• Physician-mothers have lower C-section rates

    From a new NBER working paper by Erin Johnson and M. Marit Rehavi:

    We find that physician-mothers are significantly less likely to have a C-section than other highly educated patients. In California physician-mothers are 7% less likely to have a C-section; in Texas there is an 8% difference. This difference stems not from different preferences for attempting labor, but instead comes almost entirely from the two-thirds of C-sections that are performed after an attempt at labor (herein “unscheduled C-sections”). Doctors are 11% less likely to be ushered into surgery as a result of complications arising during labor or the failure of labor to progress. Moreover, even after accounting for differential sorting of patients to hospitals, physician-mothers have unscheduled C-section rates that are 9% lower than other educated mothers. After controlling for the attending obstetrician, the difference is just under 8% in Texas.

    We also find a stark difference in the impact of the incentive environment on informed and uninformed patients. Financial incentives have a large effect on a non-physician’s probability of receiving a C-section: in hospitals where there is a financial incentive to perform C-sections, they have much higher C-section rates. However physician-patients appear to be unaffected by the financial environment on net (they have the same risk-adjusted C-section rates inside and outside of HMO-owned hospitals). These results suggest financial incentives are an important determinant of treatment; and that patient information is an effective counterweight.

    The consequences of these treatment differences are not only financial. Physician mothers and their infants have reduced morbidity compared with other patients. Moreover, it appears that physicians achieve these outcomes without using more hospital resources. Controlling for method of delivery (and netting out the substantial cost savings of fewer C-sections among physician-mothers), the hospital charges for physician-births are similar to those of non-physicians.

    Here’s one, of several, previous TIE posts on supplier induced demand.


    • What should we make of this then?

      Physicians have a higher tolerance for pain and will willfully postpone a section? They do something in the prenatal period as compared to their non-physician, equally educated and affluent peers allowing a better outcome (better = no c/s)?

      I did not read paper but what do the authors speculate. Very interesting?

    • Having watched this where I work, I suspect a lot of this is from fewer midnight sections. If you look at the timing of C-sections you find that they occur more frequently at some times than others. The midnight section occurs (often) when the OB decides there will probably not be a vaginal delivery, and if you a section at midnight, you can still get some sleep so you can work the next day. As a courtesy, most OBs will not push another doc and will let them labor a bit longer. IOW, there is a financial factor, but I think it is mostly one of time.

      You also get some sections because patients give up and just want a section. Some wanted a section all along. A physician patient is a bit less likely to want a section.


    • Though the title that Austin chose is a bit misleading – physician-mothers are less likely to have an unscheduled c-section after an attempt at labour. The title implies that physician-mothers generally choose fewer c-sections than the general population, which is not the case (in this article – it may be the case based on other data). Here in Canada, that is an important distinction because scheduled c-sections are generally so frowned upon.

    • Agree with BradF.

      -Variations in pre-natal care amongst physicans vs non-physicians may reduce the extent to which physician mothers undergo unscheduled c-sections.

      -The authors would need to include an analysis of scheduled c-section rates, and demonstrate that physician moms also undergo fewer scheduled c-sections than equally educated mothers in order to strengthen their argument that physician moms tend to opt for fewer c-sections than their non-physician equivalents.