BACKGROUND: Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians' decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients.
SETTING: We test our prediction on general practitioners' antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population.
METHODS: We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs' prescribing.
RESULTS: We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure.
CONCLUSIONS: Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians' work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45.
HIGHLIGHTS: Many physicians are working under increasing pressure.We test the importance of pressure on physicians' prescribing of antibiotics.The prescribed rate of broad-spectrum antibiotics increases with pressure.Policy makers should be aware of the societal costs of pressured physicians.[Formula: see text].
Bibliografisk noteFunding Information:
We are grateful to Luigi Siciliani for helpful discussions. We would also like to thank participants, chairs, and discussants at the Health Economists’ Study Group Winter 2019 meeting, the 39th Nordic Health Economists’ Study Group meeting, and the Health Economics Workshop 2019 in Stralsund. Any remaining errors are the authors. Financial support from the Novo Nordisk Foundation (grant NNF18OC0033978), Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis’ Legat is gratefully acknowledged. The GP Worklife Survey was funded by the NIHR Policy Research Programme through the Policy Research Unit in the Health and Care System and Commissioning (PRUComm). Søren Rud Kristensen was supported by the NIHR Imperial Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the funders, the NHS, the NIHR, the Department of Health and Social Care, or its arm’s-length bodies. Ethical approval for the GP Worklife Survey was obtained from the University of Manchester Ethics Committee following proportionate review (ref 2017- 2638-3884).
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided in part by a grant from Novo Nordisk Foundation (grant NNF18OC0033978) as well as by Læge Sofus Carl Emil Friis og Hustry Olga Doris Friis‘ Legat. SRK was supported by the NIHR Imperial Patient Safety Translational Research Centre. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.
© The Author(s) 2022.