The Accidental Economist: How Prof. Richard Scheffler skipped med school—and made a profound impact on public health

In 1971, Richard Scheffler was an assistant economics professor at the University of North Carolina, when a professor at a nearby medical school posed an intriguing question:

Too many physicians were going into specialties, said the professor, Dr. Harvey Estes Jr. of Duke University. There was already a shortage of primary care practitioners. Yet some of the work that physicians do, Estes believed, might be handled by well-trained physician assistants.

Could Scheffler, he asked, figure out how much work might be done by assistants—and what the cost savings would be?

Scheffler could.

He conducted a series of task analyses and time-motion studies, in which he looked at how much time doctors spent on specific patient care tasks; and compared it to how much time it took physician assistants to do the same thing. He calculated the wages that doctors made, and concluded that the physician assistants could do two-thirds of a doctor’s work for one-quarter of the cost.

“Dr. Estes had this idea because he’d been in the military, and they train people in less than three months to be medics,” Scheffler said in a recent interview. “I told Harvey I had a feeling that we don’t need all these doctors. We could train physician assistants in a year or two, to do a lot of what doctors do, which is pretty routine stuff.”

“So, Harvey said, ‘Can you help me out? I’m trying to get Duke to fund this training program and they are being resistant.’”

Scheffler and his team published a paper and several follow ups. The research launched Duke’s physician assistant training program—and propelled Scheffler into the forefront of the field of health economics.

Since then, his work has often driven the national conversation on health policy with impact on federal and state governments, as well as overseas. He has shown how consolidation of health care systems forces patients to pay more for lower-quality service; exposed how private equity investment harms healthcare; explored diagnosis and treatment of ADHD in children; and revealed widespread disparities in insurers’ mental health coverage — leading to changes in federal law.

“Richard’s work across a range of topics has furthered our understanding of the healthcare system,” said Stephen Shortell, dean emeritus of UC Berkeley School of Public Health. “He’s a big thinker, with a lot of ideas. He has a very challenging style—in a positive way. He’s very persistent in pushing ideas and getting access to data. He’ll say, ‘Well okay, that’s a problem. How do we fix it?’’’

Scheffler’s impact as a professor at UC Berkeley School of Public Health has been strong. He founded a dual masters degree program (MPH and MPP) with The Goldman School of Public Policy and the UC Berkeley Ph.D. program in health policy. For 15 years, Scheffler also ran a large and prestigious postdoctoral program, funded by the Robert Wood Johnson Foundation, Scheffler Award in Health Economics. In Scheffler’s honor, the university awards the Richard Scheffler Prize in Health Economics to the best doctoral dissertations on the subject each year.

Timothy Brown, UC Berkeley associate research professor of health economics, who has collaborated with Scheffler on research into the relationship between social capital—the value of a person’s relationships and networks—and cardiovascular disease, praises his penchant for taking risks in his research.

“One thing about Richard is that he is a man who is not afraid to try very new things,” Brown said. “Social capital was a very new thing and he just jumped right in. Our main finding was that social capital mattered a lot in cardiovascular disease.”

A home at the Petris Center

The home for much of Scheffler’s work has been the Nicholas C. Petris Center on Health Marks and Consumer Welfare at UC Berkeley. Scheffler founded the Petris Center in 1999 with a $2 million endowment from the Attorney General of California, William Lockyer, an antitrust crusader who was eager for a source of unbiased research to counteract information put out by industry. Lockyer got the money from a $10 million settlement with Levi Strauss for price fixing. The research center was named after the late California State Senator Nicholas Petris, a longtime advocate of California consumers for affordable, accessible, and quality health care.

The Petris Center, which celebrated its 25th anniversary last year, produces empirical research that policymakers can use for guidance on critical healthcare matters. Recent reports have shed light on healthcare affordability and access, medical market consolidation, and related issues. In a video tribute shown at the Petris Center’s anniversary party, Attorney General Rob Bonta thanked Scheffler, “for his commitment to protecting consumers and examining competition or the lack thereof in the healthcare sector.”

Bonta also noted the Petris Center’s role in the 2021 landmark $575 million settlement with Sutter Health for their anti-competitive practices which forced patients to pay more for health services.

“We couldn’t have done that without the help of the Petris Center,” Bonta said.

Scheffler, emeritus professor since 2019, has continued to serve as Petris Center director. In recent years he has also put a stronger emphasis on accountability in the healthcare system, with particular attention to vulnerable populations.

And in 2021, he co-authored a foundational report with colleague Laura Alexander, on the role that private equity investment plays in harming patients and impairing the functioning of the healthcare industry. Scheffler and Alexander included a decade’s worth of evidence. Scheffler has a forthcoming paper on the subject, with Preetha Subbiah, an undergraduate student in Economics for Public Health, coming out in the American Medical Association Journal of Ethics in May.

“I think having a health economist of his stature looking at these issues at the intersection of economics and healthcare was super important,” said Alexander, who is now an incoming assistant professor at Moritz College of Law at Ohio State University.

“The reports that we worked on together were cited not only by academics and the press, but also by members of Congress in hearings, by senators, and they were the basis of considerable enforcement work happening at the Federal Trade Commission and at the Department of Justice. It really broke open this new area of research,” she said.

Scheffler said he has been very pleased by the impact of their private equity research.

“You get this level of attention, maybe three or four times during a 45-year career,” he said. “Based on that report. I’ve been advising the Federal Trade Commission on private equity matters and healthcare; and I’ve also advised federal lawmakers.”

“Students always ask, ‘As professors you write all these reports and papers, what difference does it make?’ If I were still teaching, I could give them my answer, finally: “Yes, it makes a difference.”

