Stephenson Strobel | Searcharxiv

arXiv2023

Waiting for Dr. Godot: how much and who responds to predicted health care wait times?

Asymmetric information in healthcare implies that patients could have difficulty trading off non-health and health related information. I document effects on patient demand when predicted wait time is disclosed to patients in an emergency department (ED) system. I use a regression discontinuity where EDs with similar predicted wait times display different online wait times to patients. I use impulse response functions estimated by local projections to demonstrate effects of the higher wait time. I find that an additional thirty minutes of wait time results in 15% fewer waiting patients at urgent cares and 2% fewer waiting patients at EDs within 3 hours of display. I find that the type of patient that stops using emergency care is triaged as having lower acuity and would have used an urgent care. However, I find that at very high wait times there are declines in all acuity patients including sick patients.

econ.GN↗

arXiv2023

Effects of extending residencies on the supply and quality of family medicine practitioners; difference-in-differences evidence from the implementation of mandatory family medicine residencies in Canada

I examine the impacts of extending residency training programs on the supply and quality of physicians practicing primary care. I leverage mandated extended residency lengths for primary care practitioners that were rolled out over 20 years in Canada on a province-by-province basis. I compare these primary care specialties to other specialties that did not change residency length (first difference) before and after the policy implementation (second difference) to assess how physician supply evolved in response. To examine quality outcomes, I use a set of scraped data and repeat this difference-in-differences identification strategy for complaints resulting in censure against physicians in Ontario. I find declines in the number of primary care providers by 5% for up to nine years after the policy change. These changes are particularly pronounced in new grads and younger physicians suggesting that the policy change dissuaded these physicians from entering primary care residencies. I find no impacts on quality of physician as measured by public censure of physicians. This suggests that extending primary care training caused declines in physician supply without any concomitant improvement in the quality of these physicians. This has implications for current plans to extend residency training programs.

econ.GN↗