Physician work hours, especially for male doctors, have declined since 1987

Physicians in Canada, especially male physicians, are working fewer hours than they did 3 decades ago, and these long-term trends must be considered in workforce planning, according to new research in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231166.

"Canadian physicians' work hours, crucial for health care access and planning, have seen a long-term decline, especially among male and married physicians, suggesting a shift towards better work–life balance," said Dr. Boris Kralj, Department of Economics, Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, Ontario.

Using Statistics Canada's Labour Force Survey, researchers from McMaster University conducted a study on long-term trends in physician work hours, with data from 1987 to 2021. They hope that the findings will help governments make smart health care policy decisions, inform physician work force planning, and foster gender equity.

Highlights:

• Compared with the general population, physicians worked more hours per week, about 20% more hours in 2021
• Weekly physician hours decreased 13.5% from 52.7 hours per week in 1987 to 45.6 in 2019
• Average hours worked by male physicians declined markedly beginning around 1997
• No differences in declines in hours among urban versus rural settings, incorporated versus unincorporated physicians, physicians younger or older than 45 years, or those with or without children under age 5 years, were apparent
• Hours worked varied by province, but these differences declined over time

The early part of the COVID-19 pandemic was associated with a 15% decline in working hours, with an 11% decline among male physicians and a 20% decline in hours worked by female physicians in the second quarter of 2020. However, by the end of 2020, hours worked reverted to prepandemic levels.

The study's authors suggest that a desire for better work–life balance may be driving these long-term trends. For a long time, doctors have been expected to work very long hours and be available all the time. This has led to unhealthy workplaces.

"[W]e propose that a shift in male physicians' preferences toward achieving better work–life balance is an important contributing factor. The question of whether these trends are related to physician burnout is relevant. Characterized by emotional exhaustion, depersonalization, detachment from work, and reduced personal accomplishment, burnout can lead to negative effects on health, lower productivity, reduced work hours, and even exiting medical practice," write the authors.

They found no evidence that higher payments contributed to physicians working fewer hours. The observed decrease in hours persisted during periods of both rising and stable payment levels.

These trends highlight the need for Canada to have enough doctors to meet its population's evolving needs. It is important for policy-makers to consider not just how many doctors there are, but also how many hours they work.

"The way forward will likely involve policy-makers increasing the size of the medical workforce — including physicians and other occupations involved in interdisciplinary care — faster than population growth to accommodate historical and potential future hour reductions (and increasing demand from an aging population)," write the authors.