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An Empirical Investigation of “Physician Congestion” in U.S. University Hospitals

The Department of Public Policy and Administration, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel
Faculty of Management, Lev College of Technology, Havaad Haleumi 21 St., Givat Mordechai, Jerusalem 9116001, Israel
The Department of Geography and Environment, Bar-Ilan University, Ramat-Gan 5290002, Israel
IZA—Institute of Labor Economics Schaumburg-Lippe-Straße 5-9, 53113 Bonn, Germany
Cardiology Division, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem 91120, Israel
School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(5), 761;
Received: 5 December 2018 / Revised: 22 January 2019 / Accepted: 26 February 2019 / Published: 2 March 2019
(This article belongs to the Section Health Economics)
PDF [870 KB, uploaded 18 March 2019]
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We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures of clinical scores, as well as a rich set of covariates, we found that the relationship was indeed hump-shaped. At the two extremes, departments with an insufficient (excessive) number of physicians may gain a substantial increase in healthcare quality by the addition (dismissal) of a single physician. The marginal elasticity of healthcare quality with respect to the number of physicians, although positive and significant, was much smaller than the marginal contribution of other factors. Moreover, research quality conducted at the ward level was shown to be an important moderator. Our results suggest that studying the relationship between the number of physicians per bed and the quality of healthcare at an aggregate level may lead to bias. Framing the problem at the ward-level may facilitate a better allocation of physicians. View Full-Text
Keywords: health care quality; physicians per bed; doctors per bed; clinical performance; increasing returns; inverted U-shape health care quality; physicians per bed; doctors per bed; clinical performance; increasing returns; inverted U-shape

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    Description: From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research Anat Tchetchik, Amir Grinstein, Eran Manes, Daniel Shapira, Ronen Durst

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Manes, E.; Tchetchik, A.; Tobol, Y.; Durst, R.; Chodick, G. An Empirical Investigation of “Physician Congestion” in U.S. University Hospitals. Int. J. Environ. Res. Public Health 2019, 16, 761.

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