Kathrine Aaby Lorenzen defends her PhD thesis at the Department of Economics

Candidate:

Kathrine Aaby Lorenzen, Department of Economics, University of Copenhagen

Title:

The Physician Labor Market

Supervisors:

  • Torben Heien Nielsen, Professor, Department of Economics, University of Copenhagen
  • Thomas Høgholm Jørgensen, Associate Professor, Department of Economics, University of Copenhagen

Assessment Committee:

  • Casper Worm Hansen, Professor, Department of Economics, University of Copenhagen
  • Ingrid Hägele, Associate Professor, Department of Economics, Ludwig-Maximilians-Universität München
  • Volha Lazuka, Associate Professor, Department of Economics, University of Southern Denmark

Summary:

This dissertation examines the physician labor market in Denmark from three topical angles: gender economics, health economics, and economic history. The dissertation consists of three chapters. The first two chapters study a Danish working hour reform implemented in 1982, which enforced a 40-hour workweek among subordinate hospital physicians through overtime restrictions and job creation. The first chapter investigates how this policy affected physicians' occupational choice and family formation. The second chapter goes one step further and asks whether this type of "family-friendly" policy has any implications for healthcare provision and patient safety. The last chapter in the thesis takes the reader even further back in history and studies occupational sorting over a century from when the first Danish female physician, Nielsine Nielsen, graduated medical school. 

 

Chapter 1: Family-friendly Jobs and Occupational Sorting across Gender

In this chapter, I study the impact of changes in the family-friendliness of jobs on occupational choice across gender in the labor market for physicians. I utilize a Danish working hour reform implemented in 1982, which imposed a maximum 40-hour workweek for junior hospital physicians through overtime restrictions and job creation. To do so, I digitize archival data and combine it with administrative data. I find that the reform affected some specialties more than others, with the least flexible (acute) specialties being the most affected. I exploit these differing treatment intensities across specialties in order to estimate the impact of family-friendly hours constraints on specialty choice across gender in a dose-response difference-in-differences design. My results suggest that the share of females sorting into a specialty increased more where introduction of a 40-hour workweek had more bite. Exploiting that the reform acts as a labor demand shock and creates a tight labor market two years following the reform, I examine whether dynamic effects vary with labor market conditions. I find that dynamic effects peak in the short run when the labor market was attractive from the labor supply perspective. In addition, I find little evidence that individuals sorting into specialties after the reform differ in terms of fertility or likelihood of marriage. My results suggest that preferences for working hours are important for occupational choice across gender and hence gender inequality in wages.

 

Chapter 2: Physician Overtime Restrictions and Patient Mortality

Co-authored with Gonçalo Lima

In this chapter, we study how constraining physicians' working hours affects hospitals' healthcare provision and patients' health. We evaluate a 1982 reform in Denmark that strongly restricted the scheduling of overtime, weekend, and nighttime shifts. Consistent with an hours-to-workers substitution, hospitals' labor demand increased by 35% one-year after implementation. Drawing on administrative data covering the universe of somatic hospitalizations in Denmark, we combine this labor demand shock with variation in exposure to the policy across hospital wards in a dose-response difference-in-differences strategy. As exposure, we use the pre-reform share of emergency cases in each hospital ward, that we show to be highly predictive of post-policy labor demand changes. We find that a one-standard-deviation difference in exposure to overtime restrictions led to 2.4 fewer deaths in hospital for every thousand admissions (-5.8%), three years after the onset of the reform. The overall mortality decline is driven by greater gains among patients with urgent medical needs, with no changes on post-discharge readmission rates or average length-of-stay. Our findings highlight how working hour regulations can help correct for life-costing inefficiencies in the healthcare sector.

 

Chapter 3: Sorting across a Century of High-Skilled Women and Men: Evidence from the Rise of Modern Health Care

Co-authored with Ida Lykke Kristiansen, Torben Heien Nielsen, and Frederik Plesner Lyngse

In this chapter, we study how the expansion of the medical field impacted female physician careers over a century from when the first female graduated medical school in 1885. We build a novel historical database covering the full population of physicians in Denmark from 1479 to 2000 and further enrich it with details on educational achievements in high school and medical school. We provide quantitative insights into the gender gaps in highly skilled labor. We document significant differences across gender that do not disappear over the course of a century but rather shape the norms in the profession that carry over into the contemporary labor market. Specifically, we find that although male and female physicians specialize at the same rate, female physicians take longer to do so. Women are more likely to enter new medical specialties that arise with the "rise of scientific medicine". Additionally, female physicians' returns to their medical school grades are lower, as they are persistently less likely to become chief physicians. Finally, we find that female physicians are significantly less likely to have a spouse, suggesting a trade-off between family and career for females, which is not present for males.

An electronic copy of the dissertation can be requested here: lema@econ.ku.dk