BOSTON – The average hours worked per week by physicians decreased 7.6% in the two decades between 2001 and 2021, according to a new study by researchers at Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, and Harvard T.H. Chan School of Public Health published today in JAMA Internal Medicine. The observed decreases were driven by reduced work hours among male physicians (particularly fathers), full-time physicians, and younger physicians. Physician mothers were the only group to increase weekly work hours, with a 3% increase over 20 years. The number of part-time physicians remained flat throughout the study period. Declining trends in work hours were similarly present among non-physician holders of doctoral degrees, suggesting a broader trend among highly-educated professionals in their approach to work hours.
The study used surveys of physicians from 17,599 unique households across the United States. The researchers examined trends in weekly work hours among physicians compared to nurse practitioners, physician assistants, and non-physician holders of doctoral degrees. They also assessed trends in work hours in subgroups of physicians, for example by age group and parental status. The research also examined changes in the size of the workforce for physicians, nurse practitioners, and physician assistants during the study period and estimated total hours contributed by each of these workforces, as a whole, on a weekly basis.
The physician workforce grew by 32.9% over two decades, but then fell by 6.7% during the COVID-19 pandemic, or a drop of 1 in 14 physicians. The physicians who left the workforce during the pandemic were disproportionately white and from rural areas.
Work hours generated by the physician workforce, as a whole, grew 7% over the study period, which was about half the rate of population growth in the same period (16.6%). This sluggish growth in physician workforce hours was entirely offset by large increases in the work hours contributed by nurse practitioners and physician assistants. When the clinician workforce was assessed as a whole (combining hours from physicians, nurse practitioners, and physician assistants), growth in total workforce hours was 21.4%, exceeding the population growth rate.
“A reduction in work hours suggests a trend of physicians prioritizing work-life balance to a greater degree,” said Anna Goldman, MD, lead author, general internist at Boston Medical Center, and assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine. “Nurse practitioners and physician assistants are playing a critical role in filling in the gap created by decreasing work hours and physician workforce losses during the pandemic, alleviating some of the provider access issues patients may encounter.”
“The increase in work hours among mothers, the only physician group whose work hours rose, may have mixed implications for physician mothers,” Dr. Goldman continued. “This could indicate progress on gender parity in terms of career engagement, but our findings may shed light on high rates of burnout among physician mothers found in previous studies, as physician mothers may be working longer hours while still managing significant responsibilities at home. We did observe a substantial decrease in work hours among physician fathers, and this could translate to greater equality in the balance of domestic work in heterosexual, two-physician families.”
“Our study highlights the importance of considering work hours, in addition to the size of the physician workforce,” said senior author Michael Barnett, MD, associate professor of health policy and management at Harvard T.H. Chan School of Public Health. “The loss of physicians during the pandemic, combined with an impending wave of retirements among older physicians, raises concerns for maintaining access to physicians, particularly in rural areas. Policymakers should consider an expansion of physician training programs and strengthen incentives to practice in rural areas in order to maintain a balanced clinician workforce.”