The challenges of the clock

Physicians are working fewer hours: ©Peopleimages - stock.adobe.com

Working too many hours has long been a challenge for physicians; however, recent data reveal that although average weekly work hours for physicians have stabilized, they continue to trend shorter than in previous decades.

Most major physician surveys find that physicians work on average about 50 hours per week, depending on speciality. The 2024 Medical Economics Physician Report found that physicians work on average 44 hours per week. That encompasses direct patient care, administrative duties and other professional activities, and is less than in previous years. In fact, weekly hours has been trending down since the COVID-19 pandemic, according to the Physician Report.

Despite this reduction, concerns about burnout and the impact of long hours are significant, highlighting ongoing challenges in the medical profession.

“Working too many hours impacts physicians on many levels both professionally and personally,” says Joanne Williamson, M.D., an obstetric hospitalist and market medical director for Ob Hospitalist Group based in South Carolina. “It strains the relationship between the physician and his or her family. Lack of sleep impacts decision-making and may impact focus and dexterity while performing surgical procedures.”

Jamie Colbert, M.D., attending internal medical physician at Newton-Wellesley Hospital and chief medical officer at Memora Health, notes that while the supply of physicians in the United States continues to fall, demand for care continues to rise.

“Doctors want to provide the best possible care to each of their patients, but their ability to spend adequate time with each of them is hamstrung by the increased need for after-hours documentation and administrative work,” he says. “Physicians went to medical school and chose this profession to spend time interacting with patients and providing care, but studies confirm they’re actually spending more time sitting in front of a computer screen. This dire situation is a major source of burnout across specialties for physicians.”

Suzanne Morgan, M.D., family medicine physician and chief medical officer at PeopleOne Health, calls the challenge of working too many hours “a double-edged sword.”

“The demands of the health care system often deprioritize the quality of care in favor of payment requirements, along with the large amount of documentation and administrative tasks that physicians have to handle as well,” she says. “This leaves us with an overwhelming amount of extra work. In order for us to keep those quality relationships and provide the high level of care we aspire to, we end up working significantly longer hours.”

Rise of burnout

Long hours are likely the No. 1 contributor to burnout in the medical profession. Several factors can lead to these extended hours, such as billing, coding, administrative tasks and documenting in electronic health records (EHRs). These tasks require checking the right boxes in the EHR and asking all the right questions, which takes up a good amount of the workday.

Reginald J. Ross, M.D., internal medicine specialist at CenterWell Senior Primary Care in Prairieville, Louisiana, notes many physicians also find themselves in roles where their health care organization prioritizes a high volume of patients requiring more hours than a standard workday allows.

According to Statista, the average physician works 50 to 59 hours per week, nearly 50% more hours than the traditional American workweek of 40 hours. Moreover, a study from the University of Chicago found that doctors would need almost 27 hours each day to provide guideline-recommended primary care.

“Those hours and unattainable demands often culminate in physician burnout,” Ross says. “I recommend all health care organizations make a concentrated effort to provide their PCPs [primary care providers] with more flexible scheduling [and] wellness resources and take immediate action to promote a culture truly committed to providing physicians [with] a quality work-life balance.”

In his experience, working long hours can limit the capacity to provide the required, tailored care that every patient deserves.

“Some primary care physicians may see 20 or more patients per day; most of these patients have four or more comorbid conditions,” he says. “This often leads to physical and mental exhaustion and can significantly contribute to burnout.”

Bringing work home

Too often, physicians find themselves bringing work home with them. After hours, clinicians complete EHRdocumentation, communicate with nurses and patients, respond to prescription requests and more, working long into the night and even during vacations to meet the demands of documentation.

Not only can this perpetuate a cycle of stress and burnout, but it can also intrude on a physician’s personal life — just ask their families.

“I’ve been that physician during my career,” Ross says. “Moving to the value-based care model at CenterWell, however, physicians have smaller patient panels, allowing time to build enriching relationships with our patients. I’m able to have more control over my work and not bring administrative work home with me so I can enjoy more time with my family.”

Morgan does not know many, if any, physicians who don’t bring work home with them.

“Most of us have on-call responsibilities, and we often find ourselves finishing up documentation, reviewing lab orders and answering phone calls and portal messages after hours,” she says. “Bringing work home significantly impacts our personal lives. It eats into the time we would otherwise spend with family or engag[e] in personal activities, leading to a lack of work-life balance. This continuous overlap between work and home life can increase stress and fatigue, ultimately affecting our overall well-being.”

Of course, bringing work home is nothing new for those in the medical profession, but things have only got worse since the COVID-19 pandemic.

“We’ve seen a 157% increase in digital patient messages since 2020, and there isn’t time during the workday to adequately address these messages,” Colbert says. “We have a name for this after-hours work — ‘pajama time.’ It’s time that should be spent with families, relaxing and pursuing hobbies. Instead, providers are forced to spend time in the evening responding to patient messages and completing their charting or documentation. That is not sustainable for physicians.”

Alexandra Tien, M.D., a family physician at Medical Associates of Rhode Island, has been a primary care doctor for almost two decades. Her work regularly seeps into the family dinnertime as she tries to finish documenting her notes for the day, plays “whack-a-mole” with her overflowing basket of lab and imaging results and notes from specialists, and checks patient messages and refill requests.

“I have WAC [work after clinic] every day. It is uncompensated. It disrupts our dinnertime and often leaves me feeling irritable,” she says. “The EHR is tyrannical, 24/7/365. Can’t get away from it ever, even on vacation. Yes, if I am on vacation, someone ‘covers me,’ but they cover the absolute minimum [because] they have work of their own.

“Anything major is waiting for me when I get back. I usually end up working most of my vacation because I can’t face a towering pile of work on my return,” Tien adds.

Williamson agrees that adopting technology has increased the workload in many ways, as physicians can be contacted and access work almost anywhere.

EHR adoption has coincided with increased scrutiny and requirements related to provider documentation, so providers are spending more time than ever on charting. EHR patient portals have also made it easier for patients to send questions to their providers.

“The massive influx of messages from other providers, messages from patients and patient test result alerts that have come from EHR systems are imposing enormous burdens on our physician workforce,” Colbert says. “As they exist today, electronic health records are a burden that clinicians have learned to accept, but I do believe that technologies are emerging that can help reduce the EHR and administrative burden that is such a drain on our physician staff.”

Support systems

The status quo is not sustainable, and various systems are being deployed to address particular aspects of the problem and help physicians achieve a proper work-life balance.

“There are now dozens and dozens of scribes and ambient dictation tools available as potential remedies for the documentation challenges,” Colbert says. “We are seeing many strategies being tried to address the overwhelming number of patient messages, including charging patients a fee for clinician time spent responding to messages or hiring additional staff to manage incoming patient messages on behalf of overworked physicians.”

Several physician societies have introduced initiatives to raise awareness and educate their members about burnout, including mental health or counseling support. Still, Morgan feels there is more opportunity for health systems to take action and start recognizing burnout in their physicians.

“Personally, as a physician, when I started to feel burnout due to my hours and working weekends to catch up on things, I sought out a different model of care,” she says. “Many physicians are looking for something different. As a family physician, I looked for value-based primary care opportunities that focused on patient care and relationships rather than the quantity of patients seen in a day.”