It's not the '80s anymore: Study finds Canadian docs work fewer hours a week

If Canada has a historic high in physicians per capita, why are so many Canadians struggling to find a doctor? A new study from McMaster University examines the interplay between population demographics and physician work trends in an effort to suss out the current problem of accessibility to healthcare services. The authors argue that relying simply on physician-per-capita ratios for workforce planning is not appropriate or adequate. Instead, the number of hours physicians work and the needs of an aging population must be taken into account when looking at physician supply and the demand for their services. The authors analyzed trends in the number of physicians and hours of work between 1987 and 2020. They also examined the needs of an aging population at that time. Looking at per-capita ratios paints a rosy picture, with a 35% increase in physicians per capita between 1987 and 2019. Canada increased its physician workforce through recruiting international medical graduates and upping enrollment in medical schools—with the physician per population ratio having now climbed to an all-time high. Yet, the average number of hours a physician worked declined during that time, from 54.3 hours a week in 1987 to 43.1 hours in 2020. The calculation includes weeks off for holidays. “Physicians, for various reasons are working fewer hours than they used to,” explained senior author Arthur Sweetman from the department of economics at McMaster University in Hamilton, Ont., adding that the physician work hours in the late 1980s were unsustainable. “It is worth noting that hours have come down for everybody in society, and MDs still work substantially more than the average in the population,” Sweetman said. Read: 'Institutional betrayal': CMA digs deep into the healthcare worker crisis In the time studied in the analysis, more women joined the medical workforce, but that does not seem to explain the move to fewer hours worked per week. Back in 1987, there was a gap in the number of hours worked between men and women physicians, with female physicians working fewer hours. Yet over time, the gap in the number of hours worked between men and women physicians narrowed. While the number of hours worked by female physicians remained stable, the hours worked by their male colleagues decreased. “The disproportionate driver of the declining hours of physicians has not been the increasing share of women, but the decline in hours of male physicians,” Sweetman said. Along with a trend in working fewer hours, physicians are also serving an aging population who have different healthcare needs. "The current physician practice environment is not one of resource abundance as suggested by high physician counts, but rather a period of physician shortages like that in the late 1990s. In fact, we are below levels observed in 1987," said coauthor Boris Kralj, professor of economics at McMaster University, in a press release. "The majority of the increase in physician supply over the past three decades has been offset by the rising needs of an aging population." Read: Newfoundland and Labrador doctors sign shared plan with province The analysis also uncovers considerable regional differences in the physician workforce. An examination of full-time equivalent number of physicians per 100,000 people shows that Manitoba and Saskatchewan have consistently had fewer physicians available than other areas of Canada. This is even after the data was adjusted to take into account the age of the population. For example, Alberta has a younger population than the Atlantic provinces. “Provincial governments are clearly offering different levels of services to patients,” Sweetman told the Medical Post. “The variation across provinces is quite remarkable. I was surprised how large it was.” There was even variation within regions over time. For example, while Ontario had a high number of physicians per 100,000 in the early 1990s, the number decreased around 2005 before rebounding. Next, Sweetman said he and his colleagues plan to study the reasons behind changes in number of hours worked, including the impact of an aging physician workforce, who tend to work fewer hours. The authors also hope to investigate physician work force supply by specialty, he said. The paper was published in the CMAJ. Read: Alberta health minister promises $158M in budget to recruit front line health staff

It's not the '80s anymore: Study finds Canadian docs work fewer hours a week

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