“To paraphrase Mark Twain, the reports of the death of private practice medicine have been greatly exaggerated,” Dr. Ardis Dee Hoven, president of the American Medical Association, said in a news release touting the findings of a recent survey that indicates how the trend toward hospital employment of physicians may be overstated.
Not all doctors giving up private practice
According to the AMA's new Physician Practice Benchmark Survey (PDF), 53.2% of physicians were self-employed in 2012, 41.8% were employed and 5% were independent contractors.
The findings are touted as a counterpoint to recent surveys that suggest physicians are flocking to the security of salaried positions and selling practices to hospitals as the demands of care coordination and health information technology continue to mount.
The AMA report cited an American Hospital Association study that found physicians employed by community hospitals increased 32% to 212,000 from 160,000 between 2000 and 2010. Those figures could include physicians whose practices are owned or partially owned by hospitals, and the AMA notes that the AHA report “does not track physician practice arrangements more broadly.”
Also cited was an American College of Cardiology study that found hospital employment of cardiologists grew to 35% in 2012 from 11% in 2007. Though not cited by the AMA, Merritt Hawkins physician-recruitment recently released a report noting that about two thirds of the 3,097 recruiting assignments it fielded between April 1, 2012, and March 31, 2013, were for hospital-employed positions. This is nearly six times the number of searches for similar positions in 2004.
The need to preserve and support private physician practices has been a rallying cry at recent annual meetings of the AMA House of Delegates. At the 2012 meeting, Dr. Greg Emmert of Ohio said there was a need to expose young doctors to private practice before it "becomes something in a museum."
The AMA survey found that 60% of doctors in the U.S. work in a physician-owned practice, even if 23.4% work in a practice that is at least partly owned by a hospital. Only 5.6% work directly for a hospital or system.
The AMA survey affirms, however, that private practices are aging, even if reports of their death are indeed exaggerated.
Practice ownership was more common among older doctors with 60% of physicians age 55 and older owning a stake in their practice, compared with 43.3% for those under 40.
The most common practice arrangement was a single subspecialty group, accounting for 45.5% of physicians surveyed. This was followed by multispecialty groups, 22.1%; solo practice, 18.4%; hospital or system employee, 5.6%; faculty practice plan, 2.7%; and other arrangements, 5.7%. Other arrangements included ambulatory surgical centers, urgent-care centers, health maintenance organizations and medical schools.
Almost 60% of male physicians had an ownership stake, compared to only 38.7% among women. Among specialties, 71.9% of surgical subspecialists had a stake in their practice, compared to only 37.3% for pediatricians.
“Needed innovation in payment and delivery reform must recognize the wide range of practice types and sizes that exist today so all physicians can participate in the move to a more patient-centered system that rewards high-quality care and reduces costs,” Hoven said in the release.
The Federation of State Medical Board census puts the U.S. physician-with-an-active-license population at 878,194. Of those, the AMA estimates that there are 685,000 who have completed residency training, provided at least 20 hours of patient care, and do not work for the government. For the survey, the AMA identified 155,000 of physicians with similar characteristics in the Epocrates Honors panel, a database maintained by Epocrates, a provider of electronic decision-support and clinical workflow products. Out of that number, 14,750 were e-mailed an invitation to participate in an online survey, and 3,466 (28%) did so between November and mid-December 2012.
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