Working Paper: NBER ID: w20017
Authors: Jason M. Hockenberry; Lorens A. Helmchen
Abstract: To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Using a sample of 188 surgeons who performed 56,315 CABG procedures in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality risk by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. In analyses of 93 high-volume surgeons treating 9,853 patients admitted via an emergency department, where temporal distance effects are most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.396 percentage points. These estimates imply a cost per life-year saved ranging from $7,871 to $18,500, rendering additional treatment intensity within surgery cost-effective at conventional cutoffs. Our findings are consistent with the hypothesis that after returning from temporal breaks surgeons may be less likely to recognize and address life-threatening complications, in turn reducing resource use. This form of human capital loss would explain the decrease in worker productivity and the simultaneous reduction in input use.
Keywords: human capital; surgeon productivity; temporal distance; mortality risk; healthcare costs
JEL Codes: I10; J24
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| number of days since last CABG (C41) | patient mortality rates (I14) |
| number of days since last CABG (C41) | total hospitalization costs (I11) |
| temporal distance (C41) | surgeon productivity (L23) |
| temporal distance (C41) | resource use (Q21) |
| temporal distance (C41) | in-hospital mortality (I12) |