Exclusive Survey
How hard you work

Lifestyle trumps financial worries. Primary care physicians continue to cut back their hours, according to our data.

By Robert Lowes
Senior Editor

If you're working longer hours to make up for paltry third-party reimbursements, you may well be in a minority.

Medicine will never be a profession of slackers, but the typical primary care physician continues to cut back on the number of hours spent on the job, according to the latest Medical Economics Continuing Survey, which samples MDs and DOs in office-based private practice. Internists now log a median 53 hours a week, compared to 58 in 2001 and 61 in 1989. Similarly, FPs work a median 50-hour week 10 hours fewer than in 1989.

This trend reflects several sea changes in medicine. With each year, women constitute a higher percentage of the physician workforce, and they traditionally work fewer hours than men, given their heavier domestic duties. However, a shorter week isn't just a gender issue. Hours for both sexes are down from 2001 (by eight for men and five for women), confirming that today's practitioners, unlike their predecessors, are serious about getting home in time for dinner.

"The quality-of-life issue comes to the forefront in these numbers," says Bill Bristow, a practice management consultant with Doctors Management in Knoxville, TN. "Groups that are recruiting new doctors always field questions about hours and call schedules."

Even with reduced hours, primary care doctors are typically seeing two more patients per week than they did in 2001. That suggests to Bristow that physicians have stepped up their productivity for the sake of maintaining their income level. Still, patient visits are down from their long-term averages, according to Continuing Survey data. FPs who now see 124 patients a week used to handle 144 in 1989.

The busiest physicians are between ages 40 and 54; they see 120 patients or more each week. One possible reason: "As doctors get older, they become more skillful and confident, so they can diagnose and treat patients more quickly," says practice management consultant Keith Borglum in Santa Rosa, CA. Then again, these middle-aged physicians are under the gun to earn more to pay for their children's college tuition and accumulate a nest egg.

Primary care physicians typically worked 50 hours a week, whether they were soloists or members of a group. However, members of groups tended to see more patients. Bristow surmises that doctors in group practice can devote more time to patient care than soloists because they have more staffers to handle management duties.

Intragroup competition also may come into play, adds Borglum. "If you jog by yourself, you tend to go slower than if you're jogging with somebody else," says Borglum. "Doctors in groups don't want to be in last place when it comes to productivity."

Employed physicians were on the low end of the productivity spectrum, seeing only 108 patients during their 50-hour week. True, employed physicians tend to be younger, and therefore haven't built up their practices or their clinical speed to the level of, say, a 50-year-old, says Borglum, but there's something else in the equation weaker motivation. "Employed physicians don't have an owner's attitude," he says. "They don't care as much about building up the business."

Productivity also varies by geography. Patient counts ranged from 103 in the East to 122 in the South. One thing that may contribute to the East's low numbers is an ultra-competitive environment. Eastern states collectively have the highest ratio of physicians per population. In contrast, the South not only has some very underserved states Arkansas and Mississippi, for example it also has the lowest HMO penetration in the country, according to InterStudy Publications in St. Paul. A fee-for-service environment gives doctors an economic incentive to rack up more patient visits.

Study the accompanying charts to determine how your work habits compare to those of your peers. You can find an explanation of how we conducted this survey in the Sept. 19, 2003 issue.

Hours continue to slide,
while visits edge up

¹Hours worked refers to time spent in all professional activities. ²Patient visits are the total number of times the physician saw patients in the office, hospital, and other locations during a typical week in the spring of 2003. ³Includes family physicians, general practitioners, internists, ob/gyns, and pediatricians. Hours and visits in all charts are medians. The source for this and all other tables and charts is the 2003 Medical Economics Continuing Survey.

Do you work more hours than your colleagues?

Male physicians work longer hours

How do your patient visits measure up?

 

Robert Lowes. Exclusive Survey: How hard you work. Medical Economics Nov. 21, 2003;80:41.