David C Chan  ( Stanford University )

Uncertainty, Tacit Knowledge, and Practice Variation: Evidence from Physicians in Training    

Date: April, 14th At 13,00h

Room: 23 103 (Mercè Rodoreda Builiding)  - Universitat Pompeu Fabra, Barcelona

Abstract: Studying physicians in training, I investigate how uncertainty and tacit knowledge may give rise to significant practice variation. Consistent with tacit knowledge accruing only with experience, and empirically exploiting a discontinuity in the formation of teams, experience relative to a peer substantially increases the size of variation attributable to the physician trainees. Among the same physician trainees, convergence occurs for patients on services driven by specialists, where there is arguably more explicit knowledge, but not on the general medicine service. This difference is unexplained by formally coded patient information. In contrast, rich physician characteristics correlated with preferences and ability, and quasirandom assignments to high- or low-spending supervising physicians explain little if any variation

Bio: David Chan, MD, PhD, is an Assistant Professor of Medicine at the Stanford School of Medicine. Dr. Chan's research focuses on productivity and behavior in health care. He is particularly interested in studying what drives physician behavior, including organizational features of workplace design, incentives, and the use of information. He is also interested in designing interventions to improve productivity in health care firms and to understand behavioral pathways through which this may take place. He is the recipient of the 2014 NIH Director's High-Risk, High-Reward Early Independence Award to study the optimal balance of information in health information technology for patient care.Dr. Chan received master's degrees in policy and economics from the London School of Economics and Oxford University, where he studied as a Marshall scholar. He holds a medical degree from UCLA and a PhD in economics from MIT. He trained in internal medicine at Brigham and Women's Hospital and was an instructor of medicine at Harvard Medical School, prior to coming to Palo Alto, where he currently is a hospitalist at the Department of Veterans Affairs, Palo Alto. He is also an investigator at the Department of Veterans Affairs and a Faculty Research Fellow at the National Bureau of Economic Research.