Cull W, Frintner M, Kist T, Freed G, Byrne B

Presented at the 2023 Pediatric Academic Societies Annual Meeting

Background: The total work and clinical hours of practicing pediatricians vary widely. Over the last 2 decades, the percent of pediatricians working reduced hours increased and then plateaued. Less is known about how individual hours vary over time.

Objective: Use longitudinal analyses to examine individual variation in total and clinical work hours across 9 years and identify associations with pediatrician characteristics.

Methods: We examined pediatrician-reported total work and clinical hours from 2013 to 2021 for 2 Pediatrician Life and Career Experience Study (PLACES) national cohorts: 2002-04 residency graduates (n=897) and 2009-11 graduates (n=896). Four in 10 invited pediatricians originally enrolled in PLACES; yearly participation has ranged from 75% to 92%. We computed mean total work hours per week for each year by 3 grouping variables: cohort (2002-04 and 2009-2011 graduates), sex (male and female), and career focus (general pediatrics, hospitalist, and large (neonatology, hematology-oncology, emergency medicine, critical care, cardiology, gastroenterology) and small (all other) subspecialty). When participants were in a fellowship or not working, work hours were excluded from analyses. We used mixed effects linear regression for continuous longitudinal data to examine patterns of work hours by year and the 3 grouping variables and included an indicator for pandemic years (2020-21).

Results: Analyses included 11,717 observations from 1,696 pediatricians. Mean hours across years was 42.8 for total and 33.4 for clinical work. Male total and clinical hours were higher than female hours (Figures 1-2, Table). Mixed effects models identified associations for total and clinical hours with sex, cohort and career focus. The largest associations for both were for sex (male total B=7.18, 95% CI=6.00-8.36 and male clinical B=4.67, 95% CI=3.42-5.91). Focus of career also had a strong association with total hours with large subspecialty, small subspecialty, and hospitalists working more than general pediatrics. For clinical hours, hospitalists reported the most hours. The 2009-11 cohort reported more total and clinical hours than the 2002-04 cohort, but this effect was not as large. There was also a slight decrease in total and clinical hours found across years.

Conclusion: Across 9-years, early and midcareer pediatricians reported a modest decrease in hours worked. Overall, males, subspecialists, and more recent graduates reported more hours. Clinical hours made up the majority of work hours across all career types. These longitudinal analyses strengthen and extend prior results from cross-sectional studies.

Table 1. Association between work hours and pediatrician characteristics, PLACES 2013-2021

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American Academy of Pediatrics