Doctors' workweek getting shorter

Physicians are working fewer hours per week now than they were a decade ago.

A study in the Feb. 22 Journal of the American Medical Association found that from 1996 to 2008, hours worked per week by physicians decreased 7.2%, from 55 to 51 hours.

In the same period, physician fees declined 25% (adjusted for inflation). Furthermore, physicians practicing in areas with the lowest paid fees worked less -- fewer than 49 hours per week -- than did those in higher-fee regions, who worked more than 52 hours.

Despite a strong correlation between declining fees and hours worked, one factor did not necessarily cause the other, said the study's lead author, Douglas Staiger, PhD, an economics professor at Dartmouth College. But the origin of such a significant correlation remains a mystery.

While the JAMA study did not look at physician income, Staiger said other studies have shown that, despite the decline in fees, there hasn't been a substantial decline in physician salary. Physicians may be working fewer hours each week, but they are packing more into those hours.

"Think of productivity as kind of offsetting this decline in fees," Staiger said. "So you are getting paid less per service, but physicians are doing more services per hour of work, and the services they are doing are more complicated and get them higher fees because they are changing the types of services they do."

"If they weren't doing this ... we would see a 25% decline in income, and we haven't seen that," he said.

The Physician Compensation and Production Survey conducted annually by the Medical Group Management Assn. has shown productivity climbing at a much faster pace than compensation. This increase in productivity appears to be contributing to burnout, or at the very least, a less rewarding workday.

"Our argument is that the last hour of work is less rewarding, financially and otherwise, than it used to be because of lower fees and increased market pressure on physicians," Staiger said.

Fred Corbus, co-founder of Grapevine Discovery and Design Life, an online CME program on burnout and life fulfillment, said that although Grapevine has not conducted research in this area, there are hundreds of studies showing an increase in physician burnout.

"Burnout is sending them home," Corbus said. "It's obvious."

Staiger said another theory for the decreased hours is that resident work-hour limits passed in 2003 contributed to the overall decline. But that doesn't hold true, he said. The decline was across all age groups, and the group representing the largest decline in work hours was nonresidents younger than 45.

The findings suggest that more study is needed to understand what's happening with physicians and their behavior, Staiger said. "It's telling us something about how incentives and the work life of physicians is changing that we just weren't aware of."

Researchers said the reduction in hours over a dozen years was equivalent to a drop of 36,000 doctors.