title: Time and money: a retrospective evaluation of the inputs, outputs, efficiency, and incomes of physicians.
abstract: BACKGROUND
  Physicians' concerns with the health care system focus on having less time with their patients and needing to work harder to maintain incomes. We sought to determine whether physicians are working longer hours and whether their incomes are declining.
  
  
  METHODS
  Using survey data, we conducted a retrospective analysis of physician inputs, outputs, efficiency, and incomes for generalists, general internists, general surgeons, pediatricians, and obstetrician-gynecologists from 1987 to 1998.
  
  
  RESULTS
  Physician inputs (as measured by the average hours worked in professional activities) showed little absolute change across specialties over time. Outputs (as measured by the total number of patient visits per week) decreased between 9% and 28%, depending on the specialty. Efficiency (the proportion of time spent in direct patient care and the amount of time spent during a typical office visit) remained stable over the time examined. Consumer price index inflation-adjusted annual incomes increased considerably over the time period examined (42% for general internists, 28% for pediatricians, 13% for generalists, and 8% for general surgeons); only obstetricians-gynecologists showed a net loss of annual income when adjusting for inflation (a 6% loss).
  
  
  CONCLUSIONS
  Our findings do not confirm the prevailing concern that physicians are working harder or longer or that their incomes are declining, but they offer an explanation of how physicians are maintaining incomes without increasing work inputs. There is a great deal of dissatisfaction with the health care system among physicians; exploration of perceptual reasons for that dissatisfaction may outline a course of action needed to resolve it.
authors.affiliation: Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA. bill.weeks@dartmouth.edu
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wallace
mesh_terms: D000574:American Medical Association; D003625:Data Collection; D004470:Economics, Medical / Q000706:statistics & numerical data*; D004526:Efficiency; D005249:Fees and Charges / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007407:Interviews as Topic / Q000379:methods; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010820:Physicians / Q000191:economics*; D012189:Retrospective Studies; D013038:Specialization; D013997:Time Factors; D017748:Time Management / Q000191:economics; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*