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医生的学习与遗忘:来自美国军队的证据

Physician Learning and Forgetting: Evidence from the US Military
NBER Working Papers · 2026 · Trevor Fitzgerald、Atul Gupta、Stephen D. Schwab

中文摘要

美国军队医疗体系中的医生被准随机分配参与作战部署,导致其临床实践出现时长不等的间断。我们利用这一独特情境,为医生的技能折旧(遗忘)与干中学提供新的因果证据。我们发现稳健的证据表明,外科医生结束部署返回后的前两个月内,再入院率上升48%。然而,外科医生在恢复临床实践后6个月内便恢复至基线表现水平。相比之下,产科医生的剖宫产率持续高于基线的时间长达9个月,这意味着其临床判断发生了更深层的变化。最后,我们借助一个学习模型解释这些模式,并估计外科医生与产科医生的干中学速率。近期手术量翻倍,使外科医生的再入院率下降17%,使产科医生的剖宫产率下降11%。

Abstract

Physicians in the U.S. military health care system are quasi-randomly assigned to combat deployments, leading to gaps of varying durations in their clinical practice. We leverage this unique setting to provide novel causal evidence on skill depreciation (forgetting) and learning-by-doing among physicians. We find robust evidence that readmission rates increase by 48% in the first two months after a surgeon returns from a deployment. However, surgeons return to baseline performance within 6 months of resuming practice. In contrast, obstetricians maintain elevated cesarean section rates for up to 9 months, implying a deeper change in clinical judgment. Finally, we interpret these patterns through the lens of a learning model and estimate learning-by-doing rates for surgeons and obstetricians. A doubling of recent procedure volume reduces readmission and C-section rates by 17% and 11% for surgeons and obstetricians, respectively.
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