Canadian doctors are working less than they did 30 years ago, but the decline isn’t being driven by the influx of women into medicine. It’s married male physicians who are putting in fewer hours.
That’s the conclusion of a new study that turns an old stereotype about the feminization of medicine on its head. Published Monday in the Canadian Medical Association Journal, the paper found that male physicians accounted for 83 per cent of the reduction in physician work hours that occurred between 1987 and 2021.
Doctors’ work hours declining in Canada
Three-year moving average of physician weekly hours
worked, by sex
56
54
52
50
48
Male
46
All
44
Female
42
40
1988
1990
1995
2000
2005
2010
2015
2019
THE GLOBE AND MAIL, SOURCE: CMAJ
Doctors’ work hours declining in Canada
Three-year moving average of physician weekly hours
worked, by sex
56
54
52
50
48
Male
46
All
44
Female
42
40
1988
1990
1995
2000
2005
2010
2015
2019
THE GLOBE AND MAIL, SOURCE: CMAJ
Doctors’ work hours declining in Canada
Three-year moving average of physician weekly hours worked, by sex
56
54
52
50
48
Male
46
All
44
Female
42
40
1988
1990
1995
2000
2005
2010
2015
2019
THE GLOBE AND MAIL, SOURCE: CMAJ
Doctors still work far more than the average Canadian, and male doctors still put in four more hours a week, on average, than their female colleagues. But whereas female physicians worked about the same number of hours throughout the study period, married male physicians cut way back, likely in search of a better work-life balance.
“Historically, people might have suggested that any decline in hours was due to the feminization of the physician work force,” said Boris Kralj, a McMaster University economist and one of the authors of the new study. “The females didn’t decline very much at all. It was the males that drove like 80 per cent of the decline. That was a surprise.”
The changing work habits of physicians is one of several explanations for a paradox in the modern Canadian health system. Despite the country having more physicians per capita than ever before, patients are struggling to access care – especially primary care – more than in the past.
The proportion of Canadian adults who reported having a doctor or a regular place to go for medical care dropped to 86 per cent in 2023, down from 93 per cent in 2016, the Canadian Institute for Health Information said last week as it released the findings of a 10-country survey led by the Commonwealth Fund, a non-profit health research organization in the United States.
Canada placed last in primary care access, behind the 9th place U.S.
The rising number of chronically ill seniors is also a factor in the shortfall of care, Dr. Kralj said. Doctors who spend a long time with complicated patients can’t see as many in a day.
Either way, physicians in 2024 aren’t practising the way their predecessors did in 1987, when the typical doctor was a man in solo practice with a stay-at-home wife.
Dr. Kralj and his co-authors reached their conclusions by mining data from Statistics Canada’s monthly labour force surveys going back to 1987. The average number of hours that doctors reported working a week remained stable until 1997, after which they dropped.
The researchers grouped the data into three-year moving averages. From 1987-1991, Canadian doctors worked an average of 52.8 hours a week. By 2017-2021, the average was down to 45.9 hours a week, a decrease of 6.9 hours. (The number of hours worked fell sharply in 2020, when COVID-19 forced the suspension of routine medical care but have since recovered.)
Male physicians accounted for 5.7 of the 6.9-hour reduction, the authors calculated. The gap in hours worked between male and female doctors narrowed to about four hours in 2019, down from 10 in the mid-1990s.
“We’ve certainly seen a generational change in the attitude to work-life balance and the importance of both parents being engaged in the home,” said Michael Green, president of the College of Family Physicians of Canada and head of the Department of Family Medicine at Queen’s University.
That societal shift accelerated in the 1990s around the same time as medicine was reckoning with the risks to patient safety of having hospital physicians work around the clock on no sleep, Dr. Green said. In the years since, many hospitals have instituted rules that limit the number of consecutive hours doctors can work, another possible reason they log fewer hours.
For Michelle Cohen, a family doctor in Brighton, Ont. who also studies pay disparities between men and women in medicine, the new CMAJ study is refreshing. The paper reflected what she hears from male colleagues who don’t want their medical careers to make them absentee husbands and fathers.
Dr. Cohen believes the influx of women into medicine – their share of the total doubled during the study period – has given male doctors a permission structure to set reasonable hours and devote more time to their families.
“An underappreciated side benefit of having more women in the profession,” she said, “is that it makes it a more humane profession for everybody.”
Kelly Grant