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Recent work in representative bureaucracy focuses on the micro-foundations of representation and explores the conditions for who represents and who receives representation. Drawing on insights from street-level bureaucracy, this article contributes to the micro theory of representation by exploring how workload influences the ability for a bureaucrat to represent a client. Extant literature highlights how bureaucrats’ resort to coping mechanisms to deal with conflicting demands and work requirements, yet how these mechanisms guide representation have yet to be explored. Findings from over 35,000 cases in Florida hospital emergency room departments reveal that physician-patient gender matching predicts a significant decrease in heart attack mortality when physician workload is normal. Moreover, the effects of representation are amplified when workload is low. When workload is high, however, there is no substantive benefit associated with representation. These findings suggest that representation is a discretionary action affected by workload and can carry distributional consequences depending on how bureaucrats’ cope with job stress.

Coping with representation: the moderating effect of workload on individual-level representation