This is an important study in terms of what Health Care Reform could mean if there are less physicians available to treat more people. This would include stem cell doctors as well, if stem cell therapy were to be made readily available in the U.S. and covered by insurance. The demand may well exceed the supply and long waits could be expected.
Medscape Medical News
Physician Workweek Declined by 4 Hours During Past Decade
Nancy Fowler Larson
February 23, 2010 ? The work hours of US physicians fell from 55 to 51 between 1996 and 2008, according to a study published in the February 24 issue of the Journal of the American Medical Association.
"Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed," write Douglas Staiger, PhD, from the economics department, Dartmouth College, Hanover, New Hampshire, and colleagues. "Although the number of physicians has nearly doubled during the last 30 years, many workforce analysts and professional organizations are concerned about the adequacy of the size of the future physician workforce."
The study's goal was to assess physician work hours and their relationship to declining fees. Workweek data were gathered from US Census Bureau monthly Current Population Surveys (CPSs). The final study sample consisted of 116,733 physician surveys from 27,874 households during the period between 1976 and 2008.
The researchers observed trends for physicians regarding residency status, sex, age, and whether or not they worked inside a hospital. They also compared work hours with national developments in physician fees. Separate calculations were performed for physicians working in areas with high and low fees in 2001.
Reduced Fees May Cause Some to Work More, Others Less
For a 20-year period beginning in 1977, physicians worked approximately 55 hours each week, with little variation. But between 1996 and 2008, work hours declined steadily, as indicated by the following results:
* Total physician work hours decreased 7.2%, from 54.9 to 51.0 (95% confidence interval [CI], 5.3% - 9.0%; P < .001).
* Resident physician work hours fell by 9.8% (95% CI, 5.8% - 13.7%; P < .001), but an 80-hour cap on resident workweeks imposed in 2003 is credited for that drop.
* After excluding resident data, physician work hours fell 5.6% (95% CI, 3.8% - 7.7%; P < .001) during the period.
Nonresident physicians younger than 45 years had the largest decline ? a 7.4% drop (95% CI, 4.7% - 10.2%; P < .001). Those older than 45 years showed the smallest reduction (3.7%; 95% CI, 1.0% - 6.5%; P = .008). The hours of physicians working outside a hospital setting decreased more than those of physicians employed in hospitals.
In tandem with the decline in hours, physician fees fell by 25%, after adjustment for inflation, between 1995 and 2006. In metropolitan areas with the lowest fees in 2001, physicians worked fewer than 49 hours; in other areas with lower fee reductions, they worked more than 52 hours a week (P < .001 for difference). However, the exact relationship between reduced fees and fewer hours remains unclear.
"When fees decrease, a physician earns less for working an additional hour, all else equal, and may have less incentive to work long hours," the authors write. "However, the evidence on the relationship between fees and work hours is mixed, with some studies finding that lower fees encourage physicians to work more hours to achieve a target income."
According to the researchers, physicians have attempted to make up for the loss in income in a myriad of ways: by decreasing time spent in activities other than patient care, offering more ancillary services and increasing their ownership in such services, or spending less time with each patient.
Limitations, Concerns for the Future
The researchers reported 2 limitations to their study. First, the CPS survey does not differentiate among physician specialties or resident status. Because of this, the study authors designated all physicians younger than 35 years and working in a hospital as residents. Second, CPS does not consider many physicians in group practices to be self-employed, and before 1989, the survey did not designate any incorporated physicians as self-employed. This resulted in an inexact definition for self-employment.
The overall decline in physician work hours calls into question the ability of the medical community to meet the nation's future healthcare needs, according to the study authors. That concern is particularly relevant because the possibility of healthcare reform may enable more people to afford medical care.
"This trend toward lower hours, if it continues, will make expanding or maintaining current levels of physician supply more difficult, although increases in the number of practicing physicians either through increases in the size of domestic medical school classes or further immigration of international medical graduates would mitigate those concerns," the authors write. "Moreover, 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."
