• February 2025
• Article

Objectives: To examine heterogeneity in physician batch ordering practices and measure the impact of a physician's tendency to batch order imaging tests on patient outcomes and resource utilization. Study Setting and Design: In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates. Data Sources and Analytic Sample: The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters. Principal Findings: Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order. Conclusions: This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.

• 2025
• Working Paper

Across three studies, combining survey data, transaction-level analysis from 90,548 customers of a nationwide retail bank, and insights from the General Social Survey, we study whether people with multiple jobs spend their labor income differently than people who earn the same total income from a single job. Inclusive of housing spend, we find that individuals who are more reliant on multiple jobs spend 17.0 percentage points (p.p.) less of their labor income overall, which is driven by a 15.5 p.p. decrease in the share of income spent on necessities and a 1.9 p.p. decrease in the share of income spent on indulgences. Examining differences in spend by expenditure category reveals that peoples’ lived experiences differ meaningfully based on their income composition: individuals with multiple jobs spend meaningfully more on education and transportation, but notably less in all other key spending areas including groceries, dining out, healthcare, entertainment, home improvement and shopping. Although it’s not possible in our data to directly assess whether these spending differences drive differences in individual wellbeing, we observe that those who are reliant on multiple jobs spend meaningfully less in categories traditionally associated with enhanced physical and mental wellbeing, such as healthcare and food, and less on experiential categories traditionally associated with enhanced emotional wellbeing, such as travel and entertainment. These patterns converge with responses from the General Social Survey, in which equivalently-compensated individuals who rely on multiple jobs report lower general happiness and financial satisfaction than their single-income counterparts. These findings suggest that it’s not only the amount a person earns, but also the way they earn it, that links to variations in spending behavior and overall wellbeing, which offers significant insights for the design of sustainable work in operations.

• January 2025
• Case