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Although extensive research has documented the benefits of increased organizational experience on performance (also known as learning-by-doing), our understanding of how learning occurs is still limited. One of the factors that have been identified to affect the rate at which a firm learns is the competence of individual workers. In this paper I examine a mechanism through which individual workers acquire (or maintain) competence, namely that of experience. Specifically, I analyze whether cardiac surgeons who perform more procedures experience an improvement in performance. In order to do so, I develop an instrumental variables estimation method that addresses the potential endogeneity of surgeon experience (measured by recent procedure volume). As my identification strategy, I consider exogenous shocks to the procedure volume of CABG surgeons in Florida caused by the exit of other surgeons from the same hospital. Using this instrument, I find evidence indicating a strong learning-by-doing effect for cardiac surgeons: an additional procedure a year leads to a reduction in the probability of patient mortality by .05 percentage points. Further, I find this improvement in surgeon performance to be completely transferable across different hospital settings, and find evidence of some economies of scope among the different surgical procedures performed by a cardiac surgeon.

Does Practice Make Perfect: An Empirical Analysis of Learning-by-Doing in Cardiac Surgery