斯坦福卫生经济学教材（Health Economics）杰伊·巴塔查里亚《健康经济学》课程教学资源（PPT课件，英文版）Chapter 05 THE PHYSICIAN LABOR MARKET

CHAPTER 5 THE PHYSICIAN LABOR MARKET

CHAPTER 5 THE PHYSICIAN LABOR MARKET

Outline The training of physicians Medical school residency Returns to medical training Work hours Barriers to entry ▣Physician agency Physician-induced demand ▣Discrimination Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Outline  The training of physicians  Medical school & residency  Returns to medical training  Work hours  Barriers to entry  Physician agency  Physician-induced demand  Discrimination

The training of physicians

The training of physicians

Medical school Entry into med school is competitive and selective worldwide In the US,average 50%of applicants are accepted into at least one school Length of medical school varies across country US Canada applicants must first get a bachelor's degree European applicants go directly from high school Medical school can be super-expensive US:$140k--$225k for four years European medical training often heavily subsidized Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Medical school  Entry into med school is competitive and selective worldwide ◼ In the US, average 50% of applicants are accepted into at least one school  Length of medical school varies across country ◼ US & Canada applicants must first get a bachelor’s degree ◼ European applicants go directly from high school  Medical school can be super-expensive ◼ US: $140k -- $225k for four years ◼ European medical training often heavily subsidized

Residency In addition to classroom work,physicians-in- training must also gain hospital experience Residency is a period of on-the-job training following medical school New residents lack experience,and when new residents arrive at a hospital,empirical evidence that medical errors go up ▣“July effect'"in the US ▣“August killing season"'in the UK Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Residency  In addition to classroom work, physicians-in￾training must also gain hospital experience  Residency is a period of on-the-job training following medical school  New residents lack experience, and when new residents arrive at a hospital, empirical evidence that medical errors go up  “July effect” in the US  “August killing season” in the UK

Physician work-hours Work hours Over 60 hours a week On call residents could work up to 3o consecutive hours In 2003,implementation to limit number of hours/week for US doctors No more than 80 hours a week No change in patient mortality Many residents still work over 80 hours a week,but report only 80 hours Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Physician work-hours  Work hours  Over 60 hours a week  On call residents could work up to 30 consecutive hours  In 2003, implementation to limit number of hours/week for US doctors  No more than 80 hours a week  No change in patient mortality  Many residents still work over 80 hours a week, but report only 80 hours

Work-hour tradeoffs ▣Longer work-hours Fatigue may impair physicians'cognitive abilities and in turn may affect patient health Shorter work-hours Requires more hand-offs by physicians and thus greater chance for error Empirical question which effect dominates Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Work-hour tradeoffs  Longer work-hours  Fatigue may impair physicians’ cognitive abilities and in turn may affect patient health  Shorter work-hours  Requires more hand-offs by physicians and thus greater chance for error  Empirical question which effect dominates

Shorter hours leads to fewer errors Randomized experiment at Brigham and Woman's ICU at Harvard (2004) 2 groups:traditional hours(8o hours/week)&short work week (60 hours/week) Traditional hour group Committed 36%more serious medical errors 21%more medication errors 5.6 times more diagnostic errors Senior physicians intercepted most serious errors Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Shorter hours leads to fewer errors  Randomized experiment at Brigham and Woman’s ICU at Harvard (2004)  2 groups: traditional hours (80 hours/week) & short work week (60 hours/week)  Traditional hour group  Committed 36% more serious medical errors  21% more medication errors  5.6 times more diagnostic errors  Senior physicians intercepted most serious errors

Returns to medical training

Returns to medical training

Returns to medical training Unlike most occupations, (a)US physician returns to medical CUS training are very back- loaded Medical school residency -surfer expensive in direct costs and opportunity costs 口So those who choose $0 Time being physician are patient enough to value future returns aus Bhattacharya,Hyde and Tu-HealthEconomics

Bhattacharya, Hyde and Tu – Health Economics Returns to medical training  Unlike most occupations, returns to medical training are very back￾loaded  Medical school & residency expensive in direct costs and opportunity costs  So those who choose being physician are patient enough to value future returns