Physicians — especially male, married doctors — are working fewer hours

Physicians in Canada, especially male physicians, are working fewer hours than they did three decades ago, and these long-term trends must be considered in workforce planning, according to new research in the CMAJ. 

“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 lead author Boris Kralj, adjunct assistant professor in the department of Economics and member the Centre for Health Economics & Policy Analysis at McMaster.

Using Statistics Canada’s Labour Force Survey, researchers conducted a study on long-term trends in physician work hours with data from 1987 to 2021.

They hope the findings will help governments make smart health-care policy decisions, inform physician work force planning, and foster gender equity.

Here are some highlights:

• Compared with the general population, physicians worked more hours per week, about 20 per cent more hours in 2021
• Weekly physician hours decreased 13.5 per cent 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 were apparent among urban versus rural settings, incorporated versus unincorporated physicians, physicians younger or older than 45 years, or those with or without children younger than five years of age
• Hours worked varied by province, but these differences declined over time

The early part of the COVID-19 pandemic was associated with a 15 per cent decline in working hours, with an 11 per cent decline among male physicians and a 20 per cent decline in hours worked by female physicians in the second quarter of 2020.

However, by the end of 2020, hours worked reverted to pre-pandemic levels.

A desire for better work–life balance may be driving these long-term trends, study authors suggest: For a long time, doctors have been expected to work very long hours and be available all the time, leading to unhealthy workplaces.

“We propose that a shift in male physicians’ preferences toward achieving better work–life balance is an important contributing factor,” the authors write.

“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.”

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.