:
newborn deliveriesobstetric unit closuresobstetricsphysician practice patterns

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Area of Science:

  • Obstetrics and Gynecology
  • Health Services Research
  • Medical Decision-Making

Background:

  • Physician treatment decisions significantly impact maternal and infant outcomes.
  • Understanding the influence of hospital-level norms on clinical practice is crucial for improving healthcare quality.

Purpose of the Study:

  • To investigate how variations in physicians' treatment decisions for newborn deliveries are affected by changes in hospital-level obstetric clinical decision-making norms.
  • To assess the impact of shifting hospital practice patterns on physician behavior regarding newborn delivery interventions.

Main Methods:

  • Utilized a difference-in-differences approach analyzing all hospital-based births in Florida (2003-2017).
  • Leveraged exogenous variation from obstetric unit closures to shift physicians to hospitals with different delivery care norms.
  • Compared physicians continuously observed before and after closure (treatment) with those around a placebo date (control).

Main Results:

  • Physicians relocating due to unit closures adopted less aggressive newborn delivery practices at their new hospitals.
  • Observed an 11-percentage point (33%) statistically significant increase in delivering newborns without procedures, persisting over time.
  • Physician payer and patient mix remained unchanged, indicating behavior change was driven by practice norms.

Conclusions:

  • Physician behavior in newborn delivery care is malleable and sensitive to prevailing hospital practice patterns.
  • Hospital-wide policies promoting appropriate clinical care norms can significantly improve physician decision-making and benefit maternal and infant outcomes.