Hours push docs away from primary care

UC DAVIS (US) — The combination of longer hours and lower wages for primary care physicians could make it more difficult to attract medical students to a specialty where doctors are already in short supply.

“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,” says J. Paul Leigh, professor of public health sciences at the University of California, Davis and lead author of the study.


“Policymakers who make medical payment decisions should strive for better balance. We can expect 30 million more Americans to have insurance soon, and they’ll all need primary-care physicians to help manage their care,” says Leigh.

“The results could be an even bigger shortfall in primary-care providers than currently expected.”

For the study, published in the Archives of Internal Medicine, Leigh 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,” says 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, says Kravitz. The study explains current difficulties in recruiting physicians into certain specialties.

“Two specialty areas with particular difficulties in meeting population needs are primary care and general surgery,” says 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 include:

  • 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.

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