The number of hours U.S. physicians work each week has markedly and steadily decreased during the past decade, after having remained stable during the 2 preceding decades, according to a report.
While the study was not designed to identify why such changes have occurred, investigators did find a striking correlation between physicians' decreasing hours and decreasing fees for their services.
Inflation-adjusted physician fees changed little until the mid-1990s, when they began a steady 10-year decline. “By 2006, physician fees were 25% lower than their inflation-adjusted 1995 levels,” Douglas O. Staiger, Ph.D., of Dartmouth College, Hanover, N.H., and his colleagues noted.
The decrease in hours worked per week “was broad-based and not concentrated among physicians with particular demographic characteristics or working in particular settings.” Physicians from all demographic areas have shortened their typical work weeks from the approximately 55 hours that prevailed since 1977 to 51 hours, the investigators said.
In contrast, mean weekly hours worked by other professionals such as lawyers, engineers, and registered nurses “changed very little during the past 30 years, which is consistent with national trends in mean weekly hours among all workers published by the Bureau of Labor Statistics,” they said.
The researchers said they examined this issue because most studies concerning the medical work force, as well as the policy decisions based on those studies, have assumed that hours worked by physicians have remained constant.
A few recent studies have suggested that this assumption may no longer be warranted.
Dr. Staiger and his colleagues analyzed data from the Census Bureau's Current Population Survey, an annual report that obtains detailed information about employment from a nationally representative sample of adults. They examined data from the late 1970s through 2008 on all 116,733 survey subjects listed as physicians or surgeons.
Physician weekly work hours were stable during 1977-1997, ranging only from a low of 54.6 hours to a high of 55.9. Since then, however, work hours have declined steadily, and they currently total 51 hours per week.
During the same interval, mean physician fees, adjusted for inflation, decreased by 25%.
“It is likely that a third factor that was associated with lower fees, such as growing managed care penetration or market competition, may have contributed to the decrease in physician hours,” Dr. Staiger and his colleagues noted (JAMA 2010;303:747-53).
“Whatever the underlying cause, the decrease … raises implications for physician workforce supply and overall health care policy. A 5.7% decrease in hours worked by nonresident physicians in patient care, out of a workforce of approximately 630,000 in 2007, is equivalent to a loss of approximately 36,000 physicians from the workforce.
“Although the number of physicians has nearly doubled during the last 30 years, many workforce analysts and professional organizations are concerned about the adequacy of the size of the future physician workforce.
This trend toward lower hours, if it continues, will make expanding or maintaining current levels of physician supply more difficult,” they noted.
The trend also “could frustrate stated goals of health reform, which may require an expanded physician workforce to take on new roles and enhanced functions in a reformed delivery system.”
Disclosures: This study was supported by the National Institutes of Health. No financial conflicts of interest were reported.
My Take
These Findings Are Limited
This study is flawed, as it fails to take into account more part-time physicians and more women physicians, especially in pediatrics.
I believe that for male, head-of-household, sole provider physicians, hours spent weekly likely have risen, and incomes are up or steady as well.
I wouldn't intuit anything at all from this study, other than to say it will be most difficult for us to assess workforce needs of the future, given the change in physician demographics and the needs of the newer generation, and given the possibilities of increased access to care someday with health care reform. We likely will need more providers, but we cannot just tie it in to the conclusions of this study.