The National Institute on Aging supported this study. The study authors have disclosed no relevant financial relationships.
JAMA. 2010;303:747-753.
Medscape Medical News
Physician Workweek Declined by 4 Hours During Past Decade
Nancy Fowler Larson
February 23, 2010 ? The work hours of US physicians fell from 55 to 51 between 1996 and 2008, according to a study published in the February 24 issue of the Journal of the American Medical Association.
"Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed," write Douglas Staiger, PhD, from the economics department, Dartmouth College, Hanover, New Hampshire, and colleagues. "Although the number of physicians has nearly doubled during the last 30 years, many workforce analysts and professional organizations are concerned about the adequacy of the size of the future physician workforce."
The study's goal was to assess physician work hours and their relationship to declining fees. Workweek data were gathered from US Census Bureau monthly Current Population Surveys (CPSs). The final study sample consisted of 116,733 physician surveys from 27,874 households during the period between 1976 and 2008.
The researchers observed trends for physicians regarding residency status, sex, age, and whether or not they worked inside a hospital. They also compared work hours with national developments in physician fees. Separate calculations were performed for physicians working in areas with high and low fees in 2001.
Reduced Fees May Cause Some to Work More, Others Less
For a 20-year period beginning in 1977, physicians worked approximately 55 hours each week, with little variation. But between 1996 and 2008, work hours declined steadily, as indicated by the following results:
* Total physician work hours decreased 7.2%, from 54.9 to 51.0 (95% confidence interval [CI], 5.3% - 9.0%; P < .001).
* Resident physician work hours fell by 9.8% (95% CI, 5.8% - 13.7%; P < .001), but an 80-hour cap on resident workweeks imposed in 2003 is credited for that drop.
* After excluding resident data, physician work hours fell 5.6% (95% CI, 3.8% - 7.7%; P < .001) during the period.
Nonresident physicians younger than 45 years had the largest decline ? a 7.4% drop (95% CI, 4.7% - 10.2%; P < .001). Those older than 45 years showed the smallest reduction (3.7%; 95% CI, 1.0% - 6.5%; P = .008). The hours of physicians working outside a hospital setting decreased more than those of physicians employed in hospitals.
In tandem with the decline in hours, physician fees fell by 25%, after adjustment for inflation, between 1995 and 2006. In metropolitan areas with the lowest fees in 2001, physicians worked fewer than 49 hours; in other areas with lower fee reductions, they worked more than 52 hours a week (P < .001 for difference). However, the exact relationship between reduced fees and fewer hours remains unclear.
"When fees decrease, a physician earns less for working an additional hour, all else equal, and may have less incentive to work long hours," the authors write. "However, the evidence on the relationship between fees and work hours is mixed, with some studies finding that lower fees encourage physicians to work more hours to achieve a target income."
According to the researchers, physicians have attempted to make up for the loss in income in a myriad of ways: by decreasing time spent in activities other than patient care, offering more ancillary services and increasing their ownership in such services, or spending less time with each patient.
Limitations, Concerns for the Future
The researchers reported 2 limitations to their study. First, the CPS survey does not differentiate among physician specialties or resident status. Because of this, the study authors designated all physicians younger than 35 years and working in a hospital as residents. Second, CPS does not consider many physicians in group practices to be self-employed, and before 1989, the survey did not designate any incorporated physicians as self-employed. This resulted in an inexact definition for self-employment.
The overall decline in physician work hours calls into question the ability of the medical community to meet the nation's future healthcare needs, according to the study authors. That concern is particularly relevant because the possibility of healthcare reform may enable more people to afford medical care.
"This trend toward lower hours, if it continues, will make expanding or maintaining current levels of physician supply more difficult, although increases in the number of practicing physicians either through increases in the size of domestic medical school classes or further immigration of international medical graduates would mitigate those concerns," the authors write. "Moreover, 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."
The National Institute on Aging supported this study. The study authors have disclosed no relevant financial relationships.
JAMA. 2010;303:747-753.