1. Romero N. Santiago
Mentors: Guy David, Ph.D. and Mark Neuman, M.D.

2. Motivation

 Elements that distort efficient matching of patients to
physicians may impact patient wellbeing.
 Perverse incentives to take or avoid difficult cases.
 For the same condition, recommendations may vary
by specialty (supplier induced demand).
 Inefficient matching is potentially costly to the
healthcare system.
 Hospital reputation and malpractice pressure may
not provide sufficient incentives to induce efficient
matching.

3. Strategy Used to Study
Task-Talent Matching

 Review previous research discussing current
framework of task-talent matching
 Read through the literature to find various incentives
that could help explain cause of inefficient matching
 Analyze task-talent matching in a specific region and
specialty to observe degree of matching problem

4. Project Overview

 Are highly talented physicians performing the most
difficult cases?
 Theoretical Framework
 Empirical Work
 Valuable insights about research experience

5. Garicano’s Pyramid Hierarchy is Not a
Perfect Fit for Medicine

 “Hierarchies and the Organization of Knowledge in
Production” – Garicano
 “Knowledge-based hierarchy” – production workers and
specialized problem solvers (industrial sector).
 Pyramidal structure with multiple levels, communication
costs incurred with specialization
 Knowledge of problem solvers incorporates knowledge of
those asking them for advice on solving a particular problem
 In medicine, no fine line between base level
(production worker) and problem solver, levels overlap.

6. Specialization Creates Matching
Issue Through Incentives
Santos
 “Referrals” – Garicano and
 Agent diagnosing opportunity/task incentivized to keep
most valuable ones and refer least valuable
 Top-down diagnosis generates no inefficiency, unlike
bottom-up arrangements
 “Specialization and Matching” – Epstein and colleagues
 Physicians in group partnerships specialize more than
solo physicians, utilizing referral system
 Matching of specialists to patient heightened under firm
or group practice.

7. Macroscopic View of Florida’s
Cardiac Surgeon Population
 of Health website
 Utilized the Florida Department
 Board-certified cardiac surgeons (162)
 Graduation Year from Medical School
 Residency and Fellowship Information
 Age of patient utilized as proxy for task difficulty
 Years of experience used as proxy for talent
 Data represents inpatient cases from 2005 to 2007
 Mean age of patient = 66 years
 Standard Deviation = 10.7 years
 Mean Experience for Surgeon = 28.8 years
 Standard Deviation = 7.9 years

8. Using Experience=15 as Cutoff
Experience<15 Experience>=15
Age<70 233 (60%)  24215 (57%)
Age>=70 153 (40%) 18130 (43%)
Experience<15 Experience>=15
Age<80 343 (89%) 37359 (88%)
Age>=80 43 (11%) 4986 (12%)
Experience<15 Experience>=15
Age<90 380 (98%) 41804 (99%)
Age>=90 6 (2%) 541 (1%)
Chi-squared values were 0.21, 0.70, and 0.63 respectively

9. Using Experience = 20 as Cutoff
Age<70 2815 (56%)

Experience<20 Experience>=20
21633 (57%)
Age>=70 2174 (44%) 16109 (43%)
Experience<20 Experience>=20
Age<80 4393 (88%) 33309 (88%)
Age>=80 596 (12%) 4433 (12%)
Experience<20 Experience>=20
Age<90 4923 (99%) 37261 (99%)
Age>=90 66 (1%) 481 (1%)
Chi-squared values were 0.23, 0.68, and 0.77 respectively

10. Using Experience=25 as cutoff
Age<70 6962 (58%)

Experience<25 Experience>=25
17486 (57%)
Age>=70 5044 (42%) 13239 (43%)
Experience<25 Experience>=25
Age<80 10635 (89%) 27067 (88%)
Age>=80 1371 (11%) 3658 (12%)
Experience<25 Experience>=25
Age<90 11852 (99%) 30332 (99%)
Age>=90 154 (1%) 393 (1%)
Chi-squared values were 0.05, 0.16, and 0.98 respectively

11. Next Steps

 Look for a more accurate way to define task and talent, as
age and experience are very approximate proxies
 Analyzing various comorbidity indices to account for
preexisting conditions among patients (task)
 Attempt to verify payment structure’s effect on task and
talent matching in cardiac surgery
 Compare and contrast incentives and payment structures
of various specialties

12. Interdisciplinary Mindset and
Communication are the Keys to Success

 Thoroughly understanding the significance of
assumptions is crucial.
 Health services research requires an interdisciplinary
approach and mindset.
 Learning about prior research done in one’s topic is
essential for future growth and advancement.
 Communication and conversation is vital.
 Combining Economics and Medicine

13. Special Recognition

 Leonard Davis Institute of Health Economics
 Anesthesiology Department at Penn Medicine
 Mentors: Guy David, Ph.D. and Mark Neuman, M.D.
 LDI Staff
 Joanne Levy,
 Elisabeth Madden,
 Hoag Levins,
 Megan Pellegrino
 Renee Zawacki

14. 