JAMA: Steady decline in docs' weekly hours has market, policy implications

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Physicians are working fewer weekly hours and making less money than they did in recent decades, which is inconsistent with other professional careers. Any further negative economic factors could be the tipping point for unsustainable decreases in hours worked in a market already hurt by physician shortages, according to a study in the Feb. 24 issue of Journal of the American Medical Association.

“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,” Douglas O. Staiger, PhD, of Dartmouth College in Hanover, N.H., and colleagues wrote.

They said that most research and policy debate on this topic has focused on physician numbers and not the hours they worked.

In the study, Staiger and colleagues found that between 1977 and 1997, physician work hours were fairly stable (55 hours per week). However, between 1997 and 2007, work hours per week decreased steadily (51 hours per week—a decline of 7.2 percent).

Hours decreased significantly 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,” they wrote.

Among nonresident physicians, they found that 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 percent).

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 U.S. 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.

Researchers said their findings 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.”