Dissertation Defense: Do Clinicians Have Patience? Examining Delay Discounting, Perceived Stress, and Low-Value Antibiotic Prescribing for Acute Bronchitis
Dissertation Defense: Do Clinicians Have Patience? Examining Delay Discounting, Perceived Stress, and Low-Value Antibiotic Prescribing for Acute Bronchitis
Mary J. King
Graduate Student, Translational Biology, Medicine, and Health
Graduate Research Assistant, Stein Lab, Fralin Biomedical Research Institute at VTC
Feb. 20, 2026, at 2 p.m.
Room G101 A/B, 4 Riverside Circle
About this Dissertation
Antimicrobial resistance has been deemed one of the top global threats by the World Health Organization and is largely driven by the overuse of antibiotic medications. Yet low-value antibiotic prescribing (LVAP; the prescription of antibiotics when it is not clinically indicated) is still widely prevalent across multiple healthcare disciplines, often for viral illnesses such as acute bronchitis. Behavioral factors such as delay discounting (DD; the extent to which someone prefers smaller, sooner rewards over larger, delayed rewards) and stress may independently and interactively contribute to clinicians’ high rates of LVAP. Examining how these variables are related to each other and LVAP can help develop future interventions focused on improving prescribing rates and ensuring appropriate patient care. In study one, King, mentored by Jeff Stein, compared DD and probability discounting (PD; the extent to which someone prefers smaller, guaranteed rewards over larger, risky rewards) between primary care clinicians and non-healthcare workers, finding that clinicians had lower DD and higher PD rates compared to non-healthcare workers. In study two, she analyzed data from the group of non-healthcare workers to determine whether there was a significant relationship between DD, PD, and perceived stress levels, finding that both DD and PD were associated with perceived stress. In study three, King examined the associations between DD, perceived stress, and LVAP in a sample of clinicians from multiple departments across a large healthcare system. This included both self-reported likelihood of LVAP based on two clinical vignettes, as well as electronic health record-based incidence rates, and King found that DD was associated with self-reported LVAP likelihood in both clinical scenarios assessed. Ultimately, these three studies suggest that DD may be an important behavioral marker in the context of LVAP that warrants further investigation. Future studies investigating the connection between LVAP and behavioral factors such as discounting and stress should seek to examine workplace-specific stress levels and further explore possibilities for interventions involving DD as a behavioral marker.
More About the Candidate and Project
Education
Virginia Tech, Translational Biology, Medicine, and Health, Ph.D. Candidate
University of Lynchburg, B.S., Psychology
Training
Graduate Research Assistant, Stein Lab, Fralin Biomedical Research Institute at VTC
Mentor
Jeff Stein, Ph.D., Assistant Professor and Interim Co-director, Center for Health Behaviors Research, Fralin Biomedical Research Institute at VTC
Committee Members
- Michelle Rockwell, Ph.D., RD, Director of Research, Department of Family and Community Medicine, Carilion Clinic; Co-Director, Health Systems Science and Interprofessional Practice, and Assistant Professor, Family and Community Medicine, Virginia Tech Carilion School of Medicine
- John W. Epling Jr., M.D., MSEd, Vice Chair, Research and Population Health, Professor, Department of Health Sciences and Family and Community Medicine, Virginia Tech Carilion School of Medicine
- Allison Tegge, Ph.D., Research Associate Professor, Fralin Biomedical Research Institute at VTC, Department of Statistics, Virginia Tech, Department of Basic Science Education, Virginia Tech Carilion School of Medicine
Publications
King, MJ, Rockwell, M, Epling, JW, Tegge, A, & Stein, JS. (2026). The Impacts of Delay Discounting and Perceived Stress on Low-Value Antibiotic Prescribing for Acute Bronchitis. [Manuscript in preparation]
King, MJ, Rockwell, M, Epling, JW, & Stein, JS. (2026). Examining Relationships Between Delay and Probability Discounting and Perceived Stress in the Absence of Socioeconomic Constraint. [Manuscript under review]
King, MJ, Rockwell, M, Epling, JW, & Stein, JS. (2026). Examining Differences in Delay and Probability Discounting Between Primary Care Clinicians and Non-Healthcare Workers. [Manuscript in preparation]
Epling, JW, King, MJ, Rockwell, M, Tegge, A, Hester, CM, Clay, TL, Callen, EF, Turner, JK, & Stein, J. (2026). Delay Discounting and Low-Value Care Decision-making by Primary Care Clinicians in a Survey-Based Vignette Experiment. [Manuscript in revision]
Rockwell, MS, King, MJ, Mercogliano, EH, Bortz, BA, Karanjeet, R, Stewart, J, Fendrick, MA, Mafi, JN, & Epling, JW. (2026). Characterizing Variation in Low-Value Acute Low Back Pain Imaging in Primary Care. [Manuscript submitted for publication]
Ruhi-Williams, P., King, M. J., Stein, J. S., & Bickel, W. K. (2022). Episodic Future Thinking about Smoking-Related Illness: A Preliminary Investigation of Effects on Delay Discounting, Cigarette Craving, and Cigarette Demand. International journal of environmental research and public health, 19(12), 7136.
