The number of hours logged by physicians has steadily declined over the last 15 years due to lower per-patient compensation and increasing government regulations, according to a study conducted this year by Dartmouth economics professor Douglas Staiger. Although doctors now work fewer hours, the conditions under which they work have become increasingly stressful, Staiger said.
Until the mid-1990s, physicians typically worked an average of 54.9 hours a week, according to Staiger, an amount that remained fairly constant over the years. Change came in 2008, when data showed physicians working an average of 51 hours a week, he said.
Although many may consider a shorter workweek a benefit, Staiger attributed the change to obstacles many doctors now must face in the workplace, including collecting less fees per patient now than they did in the mid-1990s. Due to lower compensation, doctors are less willing to put in the extra hours, Staiger found.
"We created an index of physician fees what doctors make for typical visits and noticed that these fees were pretty constant until the mid '90s," Staiger said. "Since then, they have declined around 25 percent."
Lower per-patient compensation rates have led doctors to see increasing numbers of patients per day in order to maintain the size of their paychecks despite working less hours, Staiger said. This could have a negative impact on patient care, he said, adding that the study may begin to shed light on whether or not the health care industry is in need of modifications.
Adding to doctors' difficulties, Staiger said, was the increase in the number of operating health maintenance organizations, which coincided with doctor's fees were declining. This made the lives of physicians more stressful because of the need to comply with more guidelines and restrictions, he said.
The increase in HMOs, combined with lower per-patient compensation and other factors, likely contributed to the decrease in weekly working hours, according to Staiger. He found that those physicians who received the least amount of per-patient compensation also had the shortest workweeks, according to Dark Daily, a clinical laboratory and pathology news website.
"When these elements combine, it makes those three or four extra hours a lot less pleasant to do," Staiger told The Dartmouth.
Physicians echoed Staiger's sentiments.
"If you get paid less, you have less incentive to work harder," Michael Reis, the associate regional chief medical officer of the Northern Regional Clinic, told U.S. News and World Report.
In an attempt to identify whether this trend applied exclusively to physicians, Staiger said he tracked the historical workweeks of several other professions, including lawyers.
"We found that no other occupation [besides physicians] has seen that kind of a decline." Staiger said.
In fact, the trend indicates that physicians work fewer hours per week than lawyers, according to Dark Daily.
When other physicians were asked to account for the trends Staiger had observed, they suggested several other potential causes, he said.
"A lot of physicians said the cause was more female doctors since women work fewer hours than men," Staiger said.
He also determined that women work fewer hours on average than men, but that the decline in workweeks held true for both male and female doctors, he said.
Other physicians suggested that the emergence of more young doctors who were not as willing to put in long hours was at the root of the decrease, according to Staiger.
"But this trend held true for physicians of all ages," he said. Staiger's use of work schedule data collected by the U.S. Census Bureau to study health care professionals was unprecedented among academics, he said.
"We used a large national data set that is commonly used when people look at all kinds of occupations, but hasn't been used when looking at health care occupations," he said.
This trend toward shorter workweeks may become even more pronounced in light of national efforts toward health care reform, Staiger said.
Staiger studied working trends among nurses for years before he began documenting trends among physicians.
