Forgetting-by-not-doing: The case of surgeons and cesarean sections

This paper provides new evidence on the link between patient outcome and physician experience. Using birth certificates data from a large hospital in Italy, I analyze whether cesarean section surgeons who have performed more procedures in the recent past observe an improvement in performance. By using data from the Italian health care system, where patients are not allowed to choose their physician, I lower concerns of potential reverse causality (selective referral). I find evidence indicating a strong learning-by-doing effect: for emergent cases, a one standard deviation increase in recent experience reduces the likelihood of neonatal intensive care unit admission by nearly 2.9 percentage points (12%) and of being born with a low Apgar Score by about 1.3 percentage points (9.5%), all else equal. This effect is not present for the case of elective C-sections.