More recently, Scheffler was a member of the Aspen Institute working group, which released a report in February 2025, describing the increasing consolidation of healthcare systems, and spelling out ways to reduce practices that raise costs, harm quality or limit access to care.

How he got there: Surviving a tough neighborhood and avoiding the draft

Scheffler grew up in East New York, a Brooklyn neighborhood so tough that 60 years later it remains one of the least gentrified places in that trendy borough.
“I grew up with three younger sisters that I had to walk to school,” he said. “I learned to look tough, so I avoided a lot of fights. If you have a tough persona, it kind of saves you.”

Scheffler was also protected by his math skills, which landed him at Brooklyn Technical High School, a magnet school for gifted students, about an hour by subway from his house.

“It got me out of the neighborhood,” he said. “It was still in Brooklyn but a different part of Brooklyn.”

When Scheffler started college at Hofstra University in Long Island, he planned to become a doctor, but he didn’t click with his fellow students on that track.

“I had very little rapport and interest in talking to the people in the class who were also trying to go to medical school,” he said. “So I thought, ‘Gee, I don’t really get on with these people, I don’t want to work with them.’”

He took an economics class and did well in it, thanks to his math skills.

“That was the segue,” he said. “I matched my interest in healthcare with my abilities in economics, which came from my mathematical background.”

He earned a Bachelor of Science degree from Hofstra University in 1965. After graduating, a cousin who worked in advertising—which was booming at the time—helped him line up a job. But before Scheffler could begin, he got a draft notice from the U.S. Army.

“I thought, this wasn’t so good, you know,” he said. “I needed a student deferment to avoid the war in Vietnam.”

Graduate school seemed Scheffler’s best chance for a deferment, but he had already missed the deadline for the master’s program he had his eye on at Brooklyn College. A sympathetic economics department secretary sent him to see the department chairman, who was impressed with Scheffler’s graduate entrance exam scores and admitted him on the spot.

He became fascinated by the question of how the healthcare system worked as a market, compared to markets for widgets or cars.

“During my whole career, I’ve thought, we can’t change the country we’re in,” Scheffler said. “Medicine was set up for people to make profits off—and it just struck me that was something I wasn’t comfortable with. So, I wanted to study what the drive for profits does to medicine and how it distorts healthcare.”

He received his PhD with honors in Economics in 1971, from New York University. His first academic job took him to UNC, Chapel Hill, where he started teaching a health policy class – and conducting research on physician assistants. Eventually, Scheffler wrote a book on the topic; one of 12 books he has written or edited over the years.

In 1981, Scheffler landed at UC Berkeley for a one-year visiting post at the UC Berkeley School of Public Health. Happy at Berkeley, Scheffler in 1982 became an associate professor in what was then the Department of Social and Administrative Health Services within the School of Public Health. He went on to become a Distinguished Professor of Health Economics and Public Policy, with joint tenured appointments at UC Berkeley Public Health and the Goldman School of Public Policy.

One of the first issues Scheffler took on at the school was the economics of mental health treatment— the sparse coverage for mental health treatment compared to more physical maladies, like cancer. He knew mental health treatment was expensive, and he wondered if he could convince insurance companies and society as a whole that spending money to treat mental illness would actually save money long term.

“We found out early on that if you treat people with mental health problems, they end up having fewer physical problems because the mind and the body are connected,” he said. “If you just try to deal with the physical problems and not the mental problems, you don’t really cure anybody.”

Scheffler worked behind the scenes of the federal government, helping pass a law that required insurance companies that covered people for physical health problems to also cover them for mental health problems.

“We had an amazing impact,” he said. “Now virtually all health insurance plans cover mental health services, but back then, it was not the case.”

One of Scheffler’s most significant projects was a 2018 study of the effect of hospital consolidation on patients. He examined the expansion of Sutter Health, a nonprofit chain that then had 24 hospitals, 34 surgery centers, and some 5,000 doctors across Northern California.

“I noticed that these very, very big players became hard to deal with and they were raising their prices, quite frankly,” Scheffler said. “And when the hospitals raised their prices, of course, the insurance companies have to raise their prices, and insurance coverage was becoming unaffordable for the average worker system.”

Scheffler found that for the exact same service, Northern California hospitals charged 30% more than Southern California hospitals.His report drew the attention of another California attorney general, Xavier Becerra, who held a press conference to showcase Scheffler’s work. The study also prompted Becerra to sue Sutter, arguing that the health care giant used its market position to drive up prices.

“Xavier said, ‘There’s the evidence I need, Boom,’” Scheffler said.

The case was settled in August 2021, with Sutter agreeing to pay $575 million; limit what the network charges out-of-network patients; and stop its anti-competitive practices. It also resolved an earlier legal action begun in 2014 by the United Food and Commercial Workers and Employers Benefit Trust, and class action plaintiffs. “They settled right before the trial started,” Scheffler said. “It would have been much higher—and it was all based on these four undergraduates who wrote down all the data.”

A continuing legacy

And his work continues to earn honors. In 2018, Scheffler was awarded the Berkeley Citation, among the highest honors the campus bestows, presented on behalf of the UC Berkeley chancellor to individuals whose contributions to UC Berkeley, “go beyond the call of duty.”

In 2024, he was named UCB’s 2024 Emeriti of the Year, alongside the School of Information’s Michael Buckland. The award is given to emeriti who have made significant contributions to their fields after retirement, and who continue to have a major influence on academic and policy discussions in their fields. Also last year, Scheffler was made a lifetime fellow of the AAAS.

Scheffler is proud to stay active in the research community. He notes that more than 30% of his 11,000 citations have been reported since 2020.

“I continue to double down on my interests and look at profits in the healthcare system, like the impact of private equity in the healthcare system,” Scheffler said. “I am now studying private equity in healthcare in other countries.”