The working hours of male physicians in Canada have sharply declined over the past three decades, a new study says, amid increased burnout and ongoing health-care staffing challenges in the country.
The research published in the Canadian Medical Association Journal (CMAJ) Monday showed that doctors continue to work longer hours than the rest of the labour force in Canada, but the working hours of family physicians and specialists have dipped between 1987 and 2021. Surprisingly, the shift among men was more noticeable.
“Often, it’s hypothesized that the feminization of the physician workforce, more and more females in medicine, who tend to work few hours due to various responsibilities outside of work, may be a cause of declining hours, but we found mostly with males and married males whose hours declined over that two-, three-decade period of time,” said Boris Kralj, lead study author and an adjunct professor in the department of economics at McMaster University in Hamilton, Ont.
Overall, both male and female physicians worked on average nearly seven fewer hours per week from 2017 to 2021 than they did from 1987 to 1991, representing a 13 per cent decline.
From working 55.2 hours per week on average to 47.7, male doctors worked 7.5 hours less over this time period, which is a 13.6 per cent decrease.
However, the working hours for female doctors who have doubled in proportion in the health-care workforce have remained relatively stable over the same time period at roughly 45 hours per week, the study said.
Researchers at McMaster University analyzed Statistic Canada’s labour force survey data from 1987 to 2021.
They also found that married physicians are working considerably fewer hours than they did 30 years ago — from 53.1 on average weekly in the 1987-1991 time period to 45.7 on average weekly in 2017-2021 — a 14 per cent decrease.
In comparison, unmarried physicians worked 2.2 hours less on average in 2017-2021, which is a 4.6 per cent decline.
Kralj said in an interview with Global News that it’s “really unreasonable” to expect physicians to work long hours and be available 24/7.
“They’re expected to work so many hours that it might be surprising to some that’s starting to change.”
Why are physician work hours declining?
It is no secret that Canada has an ongoing crisis of health-care staffing and long emergency wait times — challenges that were exacerbated during the COVID-19 pandemic.
There was a “dramatic drop” in the working hours of physicians during the second quarter of 2020 amid the lockdowns and closures, Kralj said.
But that decline was temporary, as physicians’ working hours reverted swiftly back to pre-pandemic levels by the end of the year.
In 2021, nearly half of physicians and medical learners, also known as residents, who were surveyed indicated that they were considering reducing or modifying their clinical work hours within the next two years, according to the Canadian Medical Association.
Physician burnout is likely a contributing factor to the declining work hours, Kralj said.
“Research has shown that reducing work hours is a way to kind of address burnout, to deal with the issues of burnout and the heavy workload that physicians and other health-care providers face,” he said.
Changes in the household structure, with more spouses joining the workforce could be another reason.
For instance, compared with three decades ago, male physicians mostly likely have spouses in the workforce, so there is a greater degree of household work activity.
The study authors said this trend of declining work hours among physicians is not unique to Canada, pointing to a similar shift seen in the United States and the United Kingdom.
They say these trends “reflect a cultural shift, primarily among male physicians, toward more balanced home and work lives.”
Payment increases exceeding target incomes could be another likely explanation, but no evidence was found to support this hypothesis, the authors said.
Gender wage gaps should be considered in the decreased working hours, as female physicians earn 10 to 15 per cent less than their male counterparts, according to 2022 research citing census data.
“More research is needed to establish the causes of declining hours and the resultant supply of physician services, as well as related changes in physician labour market behaviours, such as retirement ages,” the authors said in the study.
Reducing the burden of paperwork on physicians could be helpful in easing their workload so they can spend more time on direct patient care, Kralj said.
Substitute physicians through broader locum programs in provinces can also help relieve some of the pressure on health-care workers, he added.