As a Ph.D. student on the academic job market in 2016, Diane Alexander was hoping for a research opportunity in Chicago. She ultimately landed at the Federal Reserve Bank of Chicago, where she worked in the bank’s Research Division until 2021.

Today, Alexander is an Assistant Professor in the Department of Health Care Management at the Wharton School of the University of Pennsylvania. In the latest episode of our “Alumni Conversation” series, Alexander talks to her advisor Janet Currie about: 

• Her experience working as a researcher and applied economist in the Federal Reserve system, and how her new role in academia compares.
• Her recent research in health economics, with a focus on how providers make decisions in the health care system.
• Why graduate students should prioritize building strong presentation skills.
• What she likes about teaching and her new role at Wharton.

We’re very grateful to Diane for stopping by campus to visit and record this interview. You can watch the entire video on YouTube or read the transcript below. 

Transcript

Janet Currie: Hi, Diane.

Diane Alexander: Hi. Thanks for having me.

Janet Currie: Well, thanks so much for taking the time to come and talk to your old advisor and do this interview. This is a new series that we’re doing to check in with our Ph.D. alums and hear more about what they’ve been doing since graduating from Princeton.

For people watching, Diane was a Ph.D. student of mine who graduated from Princeton in 2016. After graduation, Diane joined the research division at the Chicago Federal Reserve, and then in 2021, she moved to the Wharton School at the University of Pennsylvania, where she’s now an assistant professor in the Department of Health Care Management.

So Diane, it hasn’t been too long since you graduated, but already you’ve had experience in both government and academia, which seems like something that could be of a lot of interest to our listeners.

I thought maybe we could start by asking you to reflect on how the experiences in the two different places compare and if that was what you expected when you were a Princeton student on the job market.

Diane Alexander: Yeah, that’s a  great question and one that I feel like I end up talking with students a lot about. I think there’s a lot of curiosity about what it’s like to be at the Fed as an economist, I think.

And so I moved to the Chicago Fed after grad school, not super intentionally, mostly because I wanted to move to Chicago. That’s where my husband was. And so it ended up working out great. But I was very pleasantly surprised by how great of an experience being at the Fed was as an academic economist. I think there is…it makes sense more so in macro and finance. There’s a lot of kind of cross-pollination between the Federal Reserve banks and economics departments that’s a bit less so in applied economics. And so I think that there’s a little bit less awareness in coming from applied fields in terms of what life is like at the Fed and that being an option for a job after you get your Ph.D. in economics.

I think each Fed has its own distinct work culture. But at the Chicago Fed, it was a really great kind of first job after the Ph.D. for me. The department was very generous. They gave me a lot of time to do research, and I had a lot of resources as well and data at the Fed.

And so my first year at the Fed, I think was almost like a postdoc in that I wasn’t given a lot of policy work to do, which is kind of at a high level, the difference between being at a Fed versus at a university, is that instead of teaching you’re doing policy work. And so that’s kind of the part of the job that isn’t research for the most part.

And at the Fed, especially at the beginning, that part of the job that isn’t research was very light. And so I had a ton of time to kind of really build out my research portfolio just after the Ph.D.

So that was something that I think I didn’t know exactly how that would go, but I was only pleasantly surprised.

It was a really great community to start out in, and it was also fun to, you know, when you’re in grad school, you kind of zoom in, you start broad with micro, macro and metrics, and then you zoom in to your field. And then being at the Fed kind of pulled me back out because we had, you know, we had people from all those different groups at the Fed.

And a lot of the policy work that we were doing, of course, was not just specific about health. And so I think that that also was nice, from just kind of like the academic environment being very broad. It’s nice to be kind of introduced to other types of research, as well.

Janet Currie: Great. Do you do you want to say a few words about being in a department of health care management, which is also a little different.

Diane Alexander: Yeah, that’s right. I liked the Fed a lot and I wasn’t looking to leave. That was a great environment. But when the opportunity arose to move to Wharton, I was also very excited about that and we ended up moving. I think in grad school I always imagined myself being at university and so I wanted to see, you know, kind of what that style of job would be like, as well.

And I’m in a business school now, which at Princeton we didn’t have a business school, so it was a little bit new to me. And then also being in a department of health care management instead of in an econ department is also a bit new. I’m still…everything is a little bit…I joined during 2021 at the beginning of the year, and so it’s hard to disentangle a little bit the effects of COVID with the differences between the Fed and Wharton. I think now things are mostly back in person, but it took a little bit of time to get there. It’s really nice.

It’s kind of the opposite, I guess. At the Fed, there weren’t a ton of health economists and I was talking, you know, regularly to people across all these different fields. And now I’m in a department where everyone is interested in kind of the same issues, which is really exciting. And, you know, that’s mostly the reason that we moved there. It’s really nice to be back, I guess kind of back more like the Center for Health and Wellbeing, where you’re surrounded by a bunch of people who are interested in the same issues. So that’s been really exciting. And now that we’re all back in person, for the most part, I’m finally, finally really getting to experience what that’s like. And having a lot of kind of, we also in my department have several junior people, so that’s kind of a fun and, you know, very dynamic work environment to be a part of.

