title: Doctors' labour supply and incentives
title: a collection of essays
titleType: Subtitle
Creators: name: Nunez Elvira, Alberto
Publisher: name: Lancaster University
Year: 2018

description: This thesis examines UK doctors’ labour supply from the intensive margin.
      Initially, it explores trends in average weekly hours of work using data
      from the Labour Force Survey (LFS). Next, it compares how average weekly
      hours of work vary over the lifecycle for doctors and compare to with
      other professionals’ hours (lawyers and accountants). Finally, as doctors
      continuously report being stressed and unhappy, this thesis explores data
      from the Annual Population Survey (APS) to assess whether hours of work
      could alter self-reported wellbeing levels for doctors and other workers.
      
      This thesis is made up of five chapters with three main essays on the
      topic of interest. Chapter 1 conveys an extensive background on what we
      know about doctors’ labour supply in the UK and other countries.
      
      Chapter 2 exploits the LFS to examine main trends in doctors’ weekly hours
      of work (GPs and hospital doctors) over 21 years (1994-2014). It proposes
      a definition of total hours worked that encompasses total usual hours in
      main job (basic hours and overtime hours, paid or unpaid) plus total hours
      in second job. The chapter is mostly descriptive and focuses on changes in
      average weekly hours of work of the headcount of doctors over the period
      and on variation across different characteristics. It also portrays
      irregular working patterns, second job hours and desired hours of work
      (both more and fewer hours). The main finding conveys that despite
      training more doctors every year and the increasing female participation
      in the medical profession, hours of work have fallen over time and the
      sharpest fall occurs between 1994 and 2004. From 2004, this trend
      attenuates but continues falling though at a reduced rate.
      
      Chapter 3 estimates labour supply models over the lifecycle for a
      representative agent using a pooled cross-section dataset from the LFS for
      ‘partner’ GPs (Selfemployed), ‘salaried’ GPs, hospital doctors, lawyers
      and accountants. The main finding posits that the reduction in female
      doctors’ average weekly hours of work – especially ‘salaried’ GPs – has
      been larger than those of lawyers and accountants. This is attributed to
      lifecycle effects and, particularly, children.
      
      Chapter 4 examines self-reported well-being outcomes (anxiety, happiness,
      life satisfaction and worthwhile levels) and variables relating health
      problems (depression, hypertension or whether having a health problem
      limits activity to work). We examine the relationship between hours of
      work and well-being levels. Although there is considerable literature on
      doctors’ job satisfaction, especially GPs, and, also, there are numerous
      studies on the issue of burnout, this is not the case for well-being of
      physicians which is underexplored. The few existing studies come from
      small snapshots and unrepresentative samples. This chapter explores a
      large well-established dataset using conventional screens to examine the
      distribution of well-being and their proximate determinants. The
      information is available in the Annual Population Survey (APS) from 2011
      quarter 2 to 2015 quarter 1, covering four fiscal years (2011/12 to
      2014/15). Our main finding conveys that, contrary to popular belief, and
      the assertions of the professional bodies for physicians, doctors appear
      to be more satisfied, happier, feel that their life is more worthwhile,
      and they are less anxious than other professionals. The chapter also makes
      an economic contribution on labour supply: hours of work, at the margin,
      have virtually no significant effect on the measures of well-being. This
      means that individuals are on their labour supply curve but those
      reporting to work more hours may have lower values of the well-being
      measures. This is true for lawyers and accountants but not for doctors,
      which is viewed as evidence of intrinsic motivation driven by mission
      orientation among doctors. So, there is scope for expanding supply along
      the intensive margin, which may be both an inexpensive and quick solution
      to the alleged supply shortfall, relative to the current policy of
      expanding supply along the extensive margin.
      
      Chapter 5 sums up the main findings and contributions.