Physician Work Hours Declined 7.6% Over the Last Two Decades

While the physician workforce grew by over 30 percent in the last two decades, physician weekly work hours decreased by 7.6 percent, according to a study published in JAMA Internal Medicine.

The healthcare workforce has experienced significant turnover and shortages during the COVID-19 pandemic. Past studies found that nearly one in four physicians planned to quit in the next two years, and one in three planned to reduce their work hours.

Most research tends to focus on the number of physicians rather than the intensity and volume of work physicians contribute. Researchers used data from the monthly Current Population Survey (CPS) from January 2001 to December 2021 to examine changes in physician work hours and total hours contributed by the physician and advanced practice professional (APP) workforces.

The study sample included 87,297 physician surveys from 17,599 households. The physician workforce increased by 32.9 percent over the study period, going from a three-year moving average of 711,483 in 2001 through 2003 to 945,320 in 2019 through 2021.

The number of clinically active physicians peaked in 2019 at 989,684 and then fell to 923,419 in 2021, highlighting the impact of the pandemic.

The share of female physicians grew from 29.2 percent to 38.4 percent, while the share of non-White physicians increased from 18.6 percent to 25.4 percent. Similarly, the proportion of physicians older than 65 rose from 5.5 percent to 12.2 percent over the study period.

Meanwhile, the three-year moving average of physician weekly word hours declined by 7.6 percent, going from 52.6 to 48.6 hours per week between 2001 and 2021. Three percent of this decrease occurred between 2010 and 2021, the study indicated.

Notably, average weekly work hours for individual physicians dropped significantly during the first three months of the pandemic, then returned to pre-pandemic trends.

The APP workforce experienced different trends throughout the study period. The physician assistant (PA) workforce increased by 86 percent from 2001 to 2021, and the nurse practitioner (NP) workforce grew by 110.5 percent.

PA hours decreased by 5.8 percent from 40 to 37.7 hours per week, while NP hours grew slightly from 36.6 to 37.9 hours per week.

When combining physician workforce size and hours worked, the total weekly hours contributed by the physician workforce per 100,000 residents grew at less than half the rate of the US population growth. Weekly hours contributed by physicians increased by 7 percent between 2001 and 2021, while the US population grew by 16.6 percent during the same time.

Between 2010 and 2021, physician workforce hours increased by 11 percent, while APP workforce hours per 100,000 residents increased by 71.2 percent.

After combining physician hours and APPs, weekly hours contributed by the clinician workforce per 100,000 residents grew by 21.4 percent between 2010 and 2021.

Weekly work hours contributed by physicians varied by demographics, the study found.

For example, male physicians’ weekly working hours decreased by 8.1 percent over the study period compared to 4.1 percent for female physicians. Similarly, fathers decreased their working hours by 11.9 percent, while mothers increased theirs by 3 percent.

Physicians between 45 and 54 years saw the largest decrease in work hours of 9.8 percent over the last two decades. Meanwhile, physicians older than 65 saw an increase in work hours.

Weekly hours for full-time physicians declined from 55.6 to 51.1 hours per week, but part-time physician hours remained stable throughout the study period. In the last decade, weekly hours contributed by rural physicians decreased by 9.7 percent compared to 7.5 percent for urban physicians.

Overall, the slow growth in physician workforce hours was offset by the increase in APP workforce hours. The growth in the physician workforce has kept physician hours from falling further behind population growth, indicating that upcoming retirements may accelerate the decline in physician work hours.

“If physicians across the US continue to leave the workforce faster than new trainees graduate, policymakers and leaders in medical education will likely need to allocate resources to enlarge the training pipeline for both physicians and APPs,” researchers concluded.