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Doctors Working Less, Earning Less

Seven percent drop in hours may lead to physician shortages, researchers say,,,,

TUESDAY, Feb. 23 (HealthDay News) -- Although physicians still work long hours, the past decade has seen a sharp decline in the average number of hours they work each week, a new study finds.

From 1976 through 1996, the average work week of doctors remained steady, but between 1996 and 2008, the average number of hours physicians spent at work dropped nearly four hours a week -- from 54.9 to 51 hours a week.

"After being stable at around 55 hours for decades, physicians' hours have declined 7 percent in the past decade to around 51 hours a week," said the study's lead author, Douglas Staiger, professor of economics at Dartmouth College in Hanover, N.H. "This is an unprecedented decline that we haven't seen before in physicians, and you don't see it for other professions, like lawyers."

Results of the study are published in the Feb. 24 issue of the Journal of the American Medical Association.

For the study, Staiger and his colleagues reviewed data on trends in physicians' work hours from the U.S. Census Bureau from 1976 through 2008. The survey included 116,733 doctors from across the country.

Initially, the researchers suspected that rules instituted in 2003 limiting the amount of time that physician residents can work in hospitals might have been behind the drop in physician hours. Although residents did have a larger decline in hours -- 9.8 percent on average -- the drop in hours worked affected all physicians, with non-resident physicians experiencing a 5.7 percent reduction in their work week.

"The decline in hours was very broad-based. It's happening among all types of physicians -- young and old, working at a hospital or not," said Staiger.

The biggest drops in hours worked were for non-resident physicians under 45 years old and those working outside of a hospital.

The study also found that the average physician's fees dropped by 25 percent between 1995 and 2006. In areas with the lowest physician fees, the average number of hours worked was just 49 per week in 2001, according to the study.

"If you get paid less, you have less incentive to work harder," said Dr. Michael Reis, the interim chairman of the Family Medicine Department at Scott & White Healthcare in Temple, Texas. "One of the problems is that physicians put off years of earning through college, medical school and residency, and are often way behind the eight ball when they're done training. That may drive some to pick specialties that pay more for fewer hours."

Staiger said that the data wasn't broken down by specialty, so the researchers weren't able to discern if more people were entering specialties that require fewer work hours.

But, he said, the researchers do believe that financial pressures probably have something to do with the decline in work hours.

"As fees have come down, for physicians to make the same money, they have to see more patients, and that makes it less satisfying for everybody. Patients feel rushed and physicians can't spend the time they want to with patients," said Reis.

Staiger agreed that doctors probably have to spend less time with each patient. "Physicians may be fitting more into a shorter period of time," he said.

And, with an aging population that's growing, physicians may be forced to do more in less time. Although the United States has more doctors now than ever before, the reduction in work hours is equivalent to losing about 35,000 full-time doctors, according to Staiger.

"We already know there's going to be a shortage of physicians in the future, especially primary care doctors, and this is only going to multiply the problem," said Reis.

More information

For advice on choosing your doctor, visit the U.S. National Institute on Aging.

SOURCES: Douglas Staiger, Ph.D., John French professor of economics, Dartmouth College, Hanover, N.H.; Michael Reis, M.D., associate regional chief medical officer, Northern Regional Clinics, and interim chairman, Family Medicine Department, Scott & White Healthcare, Temple, Texas; Feb. 24, 2010, Journal of the American Medical Association

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