Study: Doctors cutting back work hours

CHICAGO - Doctors have steadily cut their work hours over the past decade, a new study finds, something that experts say may only worsen the health care situation.

It's not that doctors are terrible slackers. Average hours dropped from about 55 to 51 hours a week from 1996 to 2008, according to the analysis, appearing in today's Journal of the American Medical Association.

That's the equivalent of losing 36,000 doctors in a decade, according to the researchers. And it raises policy questions amid a looming shortage of primary care doctors and Congress considering an expansion of health insurance coverage that would mean more patients.

The decline in hours "occurred among all groups of physicians . . . and it didn't occur in other occupations," said lead author Douglas Staiger of Dartmouth College. "Something has been discouraging physicians from working the long hours they used to work."

Work-hour limits for residents, or doctors in training, were introduced in 2003 and brought down the average. But when the residents were removed from the analysis, there was still a nearly 6 percent decline in work hours. Growing numbers of women in the profession contributed to the decline in hours, but they weren't a big driver of the trend, Staiger said.

Payment issues may have played a big role. The overall decrease in hours coincided with a 25 percent decline in pay for doctors' services, adjusted for inflation.

"It's not so much the fees as the hassle factor," said Dr. Robert Perlmuter, a Chicago internist who works 60 hours a week. He told about a recent problem with a pharmacy benefit manager. A series of faxes and phone calls got conflicting answers about which of three types of insulin the patient's plan would cover. By the time it was sorted out, "the patient missed insulin for a day."

"There's so much oversight for what we do, so many people we have to answer to and so little of it improves care, it's just driving us all crazy," Perlmuter said.

Four years ago, Dr. David Ellington, a family doctor in Lexington, Va., cut back from 65 to 50 hours a week, improving his life "by a factor of about a zillion."

"It added five or six years onto my practice life - and I love what I do," he said.

Primary care doctors handle 2,300 patients on average, far too many for them to be able to realistically follow guidelines for managing their patients' chronic illnesses, let alone their acute care needs, said Dr. Thomas Bodenheimer of University of California, San Francisco.