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Physician Work Hours

By March 9, 2010Commentary

Research published in the Journal of the American Medical Association looks at trends in hours worked per week by physicians and what factors may be correlated with those trends.  (JAMA Article) The issue is of more than academic interest, aside from how many physicians there are, how much they work determines the overall supply.  The researchers used data from a Census Bureau survey to collect data on hours worked for the years from 1976 to 2008 and also constructed an index of physician fee changes from 1989 to 2006.

After being stable at around 55 hours per week between 1977 and 1997, time on the job has since decreased to about 51 hours per week.  The decline is broad-based across demographic categories, although somewhat larger for younger physicians and those working outside of hospitals.  In comparison, hours worked for other professionals, such as lawyers or nurses, changed little during the same period.

This decrease in hours worked coincides with a decrease in physician fees, as adjusted for inflation.  Physicians had more of a drop in hours worked in geographic areas with larger fee declines.    The results do not suggest a “volume-offset” behavior by physicians, at least on the surface.  Some of the change may reflect lifestyle choices, especially among younger doctors.    The drop in hours worked corresponds to losing 36,000 physicians.  Reform implications are apparent, if care demanded increases as coverage is extended to more people.

A few observations on the study.  One factor not looked at by the authors, but suggested in other researchers is a link between greater malpractice liability and fewer hours worked.  The authors did not look at salaried versus non-salaried physicians.  Physicians working in hospitals are often salaried, tended to work fewer hours to begin with and had a smaller reduction in hours worked.  More physicians are now employed by hospitals.  Finally, regardless of fee reductions, what probably matters to physicians is income and if practice costs decrease more than fees, they may actually have the same or higher incomes working fewer hours.

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