Physicians under Pressure: Evidence from Antibiotics Prescribing in England

Thomas Allen, Dorte Gyrd-Hansen, Søren Rud Kristensen, Anne Sophie Oxholm, Line Bjørnskov Pedersen, Mario Pezzino

Research output: Contribution to journalArticlepeer-review


Background: Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians’ decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. Setting: We test our prediction on general practitioners’ antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. Methods: We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs’ prescribing. Results: We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. Conclusions: Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians’ work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45 Many physicians are working under increasing pressure. We test the importance of pressure on physicians’ prescribing of antibiotics. The prescribed rate of broad-spectrum antibiotics increases with pressure. Policy makers should be aware of the societal costs of pressured physicians.

Original languageEnglish
JournalMedical Decision Making
Early online date12 Jan 2022
Publication statusE-pub ahead of print - 12 Jan 2022


  • antibiotics
  • double agency
  • physician
  • prescribing
  • pressure
  • resource constraint


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