Fewer Hours for Doctors -- and Less Pay

(Feb. 23) -- American doctors are no longer burning the midnight oil, and it might have something to do with their declining salaries, according to a major study of physicians' work hours.

The trend could also lead to a major doctor shortage, some fear.

The results mark the first significant, documented drop in doctors' weekly hours. The numbers hold true across every demographic: male and female, young and old, and doctors working in the private and public sectors.

A team of researchers based out of Dartmouth College collected data from the U.S. Census Current Population Survey (CPS), which polls more than 100,000 people. The researchers concluded that after holding steady from the 1970s onward, mean work hours among doctors declined by 7.2 percent from 1996 to 2008.

Of course, the drop doesn't exactly mean that doctors are suddenly working part-time: Physicians now work about 51 hours a week, compared to an average of 55 hours during the latter half of the 20th century.

What is particularly surprising might be that while physicians are working fewer hours, other professionals -- lawyers, nurses, engineers -- are still working just as much, said lead study author Dr. Douglas Staiger. "This is unique and it is unusual," he told AOL News. "Furthermore, the results point out cause for concern."

The study suggests that debate over health care reform, along with proposed policy changes, are founded on outdated data about the status of the medical workforce. The most recent survey of doctors' hours was done by the American Medical Association in 2002, before the decline became apparent.

But the realities of the physician workforce are much different than assumed. If the trend continues, it could lead to a major doctor's shortage. Among nonresident physicians in patient care, the study found a 5.7 percent drop in hours worked per week. That would be equivalent to 36,000 fewer physicians in the work force, out of a current total of 630,000, if the reduction in hours worked is factored out.

Even before this new study, the Association of American Medical Colleges' Center for Workforce Studies was warning that retiring baby boomers would lead to a shortage of doctors: at least 124,000 by 2025.

With shorter hours factored in, that shortage is likely to be even larger -- making it imperative to consider the shift during discussions of potential changes to health care policy.

"It's unclear whether health care reform would increase or decrease doctors' hours," Staiger said. "But these results should certainly be incorporated into considering and planning the suggested changes in American health care."

And the drop in hours isn't a trend that's exclusive to a particular subset of doctors, although younger physicians did see a larger decline. They're working 7.4 percent less, compared to 3.7 percent for those age 45 or older.

The study authors speculate that a greater prioritization of "work-life balance" among younger generations could be responsible for the larger decline. And that sets up American hospitals and clinics for a new paradigm, where doctors continue to spend fewer hours on the job.

Staiger acknowledges that it's impossible to pinpoint the exact cause for the decline. But the research team does have a "best guess": a combination of lower fees and increased market pressure. The drop in hours worked can be directly stacked up against the decline in doctors' fees over the past decade. And in metro areas, where fees dropped faster and doctors faced greater competition for plum jobs, hours dropped at a greater rate.

In fact, doctors' wages dropped about the same proportion as their work hours -- 7 percent, after adjusting for inflation -- from 1995 to 2003. By comparison, salaries for other professionals increased by 7 percent in the same span of time, according to a 2007 report from the Center for Studying Health System Change.

At the time of that report, the lagging salaries led to concern that physicians might opt to specialize in revenue-generating practices, like cardiology or gastroenterology, where doctors can earn extra for tests or procedures. The result? Fewer primary care doctors.

This latest study raises the same concerns, but also suggests that doctors are tackling the same workload in less time. Whether that's a benign side effect of improved technology, or a potentially dangerous reflection of cutting corners when it comes to patient health, Staiger isn't sure.

So far, research points to the latter.

In 2009, the annual HealthGrades study concluded that medical errors continued to "occur at an alarming rate," and a recent survey out of UCLA suggests that a troubling percentage of doctors report some combination of "lack of exercise, not eating breakfast and sleeping fewer than six hours per night."