Physicians have traditionally worked long hours. Job burnout has been a major concern among physicians for many years. According to the American Medical Association (AMA), last year nearly half of physicians (48%) reported feelings of burnout on their jobs. The AMA considers 48% good news: the physician burnout rate was 53% in 2022 and 63% in 2021 not long after Covid began to wane. Between 2022 and 2023 job satisfaction also improved from 68% to 72%. However, that still means that more than one-quarter of physicians are dissatisfied with their working conditions.
The Wall Street Journal reports that older physicians complain that younger ones don’t have the same work ethic as older docs. Older physicians often resent having to take extra ER on-call duty because their younger colleagues want their evenings free to have a glass of wine and dine with friends on weekends. Furthermore, many older physicians view medicine as their calling, whereas younger physicians are offended by the idea. To them, saying medicine should be their calling is another way of saying they should forgo their personal needs and allow themselves to be taken advantage of. The younger generation wants more work/life balance. They aren’t willing to work as many hours as physicians in the past.
What is behind this shift in how physicians view their work? Much has changed with respect to physicians in the past 50 years. When I was a child, most doctors were men. Around 1975 the proportion of women in medical school was less than one-quarter, while 60 years ago it was about 10%. Today half of medical students are women. Women become mothers and traditionally have more childcare responsibilities at home than men. Female physicians work fewer hours than men once they marry and have families. Perhaps, more controversial, male physicians often marry women with incomes lower than their own, while female physicians tend to marry men with similar incomes. The Wall Street Journal reported on the male/female physician pay gap a few years ago. In response, one doctor commented that male physicians work more hours because they have to support “physicians’ wives.” He was alluding to an old stereotype when physicians’ wives have expensive tastes, but do not contribute much in the way of household income. Yet, as more women become physicians, they do not necessarily take on the role of primary breadwinner to support a lower-earning spouse. Thus, neither spouse has the desire to work long hours. In addition, a recent study on physician marriages found that marital happiness was correlated with the amount of awake time physicians spend with his or her spouse. Working long hours may result in more income; it could also result in a divorce.
Another major change that affects how much physicians want to work has to do with their practice arrangements. Recent data found that about 75% of physicians are now employees rather than self-employed business owners. Employees often feel less affinity towards their job than if they are self-employed. The AMA reports that more than two-thirds of physicians (68.2%) receive a portion of their income in the form of salary. Salary accounts for more than half of their income, with the remainder in the form of bonuses based on productivity. This suggests that working longer hours may boost employed physicians’ income but it’s not clear the marginal income from working beyond 40 hours is necessarily huge. Historically most physicians were in small or solo practices. Once office or clinic overhead was covered the marginal revenue from seeing additional patients was much higher than the average revenue per patient. A self-employed doctor may find he can double his take-home pay by working 60 hours a week rather than 40. In economics that is called the cost of leisure. An hour of leisure may cost a self-employed doctor $200 or more compared to $20 for a lower-paid employee. The same may not be true for an employed physician.
Much has changed about physicians and physician care during my lifetime. Bureaucratic paperwork is a bigger part of the job than a generation ago. Collecting from third-party payers is more onerous than a generation ago. Certain aspects of the job are less enjoyable. It should come as no surprise that young physicians do not necessarily want to sacrifice their personal life to see more patients.