Doctors are working fewer hours but not for the reason you might think

The total working hours of Canada’s doctors have declined steadily over the past three decades, with male physicians registering higher rates of reduction compared to their female counterparts, according to a new study from McMaster University.The findings from the study, published on March 25 in the Canadian Medical Association Journal, underline the need to bolster support for doctors by placing them in optimal work structures and by providing resources to alleviate their administrative burden, lead author Boris Kral—an adjunct assistant professor at McMaster University’s department of economics—told the Medical Post.“In our data, we saw a 13% decline in work hours,” he said. “That means you would need 13% more doctors, more bodies just to offset the decline in work hours alone. But that won’t be enough given our record-high population ratios and the fact that we have more older people, many of whom are complex patients requiring more care.”The study looked at annual cross-sectional data sets, spanning from 1987 to 2021, from Statistics Canada’s Labour Force Survey and found that in the period starting in 2017 and ending in 2021, doctors collectively worked almost seven hours less per week then they did in the period from 1987 to 1991—at a mean of 45.9 hours from 2017-2021 compared to 52.8 in 1987-1991.A big surprise for the study authors? The decline in hours was steepest among male physicians, who cut their work week short by 7.5 hours or close to 14% between 1987-1991 and 2017-2021. By comparison, female physicians held steady with work hour reductions between these periods of only one hour or 2.3%.Read: Gender pay gap in Canadian medicine—yes, it’s real!Marital status did not appear to have much bearing on the reduction of work hours. Whether or not they were married, male physicians still cut back their hours more than female physicians. Those male doctors who were married, however, did work 2.7 hours less per week compared to unmarried male doctors.Among female physicians, those who were married reduced their work hours by 2.3 hours.“Historically, people have suggested that the decline (of physicians’ work hours) has been due to the feminization of the physician workforce,” said Kralj, noting similar findings in studies out of the United States and the United Kingdom. “So we were surprised to see that the key driver of the decline we observed was primarily men—over 80% of the decline in hours was with men, particularly married men.A desire for greater work-life balance may be the key reason behind male physicians working less. Of particular note is the fact that male physicians had a higher baseline to go from, with 55.2 mean hours per week in 1987-1991 compared to 44.7 hours for female doctors.Even with the reduction in work hours male doctors still toiled longer, for a total of 47.7 hours per week versus 43.7 for female doctors.“These findings may indicate a long-term shift in work preferences among Canadian physicians; male physicians may be seeking a better work–life balance, which, in turn, has narrowed the gap in hours worked by sex, with potential implications for pay equity,” wrote the study authors. “Policymakers and planners should carefully consider changes in hours worked, rather than just the total number of physicians, to ensure an accurate evaluation of the physician workforce.”Read: Ontario Union of Family Physicians declares Red Alert for family medicine in OntarioSolutions to improve and ensure ongoing access to healthcare should take into account the heavy administrative load—and resulting burnout—today’s physicians have to contend with, said Kralj.“Anything that can be done to reduce that administrative burden—so they’re doing more clinical, direct patient care as opposed to doing paperwork—could be helpful in reducing burnout,” he said.Policymaker and health human resource planners should look at ways to put more doctors in health teams where they can get more support, and to build robust locum programs so doctors can take the downtime they need.“We have some locum programs that are regional and focused on certain segments, but I think what we need is a broad, province-wide locum program,” said Kralj. “Kind of like what we have for teachers, where if one teacher is sick or on vacation, a substitute teacher is sent in. We need that formalized and available for physicians to lower that feeling of burnout and improve their work life balance. And we need to decrease their administrative burden so the time they spend working is focused on clinical and direct patient care.”Read: AI and the primary care crisis: Not the solution but part of the solution

Doctors are working fewer hours but not for the reason you might think

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