Exploring Factors Associated With the Work Hours of Attending Physicians Working in Hospitals

Document Type : Original Article


1 Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan

2 Department of Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan

3 Department of Operations Management, Ten-Chan General Hospital, Taoyuan, Taiwan

4 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan


Long work hours for physicians not only harm the health of physicians, but also endanger patient safety. Compared with resident physicians, attending physicians—especially hospital-employed attending physicians—assume more responsibilities but has not gotten enough attention. The purpose of this study was to explore whether a hospital’s geographic location and emergency care responsibility might influence the number of hours worked.

The respondents of 2365 attending physicians from 152 hospitals in the 2018 survey of Taiwan physician work hours were used as the data source. The total work hour per week and its components, the regular scheduled shift and three types of on-call shifts, were used as outcome variables. Hospital geographic location and emergency care responsibility were the independent variables. The multilevel random effect model was employed to examine the study objective after adjusting for clinical specialty, hospital teaching status, and ownership.

The average number of total working hours was 69.09 hours per week; the regular scheduled shift was account for 75% of total work hours. The results showed the total work hours were only varied by the level of hospital’s emergency care responsibility. However, the results also demonstrated the hours of duty shifts were varied by hospital’s geographic location and emergency care responsibility. The results of the multilevel random effect model revealed that the hospital’s emergency care responsibility was the factor consistently associated with attending physician’s work hour, no matter the total work hours or its composition.

In this study, we explored how a hospital’s location and its level of emergency care responsibility were associated with physicians’ work hours for each type of shift. Our findings offer an opportunity to review the rationality of physician workforce allocation, and financial incentives and administrative measures could be the next steps for balancing the work hours of attending physicians.