Presentations
King, MJ (2025, September). Delay Discounting, Stress, and Low-Value Antibiotic Prescribing for Acute Bronchitis: Preliminary Results and Future Plans [Oral presentation]. Fralin Biomedical Research Institute Fall 2025 Research in Progress Seminar Series, Roanoke, VA.
King, MJ, Epling, JW, Rockwell, MS, & Stein, JS. (2025, May). Examining Delay and Probability Discounting and Stress in the General Population [Poster session]. Poster presented at: 51st annual meeting of the Association for Behavior Analysis International, Washington, D.C., United States.
King, MJ, Epling, JW, Rockwell, MS, & Stein, JS. (2025, May). Examining Differences in Delay and Probability Discounting Between Primary Care Clinicians and the General Population [Poster session]. Poster presented at: 51st annual meeting of the Association for Behavior Analysis International, Washington, D.C., United States.
King, MJ, Epling, JW, Rockwell, MS, & Stein, JS. (2025, April). Examining Differences in Delay and Probability Discounting Between Primary Care Clinicians and the General Population [Poster session]. Poster presented at: Carilion Research Day, Carilion Clinic, Roanoke, VA.
King, MJ (2024, January). Delay Discounting and Stress in Low-Value Care in Primary Care Clinicians: A Mixed-Methods Study [Oral presentation]. Fralin Biomedical Research Institute Spring 2023 Research in Progress Seminar Series, Roanoke, VA.
King, MJ, Epling, J, Rockwell, M, & Stein, JS. (2023, June). Assessing delay and probability discounting in clinical decision making and their impact on low-value care provision in clinical scenarios [Poster session]. Poster presented at: Fralin Biomedical Research Institute Annual Retreat, Hot Springs, VA.
King, MJ & Stein, JS. (2023, May). Development of a Reliable and Objective Rating System Assessing Cue Quality in Studies on Episodic Future Thinking [Poster session]. Poster presented at: 49th annual meeting of the Association for Behavior Analysis International, Denver, CO, May 2023.
King, MJ & Stein, JS. (2023, January). Exploring Novel Episodic Future Thinking Interventions for Achieving Smoking Cessation [Poster session]. Poster presented at: Translational Biology, Medicine, and Health Winter Symposium, Roanoke, VA.
King, MJ & Stein, JS. (2022, May). Episodic future thinking about smoking-related consequences: A preliminary study [Poster session]. Poster presented at: Fralin Biomedical Research Institute Annual Retreat, Hot Springs, VA.
- Graduate Research Development Program award recipient, 2023
- Member of the Board of Directors for the Calm Clinic and Caravan, Roanoke-based acupuncture clinic
- Judge, Roanoke County Science Fair, 2022-present
- Judge, Roanoke Valley Governor's School Project Forum, 2025-present
- Judge, Western Virginia Regional Science Fair, 2025-present