Lower pay drives doctors to cut hours
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Lower reimbursement in the past decade has been linked to doctors cutting their hours from a mean of 55 hours per week to 51, the equivalent of losing 36,000 physicians a year.
Researchers conducted a retrospective analysis of trends in hours worked among U.S. physicians using Census Bureau survey information between 1976 and 2008. (Researchers and the U.S. Department of Labor use the same data to calculate employment trends among many professions.) They reported results in the Feb. 24 Journal of the American Medical Association.
Average physician reimbursement fell nationwide by 25% between 1995 and 2006 after adjusting for inflation. This is the same decade in which physicians began to cut back their hours, after having stable hours-per-workweek averages for the previous two decades.
Mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (n=116,733; 54.9 hours per week in 1996-1998 to 51.0 hours per week in 2006-2008; 95% CI, 5.3%-9%; P<0.001. When researchers excluded residents, whose hours decreased due to duty hour limits in 2003, physician hours decreased by 5.7% (95% CI, 3.8%-7.7%; P<0.001).
Mean hours worked by nonresident physicians were strongly associated with the fee index (correlation=0.965, P<0.001) and even more strongly associated with the fee index from the prior year (correlation=0.969, P<0.001).
The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%-10.2%; P<0.001) and those working outside of the hospital (6.4%; 95% CI, 4.1%-8.7%; P<0.001). The decrease was smallest for those 45 years or older (3.7%; 95% CI, 1%-6.5%; P=0.008) and working in the hospital (4%; 95% CI, 0.4%-7.6%; P=0.03).
A 5.7% decrease in hours out of a workforce of approximately 630,000 physicians in 2007 equals a loss of approximately 36,000 doctors. The authors wrote, “This trend toward lower hours, if it continues, will make expanding or maintaining current levels of physician supply more difficult,” although more medical schools or international medical graduates could mitigate the problem, they suggested.