Department of Economics, Dartmouth College, Rockefeller Hall, Hanover, NH 03755, USA.
JAMA. 2010 Feb 24;303(8):747-53. doi: 10.1001/jama.2010.168.
Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed.
To estimate trends in hours worked by US physicians and assess for association with physician fees.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N = 116,733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001.
Self-reported hours worked in the week before the survey.
After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996-1998 to 51.0 hours per week in 2006-2008; 95% confidence interval [CI], 5.3%-9.0%; P < .001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%-13.7%; P < .001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%-7.7%; P < .001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%-10.2%; P < .001) and working outside of the hospital (6.4%; 95% CI, 4.1%-8.7%; P < .001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%-6.5%; P = .008) and working in the hospital (4.0%; 95% CI, 0.4%-7.6%; P = .03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere (P < .001 for difference).
A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.
医生每周工作时间的近期趋势可能会影响劳动力需求，但尚未进行全面分析。
估计美国医生每周工作时间的趋势，并评估其与医生薪酬的关系。
设计、地点和参与者：这是一项对 1976 年至 2008 年期间美国人口普查局当前人口调查中全国代表性劳动力信息的美国医生每周工作时间趋势的回顾性分析（N=116733）。趋势在所有美国医生中以及根据住院医师身份、性别、年龄和工作环境进行了评估。将工作时间的趋势与全国医生薪酬的趋势进行了比较，并分别针对 2001 年处于高收费和低收费大都市地区的医生进行了估计。
调查前一周自我报告的工作时间。
在 20 世纪 90 年代初期保持稳定之后，所有医生每周的平均工作时间从 1996 年至 2008 年下降了 7.2%（从 1996-1998 年的每周 54.9 小时降至 2006-2008 年的每周 51.0 小时；95%置信区间[CI]，5.3%-9.0%；P<.001）。由于 2003 年实施的轮班时间限制，住院医师每周工作时间减少了 9.8%（95%CI，5.8%-13.7%；P<.001），非住院医师每周工作时间减少了 5.7%（95%CI，3.8%-7.7%；P<.001）。45 岁以下、不在医院工作的非住院医生每周工作时间减少最多（7.4%；95%CI，4.7%-10.2%；P<.001），而 45 岁及以上、在医院工作的医生每周工作时间减少最少（3.7%；95%CI，1.0%-6.5%；P=0.008）。调整通胀因素后，1995 年至 2006 年全国医生薪酬下降了 25%，与医生工作时间的减少同时发生。2001 年，在医生薪酬最低的大都市地区，医生每周工作时间不到 49 小时，而在其他地区，医生每周工作时间仍超过 52 小时（两地之间的差异具有统计学意义；P<.001）。
在过去十年中，所有医生每周工作时间稳步减少，这在时间和空间上与医生薪酬降低有关。
