Most hospital-based specialists work longer hours than physicians in ambulatory settings

Specialists who care for more acutely ill patients work longer hours than those who care for more stable, chronically ill patients—though hospitalists are an exception, a new analysis found.

Researchers analyzed data from 6,381 physicians from the 2004-2005 Community Tracking Survey (CTS) who self-reported working 20 to 100 weekly work hours, and who worked at least 26 weeks per year. Work hours comprised all medically related activities, including direct patient care and administrative duties. The researchers analyzed 41 specialties with at least 20 respondents each, then separately analyzed the four broader categories of primary care, surgery, subspecialties of internal medicine and pediatrics, and other specialties. Control variables included region of residence, residence in areas with fewer than 200,000 people, foreign medical school graduation, practice ownership, academic employment, revenue from managed care, board certification status, age, sex and race. Results were published July 11 in Archives of Internal Medicine.

The mean annual hours worked were 2,524. In an adjusted regression analysis of the four broad categories, surgery had significantly more annual hours (303 hours vs. primary care; 95% CI, 219 to 387 hours), as did subspecialists in internal medicine and pediatrics (208 hours; 95% CI, 132 to 284 hours). The “other specialties” category had significantly fewer hours than primary care (−228 hours; 95% CI, −295 to −161 hours). In a separate adjusted linear regression analysis of the 41 specialties, those with the highest hours were vascular surgery (888 hours vs. family medicine; 95% CI, 446 to 1,330 hours), critical care internal medicine (689 hours; 95% CI, 350 to 1,029 hours), and neonatal and perinatal medicine (564 hours; 95% CI, 307 to 820 hours). Those with the lowest hours were pediatric emergency medicine (−440 hours vs. family medicine; 95% CI, −750 to −130 hours), occupational medicine (−360 hours; 95% CI, −527 to −193 hours), and dermatology (−346 hours; 95% CI, −574 to −117 hours).

In general, specialists with more acutely ill patients, or patients who need intensive monitoring, worked longer hours than physicians with stable, chronically ill patients. The latter tend to be in hospital settings and the former in ambulatory settings, the authors noted. Yet hospitalists and emergency medicine doctors are exceptions to the trend, as their jobs usually involve fixed, hourly shifts with limited work hours per day or month, they wrote. Generally, specialties with more work hours had lower physician job satisfaction ratings, and vice-versa, the authors said. Study limitations are that the CTS excluded radiologists, anesthesiologists and pathologists and that self-reported work hours didn't capture differences across day, swing or night shifts, or include on-call hours, they noted.