Figure 1. Share of minimally invasive procedures by physician relative skill from 2012 to 2015. In April 2014, the U.S. FDA issued a safety warning discouraging the use of laparoscopic power morcellation during all minimally invasive hysterectomies . Source: David and Wu. Journal of Health Economics, 2022.

While it is widely known that skill levels differ among physicians, it is not known how these skill differences affect their treatment choices. An unexpected safety warning from the U.S. Food and Drug Administration about minimally invasive hysterectomies offered us an opportunity to evaluate how a negative information shock affects clinical practice across physicians with different skill levels.

My colleague Bingxiao Wu and I evaluated data from patients who received either minimally invasive or open hysterectomies between January 2012 and September 2015 in Florida. We found that after the FDA issued a safety warning in April 2014, discouraging the use of laparoscopic power morcellation during minimally invasive hysterectomies due to evidence that it could spread undetected malignant tissue, oncologists shifted toward performing open procedures and away from the minimally invasive procedures. However, as the above chart shows, oncologists who were more skilled in performing minimally invasive procedures were far less likely to abandon this procedure compared to those who were less skilled in these procedures.

The results speak directly to policies that aim to integrate evidence-based medicine with individual practice. They demonstrate that differences in physician skill can be a key barrier to translating evidence into practice. Policies that ignore these differences may lead to negative consequences, including medical complications and, in rare cases, death.

The study, Information, Relative Skill, and Technology Abandonment, was published in the Journal of Health Economics in May 2022. Authors include Bingxiao Wu and Guy David.


Guy David, PhD

Allen B. Miller Professor, Health Care Management, Wharton School; Professor, Health Policy and Medical Ethics, Perelman School of Medicine; Chair, Health Care Management, Wharton School

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