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NEWS | July 15, 2011

UC Davis researchers find work hours vary widely by physician specialty, could expand gap in access to primary care

(SACRAMENTO, Calif.)

The amount of time physicians spend on the job can vary widely based on specialty, according to UC Davis research published July 11 in the Archives of Internal Medicine. More than 25 work hours per week separated the most time-consuming specialty of vascular surgery and the least time consuming of pediatric emergency medicine.

Coupled with their previous research on physician pay, the authors note that primary-care physicians (pediatricians, family practitioners, geriatricians and internal medicine specialists) have working hours toward the middle of the range but earn toward the lower end of the wage scale. Together, the outcomes indicate that the gap in access to primary-care physicians is likely to expand.

Dr. Richard Kravitz on hospital rounds with two medical students © UC Regents
Dr. Richard Kravitz (left) on hospital rounds with medical students.

“It is doubtful that medical students will want to enter primary care if there continues to be such a mismatch between hours worked and wages compared with other specialties,” said J. Paul Leigh, professor of public health sciences and lead author of the study. “Policymakers who make medical payment decisions should strive for better balance.”

Leigh said the current study has important implications for health-care reform, which will greatly increase demand for primary-care doctors who are already in short supply.

“We can expect 30 million more Americans to have insurance soon, and they’ll all need primary-care physicians to help manage their care,” said Leigh. “The results could be an even bigger shortfall in primary-care providers than currently expected.”

In conducting the work-hours study, Leigh and his colleagues used data from a nationally representative sample of physicians in the 2004 to 2005 Community Tracking Survey. More than 6,000 physicians working in 41 different specialties were included. Work hours involved time spent on all medically related activities. Data was analyzed for physicians who worked 20 to 100 hours per week and at least 26 weeks in a year.

In addition to vascular surgery, specialties with work hours that far exceeded the average were critical care, neonatal and perinatal medicine, and thoracic surgery. In addition to pediatric emergency medicine, specialties involving the fewest work hours were occupational medicine, dermatology, and physical medicine and rehabilitation.

“The specialists at the top of the work-hours ladder tend to provide more intensive care, often in hospital settings,” said Richard Kravitz, professor of internal medicine and a study co-author. “Vascular surgeons, for instance, perform highly complex surgeries, often on an urgent basis. The specialists toward the bottom of the ladder, on the other hand, tend to have more controllable hours.”

In general, physicians with the fewest hours care for more stable patients, usually in outpatient settings, or have fixed shifts, said Kravitz, whose research focuses on improving quality of care and patient satisfaction. He added that the study results help explain current difficulties in recruiting physicians into certain specialties.

“Two specialty areas with particular difficulties in meeting population needs are primary care and general surgery,” said Kravitz. “Looking at our data, it is easy to understand why. Primary-care physicians have middling hours and low pay. General surgeons work long hours and have middling pay.”

Other trends revealed in the physician work-hours evaluations included:

  • Mean annual hours worked was 2,524, or just over 50 hours per week during a 50-week year
  • Women physicians work about 12 percent fewer hours than their male counterparts
  • Doctors employed by medical schools work about 6 percent more hours than those employed elsewhere
  • Doctors in the Pacific region work 5 percent fewer hours
  • No differences in work hours were found across physicians of different races or ethnicities

The research letter “Annual Work Hours across Physician Specialties” as well as the previous study, “Physician Wages Across Specialties,” published in the Oct. 25, 2010, issue of the journal, are available by contacting JAMA/Archives Media Relations at 312-464-5262 or mediarelations@jama-archives.org.

In addition to Leigh and Kravitz, other UC Davis study authors were Daniel Tancredi, assistant professor of pediatrics, and Anthony Jerant, professor of family medicine. All of the authors are affiliated with the UC Davis Center for Healthcare Policy and Research.

The study was funded by National Institute for Occupational Safety and Health and the UC Davis Office of the Vice Chancellor for Research.

About the UC Davis Center for Healthcare Policy and Research: 
The Center for Healthcare Policy Research conducts research on health-care access, delivery, costs, outcomes and policy to improve the practice of medicine, especially primary care. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and epidemiology to psychiatry and pediatrics. For more information, visit the center's website.