  1. Hu NC, Chen JD, Cheng TJ. The associations between long working hours, physical inactivity, and burnout. J Occup Environ Med. 2016;58(5):514-518. doi:1097/jom.0000000000000715
  2. Chen KY, Yang CM, Lien CH, et al. Burnout, job satisfaction, and medical malpractice among physicians. Int J Med Sci. 2013;10(11):1471-1478. doi:7150/ijms.6743
  3. Kawamura Y, Takayashiki A, Ito M, Maeno T, Seo E, Maeno T. Stress factors associated with burnout among attending physicians: a cross-sectional study. J Clin Med Res. 2018;10(3):226-232. doi:14740/jocmr3299w
  4. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131-1150. doi:1001/jama.2018.12777
  5. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum. 2017;60(6):567-576. doi:1097/dcr.0000000000000844
  6. Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open. 2017;7(6):e015141. doi:1136/bmjopen-2016-015141
  7. Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev. 2007;32(3):203-212. doi:1097/01.hmr.0000281626.28363.59
  8. Southwick FS, Southwick SM. The loss of a sense of control as a major contributor to physician burnout: a neuropsychiatric pathway to prevention and recovery. JAMA Psychiatry. 2018;75(7):665-666. doi:1001/jamapsychiatry.2018.0566
  9. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14:325. doi:1186/1472-6963-14-325
  10. Wiederhold BK, Cipresso P, Pizzioli D, Wiederhold M, Riva G. Intervention for physician burnout: a systematic review. Open Med (Wars). 2018;13:253-263. doi:1515/med-2018-0039
  11. Chao L, Wallack MK. Limits on resident work hours. Ann Surg. 2003;237(4):456-457. doi:1097/00000658-200304000-00002
  12. Ministry of Health and Welfare. Ministry of Health and Welfare Published the Work Hour Guideline for Resident Physician (in Chinese) 2017. https://www.mohw.gov.tw/cp-2736-8859-1.html.
  13. Peets A, Ayas NT. Restricting resident work hours: the good, the bad, and the ugly. Crit Care Med. 2012;40(3):960-966. doi:1097/CCM.0b013e3182413bc5
  14. Leigh JP, Tancredi D, Jerant A, Kravitz RL. Annual work hours across physician specialties. Arch Intern Med. 2011;171(13):1211-1213. doi:1001/archinternmed.2011.294
  15. Rosta J, Aasland OG. Work hours and self rated health of hospital doctors in Norway and Germany. A comparative study on national samples. BMC Health Serv Res. 2011;11:40. doi:1186/1472-6963-11-40
  16. Chang RE, Yu TH, Shih CL. The number and composition of work hours for attending physicians in Taiwan. Sci Rep. 2020;10(1):14934. doi:1038/s41598-020-71873-3
  17. Rosta J, Aasland OG. Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work-home balance and the European working time directive: a panel study. BMJ Open. 2014;4(10):e005704. doi:1136/bmjopen-2014-005704
  18. Slade S, Busing N. Weekly work hours and clinical activities of Canadian family physicians: results of the 1997/98 National Family Physician Survey of the College of Family Physicians of Canada. CMAJ. 2002;166(11):1407-1411.
  19. Bragadóttir H, Kalisch BJ, Bergthóra Tryggvadóttir G. The extent to which adequacy of staffing predicts nursing teamwork in hospitals. J Clin Nurs. 2019;28(23-24):4298-4309. doi:1111/jocn.14975
  20. Bae SH, Trinkoff A, Jing H, Brewer C. Factors associated with hospital staff nurses working on-call hours: a pilot study. Workplace Health Saf. 2013;61(5):203-211. doi:1177/216507991306100504
  21. Ministry of Health and Welfare. Statistics of General Health and Welfare 2018. Taipei: Ministry of Health and Welfare; 2018.
  22. Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N. Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011;61(3):163-170. doi:1093/occmed/kqr004
  23. Nishimura K, Nakamura F, Takegami M, et al. Cross-sectional survey of workload and burnout among Japanese physicians working in stroke care: the nationwide survey of acute stroke care capacity for proper designation of comprehensive stroke center in Japan (J-ASPECT) study. Circ Cardiovasc Qual Outcomes. 2014;7(3):414-422. doi:1161/circoutcomes.113.000159
  24. Kawase K, Nomura K, Tominaga R, et al. Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part 1: working style. Surg Today. 2018;48(1):33-43. doi:1007/s00595-017-1556-0
  25. Tsai YH, Huang N, Chien LY, Chiang JH, Chiou ST. Work hours and turnover intention among hospital physicians in Taiwan: does income matter? BMC Health Serv Res. 2016;16(1):667. doi:1186/s12913-016-1916-2
  26. Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. JAMA. 2010;303(8):747-753. doi:1001/jama.2010.168
  27. Davies E. US physicians work fewer hours and see fewer patients than in 2008. BMJ. 2012;345:e6863. doi:1136/bmj.e6863
  28. Gravelle H, Hole AR. The work hours of GPs: survey of English GPs. Br J Gen Pract. 2007;57(535):96-100.
  29. Eltorai AEM, Eltorai AS, Fuentes C, Durand WM, Daniels AH, Ali S. Financial implications of physician specialty choice. R I Med J (2013). 2018;101(8):50-55.
  30. McGrail MR, Humphreys JS, Joyce CM, Scott A, Kalb G. How do rural GPs' workloads and work activities differ with community size compared with metropolitan practice? Aust J Prim Health. 2012;18(3):228-233. doi:1071/py11063
  31. Steinhaeuser J, Joos S, Szecsenyi J, Miksch A. A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey. BMC Fam Pract. 2011;12:112. doi:1186/1471-2296-12-112
  32. Weeks WB, Wallace AE. Rural-urban differences in primary care physicians' practice patterns, characteristics, and incomes. J Rural Health. 2008;24(2):161-170. doi:1111/j.1748-0361.2008.00153.x
  33. Leu HI, Chang WT, Lin MH, et al. Urban-rural disparity in geographical and temporal availability of pediatric clinics: a nationwide survey in Taiwan. Pediatr Neonatol. 2017;58(4):344-349. doi:1016/j.pedneo.2016.07.008
  34. Huang EC, Pu C, Huang N, Chou YJ. Resident burnout in Taiwan hospitals-and its relation to physician felt trust from patients. J Formos Med Assoc. 2019;118(10):1438-1449. doi:1016/j.jfma.2018.12.015
Volume 11, Issue 12
December 2022
Pages 2907-2916
  • Receive Date: 15 April 2021
  • Revise Date: 22 March 2022
  • Accept Date: 06 April 2022
  • First Publish Date: 09 April 2022