Work Hours of U.S. Physicians Declining, Linked to Physician Fees
Last Updated: 2010-02-23 16:00:44 -0400 (Reuters Health)
The decline has been temporally and geographically linked to lower physician fees, the report says.
"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," Dr. Douglas O. Staiger, from Dartmouth College, Hanover, New Hampshire, and colleagues state.
To assess trends in physician work hours, Dr. Staiger and his coauthors used US Census Bureau data obtained between 1976 and 2008 by surveys of households that contained individuals whose occupation was "physician or surgeon." Overall, the information came from 116,733 monthly surveys of 27,874 households.
Work hours held steady through the early 1990s, but from 1996 to 2008 the average number of hours worked per week dropped by 7.2% (54.9 to 51.0 hours/week, p < 0.001). When resident physicians were excluded from the analysis (duty hour limits were imposed in 2003), nonresident physician hours fell by 5.7% (p < 0.001).
Declines were larger among physicians younger than 45 years (7.4%) and those working outside the hospital (6.4%) than among older physicians (3.7%) and those working in the hospital (4.0%).
After accounting for inflation, the authors calculate that physicians' fees decreased by 25%, on average, at roughly the same time that physician work hours dropped.
An analysis of 2001 data showed that in metropolitan areas with the lowest fees - roughly 18% lower, on average, than in high-fee areas -- physicians averaged less than 49 hours of work per week. In high-fee regions, by contrast, physician worked more than 52 hours per week on average (p < 0.001).
"This trend toward lower hours, if it continues, will make expanding or maintaining current levels of physician supply more difficult," the authors state.
Moreover, they conclude, a trend toward lower physician hours "could frustrate the 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."
JAMA 2010;303:747-753.
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