Connecting the Anticompetitive Dots Between Physician Work Hours and Physician Supply and Demand

In a recent blog post, I wrote about doctors and nurse practitioners having a lot in common other than doctors not wanting states to expand NPs’ scope of practice — a policy change that could hurt doctors’ earning power because of more competition from NPs.

A new study in JAMA Internal Medicine adds even more intrigue to that dynamic. It turns out, doctors are putting in fewer hours per week, which, in the absence of more doctors or competition from NPs, should increase their earning power. Instead, NPs are putting in more hours per week, filling the time gap and keeping doctors’ earning power in neutral.

Researchers from Boston University and Harvard studied the weekly work hours reported by physicians and advanced practice providers, which included physician assistants and nurse practitioners, over a 20-year period, 2001 through 2021. The sample size included 36,137 physicians, 4,578 PAs and 8,326 NPs.

Here’s what the researchers found based on work-hour information reported to the U.S. Census Bureau by the physicians, PAs and NPs:

• The average weekly work hours reported by physicians dropped 7.6 percent to 48.6 hours in 2021 from 52.6 hours in 2001
• The average weekly work hours reported by PAs dropped 5.8 percent to 37.7 hours in 2021 from 40 hours in 2001
• The average weekly work hours reported by NPs increased 3.6 percent to 37.9 hours in 2021 from 36.6 hours in 2011 (NP data was not available prior to 2011, per the study)

There are a host of interesting data points in the research that suggest some of the drivers behind the decline in physician weekly work hours: younger physicians working fewer hours than older physicians, more female physicians working fewer hours than male physicians and more full-time doctors cutting back their hours than part-time doctors.

But to me, the most interesting findings are these.

First, doctors only worked an average of 48.6 hours a week last year. Every doctor I’ve ever know says they work 24/7, 168 hours per week without sleep or food and do it all for peanuts. That’s why they’re burned out and wouldn’t recommend medicine as a career to their children.

Second, the hours put in per week by the growing APP workforce offset the decline in hours put in by doctors, according to the study.

“The expansion of the APP workforce appears to play a key role in filling the gap between patient demand and physician supply,” the study said. “While the APP workforce is still small compared with the physician workforce, the rapidly increasing number of APPs is offsetting the decreasing trend in physician hours, an important shift in the composition of the U.S. clinical workforce.”

The kicker: “These findings highlight the potential importance of state legislation to expand the scope of practice for APPs, particularly to maintain healthcare access in vulnerable areas of the country.”

If physicians don’t want to put in the hours that they used to, that’s cool with me. But they shouldn’t stop others from picking up the hours that they don’t want and providing safe and effective medical care to sick and injured patients. That’s not cool.

It’s also the definition of anticompetitive behavior that harms consumers.

Thanks for reading.