Practice Variation in Team Decisions: Evidence from Physicians in Training

What causes professionals in organizations to practice differently in similar situations? This paper studies practice variation in team decisions, among physicians trainees, who frequently switch teams and are randomly assigned patients. I identify the effect of relative experience on influence in team decisions by a discontinuity in relative experience across the one-year tenure mark. The influence of senior trainees is larger for decisions requiring more discretion. Trainee effects fail to converge with training but show serial correlation consistent with learning and are unexplained by trainee characteristics or training histories. These findings suggest variation due to idiosyncratic learning and tacit knowledge. JEL Codes: D83, L23, M53 ∗I am grateful to David Cutler, Joe Doyle, Bob Gibbons, and Jon Gruber for their guidance on this project from an early stage. I also thank Achyuta Adhvaryu, Daron Acemoglu, Leila Agha, David Autor, Daniel Barron, David Bates, Amitabh Chandra, Wes Cohen, Michael Dickstein, Amy Finkelstein, Matt Gentzkow, Emir Kamenica, Pat Kline, Jon Kolstad, Eddie Lazear, Frank Levy, David Molitor, Maria Polyakova, Jon Skinner, Doug Staiger, Chris Stanton, Chris Walters, and seminar audiences at Arizona, ASHEcon, Carnegie Mellon, Case Western Reserve University, Chicago Booth, Cornell Weill, Duke, Johns Hopkins, Maryland, MIT, NBER (Organizational Economics), North Carolina, Paris School of Economics, Queen’s University, Rice, Stanford, Tulane, and WEAI for helpful comments. Joel Katz and Amy Miller provided invaluable context to the data. Samuel Arenberg, Atul Gupta, and Natalie Nguyen provided excellent research assistance. I acknowledge support from the NBER Health and Aging Fellowship, under the National Institute of Aging Grant Number T32-AG000186; the Charles A. King Trust Postdoctoral Fellowship, the Medical Foundation; and the Agency for Healthcare Research and Quality Ruth L. Kirschstein Individual Postdoctoral Fellowship 1-F32-HS021044-01. †Address: 117 Encina Commons, Room 215; Stanford, CA 94306. Phone: 650-725-9582. Fax: 650-723-1919. Email: [email protected].