Hours worked by physicians have decreased steadily in last decade

After remaining stable for 2 decades, the average hours worked per week by physicians decreased by about 7 percent between 1996 and 2008, according to a study in the February 24 issue of JAMA.

"The potential expansion of health insurance coverage and associated reform of the delivery system, combined with recent forecasts of physician shortages (particularly in primary care), have catapulted issues related to the adequacy of the physician workforce high up on the health policy agenda. Whether the workforce is equipped to handle the demand for physician services depends on both the quantity and specialty distribution of physicians and the number of hours worked per physician. Most research and policy debate on the physician workforce, however, has focused on the numbers of current and future physicians and has largely ignored the hours worked by physicians," the authors write. "Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed."

Douglas O. Staiger, Ph.D., of Dartmouth College, Hanover, N.H., and colleagues examined trends in hours worked by physicians using data from the U.S. Census Bureau for each year between 1976 and 2008, and also examined whether trends were associated with trends in physician fees both nationally and by geographic region within the United States. The final sample included 116,733 monthly surveys of physicians obtained from 27,874 households. Trends were estimated among all U.S. physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001.

The researchers found that average hours worked per week among all physicians changed significantly during the study period. Between 1977 and 1997, physician work hours were fairly stable, at approximately 55 hours per week. However, between 1997 and 2007, work hours per week decreased steadily, decreasing nearly 4 hours per week to 51 hours per week (7.2 percent). Hours decreased significantly during the last decade (between 1996-1998 and 2006-2008) for both resident physicians (9.8 percent) and all other physicians (5.7 percent). Resident hours remained high through 2002 and then decreased sharply following the imposition of work-hour limits in 2003, whereas hours of all other physicians decreased more steadily during the last decade.

"Between 1996-1998 and 2006-2008, hours worked decreased significantly among younger and older physicians, male and female physicians, physicians employed in hospital and nonhospital settings, and among self-employed and non-self-employed physicians. [Among nonresident physicians], the decrease in hours during this period was largest for [those] younger than 45 years (7.4 percent) and those working outside of the hospital (6.4 percent), and the decrease was smallest for those aged 45 years or older (3.7 percent) and for those working in the hospital (4.0 percent)," authors write.

They add that in contrast, average weekly hours of other professionals such as lawyers, engineers, and registered nurses changed very little during the past 30 years, which is consistent with national trends in average weekly hours among all workers.

The researchers also found that after adjusting for inflation, average physician fees decreased nationwide by 25 percent between 1995 and 2006, coincident with the decrease in physician hours. "In 2001, [average] physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere."

"Our results have implications for how reform efforts and market forces may affect the future physician workforce. Our findings are consistent with the possibility that economic factors such as lower fees and increased market pressure on physicians may have contributed, at least in part, to the recent decrease in physician hours. Further reductions in fees and increased market pressure on physicians may, therefore, contribute to continued decreases in physician work hours in the future. Whatever the underlying cause, the decrease in [average] hours worked among U.S. physicians during the last decade raises implications for physician workforce supply and overall health care policy," the authors write.

More information: JAMA. 2010;303[8]:747-753.

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