Nunez Elvira, Alberto and Walker, Ian and Hollingsworth, Bruce (2018) Doctors' labour supply and incentives : a collection of essays. PhD thesis, Lancaster University.
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Abstract
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.