美国医生的收入与劳动供给
The Earnings and Labor Supply of U.S. Physicians
Quarterly Journal of Economics · 2025 · [{"name": "Joshua D. Gottlieb", "affiliation": ["National Bureau of Economic Research", "University of Chicago"]}, {"name": "Maria Polyakova", "affiliation": ["National Bureau of Economic Research", "Stanford University"]}, {"name": "Kevin Rinz", "affiliation": ["Washington Center for Equitable Growth"]}, {"name": "Hugh Shiplett", "affiliation": ["University of New Brunswick"]}, {"name": "Victoria Udalova", "affiliation": ["United States Census Bureau"]}]
中文摘要
摘要 政府是否在引导劳动力市场顶端的“看不见的手”？我们利用新的行政数据衡量医生收入，并估计医疗政策对这些收入、医生劳动供给以及人才配置的影响。将美国医生行政登记册与税务数据、Medicare 账单记录及调查问卷相结合，我们发现医生年收入平均为350,000美元，占全国医疗保健支出的8.6%。经营收入占收入的四分之一，且在调查数据中被系统性低报。收入在职业生涯早期急剧上升，且在专业、地区和企业规模之间存在重大差异。与其他劳动者相比，医生收入的地理模式不同寻常。我们认为，这些模式反映了补贴医生服务需求的政策选择，并因医生准入限制——尤其是在某些专业中——而被放大。医疗政策在边际上具有重大影响：由 Medicare 报销驱动的医生服务费收入中，有25%归医生个人所有。医生赚取了用于保险扩张的公共资金的8%。这些政策进而影响医生所提供医疗服务的类型和数量、退休时机，以及人才在各专业间的配置。
Abstract
Abstract Is government guiding the invisible hand at the top of the labor market? We use new administrative data to measure physicians’ earnings and estimate the influence of health care policies on these earnings, physicians’ labor supply, and the allocation of talent. Combining the administrative registry of U.S. physicians with tax data, Medicare billing records, and survey responses, we find that physicians’ annual earnings average $350,000 and make up 8.6% of national health care spending. Business income makes up one-quarter of earnings and is systematically underreported in survey data. Earnings increase steeply early in the career, and there are major differences across specialties, regions, and firm sizes. The geographic pattern of earnings is unusual compared with other workers. We argue that these patterns reflect policy choices to subsidize demand for physician care, amplified by restrictions on physician entry, especially in certain specialties. Health policy has a major impact on the margin: 25% of physician fee revenue driven by Medicare reimbursements accrues to physicians personally. Physicians earn 8% of public money spent on insurance expansion. These policies in turn affect the type and quantity of medical care physicians supply, retirement timing, and the allocation of talent across specialties.