A recent study published in the Journal of the American Medical Association (JAMA), found that the average number of weekly hours worked by physicians decreased by about 7% between 1996 to 2008 after remaining stable for two decades. The hours of resident physicians showed an even larger decrease – 9.8% – presumably as a result of work-hour limits imposed for residents in 2003.  The decrease in physician hours over a dozen years was equivalent to a loss of 36,000 doctors, the researchers concluded.

During approximately the same time, average physician fees decreased by approximately 25% nationwide. While the study did not analyze physician income, Douglas Staiger, an Economics professor at Dartmouth and the lead author of the JAMA study, points out that other studies have shown that while physicians fees declined, their salaries remained relatively stable. Physicians are getting paid less per service and performing more services per hour of work, he noted. “T]he 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.  As a result, physician burnout has increased and may have contributed, at least in part, to the decline in physician work hours.   “Further reductions in fees and increased market pressure on physicians may,” Staiger warned “contribute to continued decreases in physician work hours in the future.”

These findings have significant implications for the supply of physicians, particularly as a result of the new Patient Protection & Affordable Care Act (“PPACA”), which will ensure healthcare coverage to millions of previously uninsured Americans, and increase the demand for physicians.  To address this concern, the authors of the JAMA study suggest that in addition to focusing on the number of current and future physicians, greater attention must be paid to the quantity and specialty distribution of physicians, as well as the number of hours they work.

This entry was written by Neil Grindstaff.