Janet Currie: Great.

Diane Alexander: And I guess the other thing is teaching. That’s the other big difference. So now at the Fed, the policy work it was very spaced out throughout the year before the FOMC meetings. And so it was like very regular. It was like short bursts that were very regular, a lot of policy work before the meetings, and it was like, you know, updating data and forecasts and writing memos and things like that, which is very different from teaching undergrads and MBAs. But it’s also very rewarding to teach.

I think that’s also a big reason why people go into our jobs, is that they like, you know, communicating about the ideas that we’re thinking about and teaching at different levels. So I think it’s been interesting to teach that. But right now I’m teaching undergrads and also MBAs and teaching kind of similar content. But it ends up as a very different classroom experience depending on kind of the level and backgrounds of the students. So that’s been fun to try.

Janet Currie: And are you teaching health economics?

Diane Alexander: I’m teaching…the title…there is a different class that’s called Health Economics, and my class is more it’s kind of almost like an intro. to the U.S. health care system. It’s a class on the health care system, though of course, since  my background is health economics, there is a lot of health economics mixed in.

So I think especially in the undergrad class one semester, it’s taught, it kind of alternates between being taught by someone at the M.D. background and then me. And so I think the flavor of the classes are a little bit different, whether it’s the doctor is teaching it versus the health economist.

But it’s so we cover, you know, the payers and net insurance and how that works and then different sources of insurance and how people respond, and kind of all the big chunks of that system. So it’s a fun class.

Janet Currie: Do you think that we prepared you well here for being a teacher?

Diane Alexander: Yeah. I mean, when we were here, I imagine it’s similar now, we had to teach as a part of the Ph.D., and we were teaching…It was a little bit different, I guess. I mean, it was very different, but we were teaching the discussion sections. And so, you know, you have to prepare material and go up in front of a room and teach.

I think my undergrad class especially is quite big. And so that’s a little bit of a new experience definitely. It’s harder to get a discussion going in a group of 120 undergrads compared to 20 or 30. But I think I mean, I think also just our job prepares us a lot for this, you know, presenting our research and standing up in front of people and kind of trying to explain concepts.

So, yeah, I think so. I think it’s good that you have to teach though, here. I think some places they don’t really, like you can get funding through research, doing research assistants for professors and not have to teach. And I think it is helpful that we did have to teach some.

Janet Currie: So let’s talk about your research. Can you give me a sort of high-level overview of some of your recent work?

Diane Alexander: Sure. I think a lot of my work is kind of under a big umbrella of kind of thinking about how providers make decisions in the health care system. And so like, for example, how different types of financial incentives affects decisions doctors make over the types of care they provide or which patients they accept.

So one recent project with Molly Schnell, who is also a former grad student here, is looking at the effect of a payment increase for primary care in Medicaid that was kind of a temporary, increased payments to doctors for treating Medicaid patients. And so there we see,  perhaps it’s not that surprising to economists, but that doctors then became more likely to take Medicaid patients when they’re being paid more for it.

So I think that, to us, was perhaps not as surprising, but also very policy relevant because I think you often hear a lot of handwringing in the policy circles about how to get doctors to take Medicaid patients.  It’s like, well, I could try paying them a bit more. That might work. And I think just in general, I’m very interested in kind of, you know, digging into the black box of how doctors are making decisions and how it can influence them.

And then I have another stream of work that I am interested in is thinking about the effect of, kind of, pollution and the effect of place on health outcomes. And so I had a recent paper with also a former Princeton postdoc Hannes Schwandt, who’s at Northwestern now, looking at the health effects of the excessive emissions from the Volkswagen, the cheating diesel cars.

And so I think that’s something especially I think about a lot now, you know, with the electric cars becoming more and more common, the effect of car pollution on health is going to be kind of changing a lot as a landscape of different types of cars changes. And so I think that will be also a really interesting thing to look at going forward. I mean, always older cars are more polluting, but if eventually you get to a point where only more older cars are more polluting, that’s going to have a big impact, I think, on kind of the landscape of local air pollution.

Janet Currie: That paper was particularly interesting, I think, because the polluting Volkswagens were quite expensive cars. So they were creating all this pollution in high-income areas. So it was just interesting to be able to separate out the effects of having these polluting cars from the effects of being in a lower-income neighborhood.

Diane Alexander: Yeah, absolutely. And I think one thing that was really interesting from that perspective is when we kind of compared the magnitude of our effects, like taking into account how big the pollution changed with like, for example, some of your work from the E-ZPass or some other works that are looking at the effect of pollution in lower-income neighborhoods, actually, the effects were pretty similar in terms of magnitude across these different types of groups.

So even though they’re not getting exposed as much, when you hit them with the same shock, you get kind of similar outcomes. I thought that was really interesting.

Janet Currie: Yeah, that is interesting. So what are you working on right now?

Diane Alexander: So I think I’m definitely continuing to be interested in kind of physician behavior. I think one thing that I am trying to work on that we’ll see how far it goes, but I think is very understudied is actually the effects of looking into the behavior of non-physician providers.

