Short Cuts

All you need to read in the other general journals

BMJ 2010; 340 doi: (Published 03 March 2010) Cite this as: BMJ 2010;340:c1162

A shorter working week and lower fees for US doctors

The working week is getting steadily shorter for US doctors. Working hours began to fall around 1996, when doctors worked a mean of 54.9 hours a week. By 2008, they reported working a mean of 51.0 hours a week, an overall reduction of 7.2% (95% CI 5.3% to 9.0%).

National survey data, collected regularly since 1977, showed a significant downward trend for doctors working inside and outside of hospital, and for both men and women. Residents’ working hours fell sharply in 2003, after limits were introduced in July, but the working week also shrank for non-residents, particularly those under 45 years of age (7.4%, 4.7% to 10.2%).

It is hard to know why all kinds of US doctors are working less hard than they used to, say researchers, but the trend has clear implications for workforce planning. Analysts are already worried that there won’t be enough US doctors to meet demand in the coming decade. A shorter working week could exacerbate the problem—the cut in hours among non-residents alone is the equivalent of 36 000 fewer doctors out of a total work force of 630 000.

The trends in working hours were matched by similar trends in doctors’ fees. A typical bundle of services cost 25% less in 2006 than it had in 1995.

New oestrogen receptor modulator fails to impress

Pfizer’s new oestrogen receptor modulator, lasofoxifene, works better than placebo for older women with documented osteoporosis—the higher dose reduced vertebral fractures by 42% over five years in the manufacturer’s latest clinical trial (hazard ratio 0.58, 95% CI 0.47 to 0.70). But does it work better than other similar treatments, such as raloxifene? Probably not, says one expert (p 752), although it is hard to be certain without direct head to head comparisons.

A close look at data from key trials suggests that the two …

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