How Practice Environments Shape Physician Behavior and Workforce Decisions

Session Submission Type: Panel

Abstract

Physician behavior shapes access to care, treatment adoption, and population health outcomes. However, clinicians do not make decisions in isolation. Practice environments structure their choices through the policy, clinical, and organizational contexts in which they work. Understanding how these environments operate is critical for designing policies that improve workforce distribution and expand access to high-value care. Hence, this panel examines how practice environments shape physician behavior across multiple stages of the medical workforce pipeline. Rather than focusing only on individual-level incentives or regulatory barriers, the session highlights how institutional context structures physician choices through exposure to policy regimes, professional evidence, and peer networks. These environments influence both training and practice location decisions and physicians’ responses to emerging clinical evidence, shaping how physicians enter the workforce, where they choose to practice, and how they adopt new treatments over time.

Across four studies, the panel demonstrates how physician behavior responds systematically to variation in practice environments. One paper examines how abortion policy changes following Dobbs v. Jackson influenced OB-GYN residency application patterns across states using a triple difference-in-differences design. The authors show that applications to OB-GYN residencies declined significantly in states implementing trigger bans and that these changes were driven primarily by female applicants. These results highlight how policy environments shape the geographic distribution of future physicians and can have long-term implications for maternal health care access. A second paper investigates how clinicians responded to the ARRIVE randomized clinical trial using nationally representative birth certificate data and shows that while physicians increased adoption of elective induction following the trial’s publication, these changes did not generate the expected reductions in cesarean section rates. This work illustrates how the translation of clinical evidence into real-world practice depends on institutional context and provider decision-making environments. The third paper evaluates how exposure to high-prescribing peer environments affects clinicians’ adoption of buprenorphine treatment for opioid use disorder using national longitudinal prescribing data and an event-study difference-in-differences design. This paper demonstrates how organizational context and peer exposure within group practices can expand treatment capacity by increasing clinicians’ willingness to prescribe evidence-based medications. A fourth paper examines how state adoption of nurse practitioner full practice authority reallocates advanced practice clinicians across healthcare facilities using national workforce and hospital staffing data. The study shows that expanded autonomy shifts nurse practitioners from hospital-based team practice toward outpatient settings while helping physician-scarce hospitals retain staffing capacity. This work highlights how policy environments shape the distribution of clinical labor across healthcare systems.

These findings contribute to policy discussions about how governments and health systems can design practice environments that support the diffusion of high-value care and address persistent workforce shortages and treatment gaps, particularly in areas facing barriers to maternal health services and treatment for opioid use disorder. Collectively, these papers fit well with the conference's overall theme of "Fifty States, Fifty Systems" by examining the role that state-level policies can play in individual-level decision making amongst both rising and already-practicing physicians.

Policy Area

• Health Policy

Chair

• Julia Eddelbuettel, Harvard University

Discussants

• Joanne Constantin, State University of New York (SUNY) Downstate Health Sciences University

• Beth Munnich, University of Louisville

Organizer

• Jiaen Wu, Indiana University

Individual Presentations

• Reproductive Health Policy and Residency Application Patterns: Evidence from Abortion Bans following Dobbs v Jackson - Presenting Author: Anjali Pai, Brown University

• Professional Recommendations and Provider Behavior - Presenting Author: Raka Datta, Georgia State University

• Trends in Buprenorphine Prescribing and the Influence of Practice Environments on Clinician Adoption - Presenting Author: Jiaen Wu, Indiana University

• Nurse Practitioner Autonomy and Hospital Staffing: The Role of Physician Scarcity - Presenting Author: Kihwan Bae, West Virginia University