Association between hours of work and subjective well-being. How do physicians compare to lawyers and accountants?

Analyses of physician well-being typically rely on small and unrepresentative samples. In April 2011, the UK Office for National Statistics incorporated subjective well-being metrics (SWB) into the Annual Population Survey (APS), a well-established survey. This survey includes variables from the labor market, making APS an ideal source for measuring the association between work hours and SWB metrics and comparing among different professionals. Using APS data from 2011/12 to 2014/15, this study examined the association between SWB levels and work hours using multiple linear models for physicians (primary care physicians and hospital doctors), lawyers, and accountants. Of the 11,810 observations, physicians were more satisfied, happier, and less anxious; females were more stressed (10.7%); and age was negatively associated with happiness and satisfaction. Incorporating information on preferences to work more hours (underemployment) did not affect physicians' but worsened the well-being of other professionals (lawyers and accountants). Surveyed physicians were less anxious, happier, and more satisfied than lawyers or accountants before Covid. Although the total work hours did not alter the SWB metrics, overtime hours for other professionals did. Increasing the working hours of underemployed physicians (with appropriate compensation) could be a relatively inexpensive solution to tackle the shortage of health workers in the short run.

Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation.

BACKGROUND: A Pay-for-Performance (P4P) programme, known as Prescribed Specialised Services Commissioning for Quality and Innovation (PSS CQUIN), was introduced for specialised services in the English NHS in 2013/2014. These services treat patients with rare and complex conditions. We evaluate the implementation of PSS CQUIN contracts between 2016/2017 and 2018/2019. METHODS: We used a mixed methods evaluative approach. In the quantitative analysis, we used a difference-in-differences design to evaluate the effectiveness of ten PSS CQUIN schemes across a range of targeted outcomes. Potential selection bias was addressed using propensity score matching. We also estimated impacts on costs by scheme and financial year. In the qualitative analysis, we conducted semi-structured interviews and focus group discussions to gain insights into the complexities of contract design and programme implementation. Qualitative data analysis was based on the constant comparative method, inductively generating themes. RESULTS: The ten PSS CQUIN schemes had limited impact on the targeted outcomes. A statistically significant improvement was found for only one scheme: in the clinical area of trauma, the incentive scheme increased the probability of being discharged from Adult Critical Care within four hours of being clinically ready by 7%. The limited impact may be due to the size of the incentive payments, the complexity of the schemes' design, and issues around ownership, contracting and flexibility. CONCLUSION: The PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could benefit from lessons learnt from this study on incentive design and programme implementation.

Trends and determinants of GPs' work hours in the UK: a quantitative study.

BACKGROUND: Information on the hours of work of UK doctors is limited, and what exists relies on self-designed questionnaires in England. AIM: To understand trends in the annual stock of physicians' hours and their main determinants. DESIGN & SETTING: A quantitative study in which data were collected from the Quarterly Labour Force Survey (QLFS) between 1998 and 2020, under the End User Licence (EUL), in the UK. METHOD: Descriptive and linear regression models of labour supply for doctors (pooled), GPs, and hospital doctors. RESULTS: Between 1998 and 2020, while the headcount of doctors grew by 128.79% for hospital doctors and 45.28% for GPs, hours of work dropped by 20.80% for hospital doctors and 25.37% for GPs. Hence, the annual stock of hours grew by 81.20% for hospital doctors but by a modest 8.42% for GPs. Female doctors worked 8.68 fewer hours than males, with GPs reporting the largest reduction (-11.82 hours, 95% confidence interval [CI] = -13.31 to -10.33 and -6.75, 95% CI = -9.32 to -4.19, in the full specification). Family decisions are associated with a fall in doctors' work hours and modest growth in the annual stock of hours. These determinants and overtime are drivers of part-time work. CONCLUSION: Despite the increase in the headcount of GPs, their hours of work dropped over the study period, generating a more steady and modest growth in their total annual stock of hours compared with hospital doctors. Female GPs work fewer hours than male GPs and are more likely to work part-time due to childbearing, marriage/co-habitation, and overtime work.