More hours, more tired, more to do: results from the CMA's 2002 Physician Resource Questionnaire

Although the emphasis of the CMA's annual Physician Resource Questionnaire (PRQ) is always on the tracking data it provides about the evolution of medical practice in Canada, it also offers several thousand physicians a year a chance to vent or rejoice about their profession. In 2002, there was a lot of venting (see sidebar).

Many of the complaints concerned the unrelenting demands of medical life. In the 2002 PRQ, respondents were asked for the first time whether their method of practice had changed significantly in the past 2 years, and one-third said it had. Nine percent indicated that they had increased call responsibility, with physicians in the under–35 and 35–44 age groups being somewhat more likely (11% and 12%) to have taken on more call responsibility than physicians in the 55–64 and ≥ 65 age groups (7% and 4%). Conversely, physicians aged 55–64 and ≥ 65 were more likely (13% and 15%) than those under 35 or aged 35–44 (3% and 8%) to have decreased call responsibilities or to have stopped taking shared call in the previous 2 years.

And a number of doctors appear to want off the “medical treadmill.” Although 5% of respondents indicated that they had expanded their scope of practice in the past 2 years, almost twice as many (9%) were moving in the opposite direction. “I resigned my hospital privileges and stopped obstetrics so that I can have a reasonable life,” one doc- tor wrote. “Never again will I work ≥ 90-hour weeks.” Those aged 55 to 64 and ≥ 65 were more likely to have reduced their scope of practice (12% and 17%) than physicians in the under–35 and 35–44 age groups (7% and 8%).

The 2002 survey also raises questions about whether rising debt loads will allow young doctors to take an early step off that treadmill. For the first time, the PRQ asked doctors about the debts they carried following postgraduate training. Those under age 35 and aged 35–44 were the most likely to have carried a debt load (79% and 66%); only 28% of those ≥ 65 and 42% of those aged 55–64 had a debt load after postgraduate training. The average debt load for surgical specialists was $39 228, compared with $32 641 for medical specialists and $29 016 for GP/FPs. The results support data from a recent study of the impact of rising tuition fees on medical students, which found that first-year medical students in Ontario expect to graduate with a median debt of $80 000 (CMAJ 2002;166[8]:1023-8).

Many of those medical students will eventually receive fee-for-service (FFS) payments, but the proportion of physicians who receive 90% or more of their professional income in this manner continues to decline, from a high of 68% in 1990 to 59% in 2001 and 58% in 2002. Physicians in the 55–64 and ≥ 65 age groups are more likely to be in FFS arrangements (63% and 73%) than their younger colleagues (55% to 56%). Three-quarters of surgeons receive the bulk of their income from FFS, compared with 59% of GP/FPs and 52% of medical specialists.

Thirty-seven percent of respondents cited FFS as their preferred mode of remuneration, down from 50% in 1995, while 23% would prefer a blended remuneration structure and another 26% would prefer to be paid by salary. “A salaried position with pension would certainly afford a better lifestyle and increased security after retirement,” one respondent suggested.

Regardless of how they're getting paid, the proportion of physicians who reported increases to their net income in the previous year has more than doubled in the past 5 years, from 13% in 1997 to 29% in 2002. Seventy-nine percent of those with increased net income also reported an increase to their workload in the last 12 months, compared with 55% of those who did not report increased income.

To earn their money they worked an average of 53.8 hours per week, excluding on-call activities, compared with 53.4 hours in 2001 and 52.9 hours in 2000. “I'm very dissatisfied with my lifestyle,” wrote one doctor. “My workload is enormous, my patients are demanding and I have too little time for my family.”

As usual, male physicians tended to work longer than females (56.0 hours per week v. 49.1), and GP/FPs worked fewer hours (51.6) than medical specialists (55.3) and surgical specialists (58.6). Following a pattern evident in previous years, those in the under 35 and 35–44 age groups tended to work fewer hours per week (52.8 and 52.0) than their colleagues in the 45–54 and 55–64 age groups (56.4 and 54.3). Respondents aged ≥ 65 worked an average of 46.6 hours per week.

The PRQ is Canada's largest annual survey of physicians' professional activities. It first started tracking physician practice trends in 1982 and has been conducted annually since 1997. The 2002 survey was mailed to a random sample of 7693 doctors and the response rate was 38%. Results at the national level are considered accurate to within ± 1.9%, 19 times out of 20. Detailed results from the 2002 PRQ are available at www.cmaj.ca with the online version of the Sept. 3 issue. — Shelley Martin, Senior Analyst, Research, Policy and Planning Directorate, CMA