Agency in Organization and Teams
Much of the research on physician agency focuses on individual decision-making, holding organizational context fixed. In practice, however, physicians rarely operate in isolation. Treatment decisions are shaped by referral networks, team-based care, and organizational constraints imposed by hospitals, physician groups, and integrated delivery systems. Today, we study how physician agency operates when decision-making authority is shared across multiple providers and embedded within organizations.
Referral networks and team structure play an important role in shaping care delivery. Patterns of interaction among physicians influence treatment intensity, coordination, and patient outcomes, even when financial incentives are held constant. Empirical studies show that referral relationships affect both where patients receive care and which treatments they receive, with implications for performance and equity in healthcare delivery (Zeltzer (2020); Agha et al. (2022)).
Physicians also exercise agency by influencing where patients receive care, including hospital choice and downstream referrals. In settings where patients rely on physician expertise to navigate complex provider choice sets, physician preferences and constraints can meaningfully affect hospital utilization. Evidence from institutional reforms that alter physician choice sets illustrates how agency interacts with market structure (Gaynor, Propper, and Seiler (2016)).
Finally, agency is especially salient in settings where care is transferred or delegated across providers or facilities. These environments highlight how organizational rules and institutional incentives shape physician decision-making under tight constraints. Evidence from long-term acute care hospitals and emergency departments shows how agency affects utilization and patient outcomes in institutional settings (Eliason et al. (2018); Gruber, Hoe, and Stoye (2023)).
Taken together, these papers show that physician agency cannot be understood solely at the individual level. Organizational structure and team-based decision-making are central to how care is delivered and how policy interventions ultimately operate. Potential papers for presentation today include:
- Gaynor, Propper, and Seiler (2016) — physician influence on hospital choice
- Eliason et al. (2018) — agency in institutional care settings
- Gruber, Hoe, and Stoye (2023) - treatment decisions and time constraints