Study points to need for training more doctors and APPs to keep up with demand for medical services
Physicians have been reducing their work hours over the past two decades, a new study finds, with the resulting gap between the supply and demand for their services increasingly filled by advanced practice professionals (APPs).
The study, published online in JAMA Internal Medicine, looks at trends in the number of practicing physicians and the average number of hours they worked between 2001 and 2021. The authors used monthly data gleaned from the U.S. Census Bureau’s Current Population Survey (CPS) to estimate numbers of practicing doctors and APPs. They arrived at a national estimation of weekly hours contributed by both groups by multiplying their workforce sizes and average hours worked per week, then dividing the total per 100,000 U.S. residents.
They found that both the number of practicing physicians and the total number of hours they worked increased during the period, by 33% and 7%, respectively. But the number of hours worked failed to keep up with the population’s growth rate of 16.6%, largely due to a 7.6% decline in the average weekly hours worked per doctor, from 52.6 to 48.6.
In contrast to the drop in physician working hours, the study found significant gains among the two professions comprising APPs, nurse practitioners (NPs) and physician assistants (PAs.) The PA workforce grew by 86% from 2001 to 2021, while the number of NPs was up 110.5% in the decade after 2011, the year the census bureau began collecting data on them. These gains resulted in a near doubling of the total hours worked overall by physicians and APPs between 2010 and 2021.
The decline in physician hours worked was driven primarily by three groups: male physicians, particularly fathers, whose work hours dropped by 11.9%, physicians age 45-54 (down 9.8%) and rural physicians (down 9.7%). The only subgroup to show an increase was physician mothers, whose hours were up by 3%.
The authors note that the reduction in work hours among male physicians and increase among females resulted in a large decline in the work hour gap between the two, particularly between fathers and mothers. The change among men, they say, “may reflect broadly changing attitudes toward work-life balance and perhaps greater sharing of domestic duties,” while for women it may imply improvements in workplace accommodations for physician mothers.
The authors also point out that the faster growth in the number of APPs compared to physicians represents “an important shift in the composition of the US clinical workforce,” and that “if physicians continue to leave faster than new trainees graduate, policy makers and leaders in medical education will likely need to allocate resources to enlarge the training pipeline for both physicians and APPs.”