Trends in Hours Worked Among US Primary Care Pediatricians 1993 to 2016: Age, Gender and Practice Type

Lynn Olson¹, Elizabeth A. Gottschlich¹, Blake Sisk¹, William L. Cull¹.

¹Research, American Academy of Pediatrics, Elk Grove Village, IL.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: In pediatrics the interest in greater work-life balance and growth in part-time work has been documented, but less understood are the broader trends in hours worked.

Objective: Assess the trends in hours worked among US primary care pediatricians and variation by age, gender and type of practice.

Methods: Cross-sectional data were pooled from 71 Periodic Surveys of American Academy of Pediatrics US members conducted from 1993 to 2016 (response rates ranged from 39%-76%). The analysis excluded residents, fellowship trainees, and retired members, and was limited to respondents practicing > 60% time in primary care, n = 32,600. Hours worked was based on a survey item consistently used across years that asked pediatricians to self-report the hours they spend on all professional activities in a typical work week. Results were clustered in 3-year intervals. Linear regression was used to examine trends for the total sample and subgroups by age (30s, 40s, 50s, 60s & older), gender, and practice type (solo/two person, group practice, hospital/clinic).

Results: Overall, the average weekly work hours reported by pediatricians dropped from 49.9 to 43.0 between 1993-95 and 2014-16, a 13.8% decline. The decline in work hours occurred primarily before 2008 (Figure). Decreases were found for men [dropping from 54.2 to 47.6 hours, coefficient (B) = -.32, p<.001] and women [44.1 to 40.8 hours, B = -.15, p<.001]. By age group, the largest proportional decline in hours was among those in their 40s at the time of the survey (50.8 to 41.5 hours) and the smallest among those in their 60s (47.1 to 43.9 hours). However, the decline was significant across all ages [30s: B = -.34, p<.001; 40s: B = -.44, p<.001; 50s B = -.34, p<.001; > 60s B = -.16, p<.001] and for pediatricians in solo/2-person [53.4 to 48.3 hours, B = -.27, p<.001], group practice [49.5 to 41.9 hours, B = -.35, p<.001], or hospital/clinic settings [46.3 to 43.2 hours, B = -.16, p<.001].

Conclusion: From 1993-95 to 2014-16 the average hours worked among pediatricians in primary care declined significantly, averaging a reduction of 6.9 hours per week. The downward trend was found for men and women and across age groups and practice type. Since 2008, coincident with the economic downturn, the decline in hours worked attenuated. The trends in pediatrician work hours and the relationship to workforce issues and physician work-life balance will need ongoing monitoring.