San Francisco Marin Medical Society Blog

Surgeons Choose Hospital Employment Over Private Practice

General surgeons and surgical subspecialists are opting for hospital employment over private practice, according to a database study published in the Archives of Surgery.

Data from the American Hospital Association indicate that the number of US physicians employed by a hospital has increased by 32% since 2000. From 2001 to 2009, there was a decrease from 48% to 33% in the proportion of surgeons who reported being self-employed in their own practice, with a corresponding increase in the proportion of employed surgeons. Moreover, there was a 32% relative increase between 2006 and 2011 in the number of surgeons in full-time hospital employment. The authors note, however, that this was an absolute increase of just 1.2%, from 9586 in 2006 to 12,626 in 2011.

At present, 68% of surgeons report being employed as their practice environment.

The trend toward employment in large group practices was particularly prominent among younger surgeons and female surgeons. Urban and rural practices showed similar employment trends.

Factors driving this trend, according to the study authors, include the complex corporate environment, high costs of malpractice insurance, difficulties in obtaining reimbursement, administrative duties, and general risks and burden of solo or small group private practices.

Limitations of this study include possible overestimation of group practice surgeons who are "employees" because data on physician ownership interest are no longer available from the AMA.

In an accompanying invited critique, Lena M. Napolitano, MD, from the Department of Surgery at the University of Michigan in Ann Arbor, notes additional limitations: About 30% of surgeons could not be categorized because of insufficient data, and several surgical specialties were characterized as general surgery, such as hand, oral/maxillofacial, pediatric, trauma, transplant, cardiovascular, vascular, surgical critical care, and surgical oncology.

Dr. Napolitano notes that there may be financial reasons for the trend. "In the current era of health care reform and the promotion of accountable care organizations, a hospital-physician integrated system is better positioned to reap benefits than the private practice independent physician," she writes.

Click here to view the abstract.

Source: Archives of Surgery, December 17, 2012

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