The average number of hours worked by physicians fell by 7.2 percent between 1996 and 2008, correlating with a decline of 25 percent in physician fees, according to a study by economics professor Douglas Staiger and his colleagues published Feb. 24 in the Journal of the American Medical Association.
Recent reports by the American Medical Association failed to include shifts in the number of hours worked by physicians when examining trends and making projections about the physician workforce, the study determined.
"Trends in the Work Hours of Physicians in the United States" was published by Staiger, Congressional Budget Office analyst David Auerbach and Vanderbilt University School of Nursing professor Peter Buerhaus. The study analyzed physician employment information from January 1976 to December 2008 collected by the Current Population Survey, a household-based questionnaire administered by the U.S. Census Bureau.
Between 1977 and 1997, physicians worked an average of 55 hours per week, with little variation over time, according to the study. Between 1997 and 2007, however, the average number of hours worked per week fell to 51, with the greatest decrease exhibited by nonresident physicians under 45 years of age.
"This is an unprecedented decline that we haven't seen before in physicians, and you don't see it for other professions, like lawyers," Staiger told U.S. News and World Report. "It's happening among all types of physicians young and old, working at a hospital or not."
Nonresident physicians are deciding to reduce their hours because of a "combination of economic and non-economic factors," the study said. Between 1996 and 2006, physician fees, when adjusted for inflation, fell by 25 percent, resulting in a loss of income that makes it less profitable for physicians to work long hours, the study said.
"Some physicians have undertaken other activities to offset the loss in income," the study said. "Such activities by physicians may make work less satisfying and only partially offset the decrease in fees."
Physicians in areas facing lower fees may also have to deal with increasing competition and restricted autonomy, meaning that rising market pressures in the future may result in further decreases in average work hours, according to the study. The doctors practicing in metropolitan areas with the lowest fees were found to work less than 49 hours per week on average, while their counterparts in other areas with higher fees work 52 or more hours per week, the study said.
The 5.7 percent drop overall in weekly hours worked over the past decade is equivalent to a loss of 36,000 doctors from the physician workforce, according to the study. Persistence of the trend in the future could make it difficult to maintain a constant workforce of practicing physicians capable of handling the needs of the American populace, the study said.
"If this trend toward lower physician hours continues, it 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," Staiger wrote in the study.
The study's authors took measures to minimize inaccuracies when calculating the figures published.
"To estimate trends in hours of residents, we excluded data from 2003 because duty hour limits were imposed mid-year," Staiger wrote in the study. "For nonresident physicians, we estimated trends overall and for subgroups of physicians by age, sex, work setting, whether the physician reported being self-employed, and whether the physician lived in an MSA [Metropolitan Statistical Area] that had high or low fees in 2001."
The survey does not distinguish between general practitioners and surgeons, according to a press release issued by Dartmouth College.
Staiger could not be reached for comment by press time.