So things like nurse practitioners or physician assistants, which we know that there are huge numbers of them and they provide a ton of care in the U.S. But I think, you know, partly just because they’re often missing, and the typical types of data that we use, it’s hard enough to get data that has that doctor attached, let alone kind of all of the other types of providers that you may have interacted with while receiving care. And so, that’s one thing that I want to look at more going forward is to try to kind of build a bigger picture of how these other types of providers are interacting in the system.

And then also, I think there is now a decent amount of work thinking about physicians and how they make decisions. But I think that there’s still a lot of room to have a lot more research there. And, you know, physicians are the ones that are making a lot of the decisions in terms of how care is provided.

And so I think, you know, digging into that black box even more like when I read papers of, you know, things like financial incentives on organizations such as hospitals or, you know, doctor’s offices or something, it’s like “the hospital did this.” My first instinct is, no, the hospital didn’t do that, the doctors did that. So how did the incentive, you know, get transmitted from the hospital level down to the doctors such that you see actually a response? And so I think those are types of questions that I’m continuing to be very interested in.

Janet Currie: Yeah. I guess there’s some interesting examples where the hospitals and the physicians don’t necessarily have the same incentives. So it can be hard to get everybody on the same page.

Diane Alexander: Yeah, Yeah, absolutely. I think. Yeah. I just I think that there is also a lot of interesting work coming out by MD Ph.D.s because I think that they have this kind of insight that that we don’t necessarily have of having actually worked in some of these places, so if you see this type of financial incentive in place, like how plausibly could that actually affect behavior?

Janet Currie: Okay. So I thought we could wrap up by talking a bit about life as an earlier career academic. It hasn’t been so long since you graduated, and so you may have some insights that are valuable to students now. Are there things that you’d like to say about either how people can maximize the value of their time here or your early career experiences that you wish you had known when you were on the job market?

Diane Alexander: Sure. Yeah. I think that that’s a great question, and something that you don’t necessarily realize how important some things were until afterwards. Reflecting back, I was just telling the Ph.D. students in our department this recently, I think the importance of presenting work to and talking about your work when you’re in grad school with the faculty that you have, that I think you take that for granted a little bit, or you can. And I think that it’s kind of amazing how big of a difference that makes in terms of kind of the quality of the research and also the quality of presentation styles.

I think…I certainly think that Ph.D. students tend to under-emphasize how important the actual presentation of the results is and kind of over-focus on getting, you know, that last appendix table or something like that. But I think that being able to practice the actual presentation of the results and prepare how you would answer questions clearly, and the kind of communication, which also extends into the writing of the paper, but on the econ job market, I think is particularly important in terms of the presentation, is something that tends to be under-invested in by Ph.D. students, and that’s something that I see happening now when I’m on the other side with our Ph.D. students.

And so I think I think that’s something that I didn’t really think about as much when I was in the Ph.D. beyond the fact that we were kind of forced to present periodically. But now, looking back, that seems like such an obvious and important skill, so I’m very glad that we were forced to present it periodically.

I think in some departments, now I’m realizing that that’s not necessarily the norm. So I’m just actually starting a workshop for our students just because I think that that’s so important. I think, you know, oftentimes people’s only impression of a paper will be the presentation and they won’t necessarily be going and reading the whole paper in its written form.

And so you want people to, you want to get your point across and you want it to be clear, and you want people to be convinced, which are all important presentation skills that don’t kind of develop out of nowhere.

Janet Currie: That’s great. It’s nice that you’re sort of passing those skills along.

Diane Alexander: I hope so. We’ll see. I mean, I also always remember back to myself in grad school, you know, you’re much more, it can be a bit, kind of intimidating to present in front of all of these more senior people. So I do remember that, as well. So I get it. But I think it’s so important.

Janet Currie: So I guess another takeaway maybe from your career experience to-date is that, you know, I think your career is thriving and your publication record is great. And so far it’s been kind of outside of traditional economics departments. So that would be one takeaway that people could get, is that they should sort of look broadly and not rule out some of the less obvious alternatives.

Diane Alexander: Yeah, that’s a great point. I mean, especially the Fed, I would love to talk up the Chicago Fed and just the Federal Reserve system in general, because I think I had very little knowledge of what it would be like to be an academic economist at the Fed. And, you know, it wasn’t as much on my radar except for the fact that I had location preferences, but it ended up being a wonderful experience.

And I think people should put it on their radar a bit more. I think especially starting out, you get so much research time and a lot of support. And so I think it can be a really good place to kind of build up a portfolio of work and kind of kick start a career. And something it’s that, like you said, is not necessarily on a lot of, especially coming out of applied micro groups, on a lot of people’s radar. They also have a great culture of everyone being around, which I think is really fun.

When we were at Princeton, I think I also didn’t realize that that’s not the case at every econ department that, you know, most people are in their offices a lot of the time. And so that that was something that was similar at the Fed, and that I really enjoyed there, too.

Janet Currie: Hey, thank you, Diane. That’s all the questions that I had. And I just want to say thank you once again for taking the time to come back to Princeton and do this. I’m sure that people that are watching will really appreciate it. And I just want to say that I really enjoyed the visit, as well.

Diane Alexander: Thanks so much. It’s been fun.