AMA Survey Results Should Ease Worries About Demise of Private Medical Practice

September 30, 2013 04:25 pm News Staff

A report recently released by the AMA provides a timely look at physician practice arrangements in the United States and concludes that, despite some media reports to the contrary, private practice remains a strong business model for U.S. physicians.

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Researchers did report, however, statistical "shifts" toward hospital employment.

The report, titled "New Data on Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts Toward Hospital Employment,"( is based on data drawn from the AMA's 2012 Physician Practice Benchmark Survey (PPBS).

Among the report's major findings are that 53.2 percent of all physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians. Twenty-three percent of all survey respondents worked in practices at least partly owned by a hospital, and 5.6 of respondents said they were hospital employees.

Story highlights
  • A recently released AMA report based on 2012 physician survey data offers statistical evidence that should ease concerns about hospital buy-outs of private medical practices in the United States.
  • The survey found that more than 53 percent of physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians.
  • Researchers detected shifts toward hospital employment and suggested that hospital interest in multispecialty practices was driven by the need for strong ties with primary care physicians.

Specific to family medicine, researchers found that of family physicians who responded to the survey,

  • 39.8 percent owned their practices,
  • 57.7 percent were employed,
  • 41.1 percent belong to a single specialty group,
  • 28.3 were part of a multispecialty group,
  • 18.8 percent were in solo practice,
  • 1.1 percent were hospital employees,
  • 2.5 percent were independent contractors and
  • 10.7 percent said they were in other types of practice arrangements.

"The 2012 PPBS offers an update on the status of physician practice arrangements and allows for a nationally representative response to the numerous (media) articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the 'death' of private practice," wrote the researchers.

Study authors noted that changes in the 2012 survey structure allowed them to "differentiate between physicians directly employed by a hospital and those working (as an owner or employee) in a practice owned by a hospital, something not possible in earlier physician surveys."

Report Methodology and Highlights

The 2012 PPBS was based on a nationally representative random sample of postresidency physicians who provided at least 20 hours of patient care per week and were not employed by the federal government at the time of the survey. More than 14,700 physicians received e-mailed invitations to participate, and a total of 3,466 physicians completed the survey, for a response rate of 28 percent.

The report offers tables with 2012 data on the distribution of physicians by ownership status and specialty level, distribution of physicians by practice type and specialty level, and the practice ownership structure of physicians in single specialty groups.

Researchers pointed out that practice ownership varied by physician specialty and ranged from a low of about 37 percent among pediatricians to a high of nearly 72 percent among surgical subspecialties. Family physicians (39.8 percent) and internal medicine physicians (46 percent) fell below the mean in terms of practice ownership.

More than 45 percent of survey respondents said they worked in single specialty practices, making that the most common type of practice arrangement in 2012; however, primary care physicians were less likely than nonprimary care physicians to practice in single specialty groups.

Regarding practice size, researchers noted that data show that 30 years ago, 40.5 percent of physicians of all specialties self-reported as solo physicians. The percentage fell to 29.3 percent in 1994, 23.2 percent in 2001 and 24.6 percent in 2007-08. "We estimate that 18.4 percent of physicians were in solo practice in 2012," said the researchers.

Researchers also found that single specialty and multispecialty groups had different ownership structures. For instance, nearly 72 percent of physicians in single specialty groups said their practices were wholly owned by practice physicians. Another 22 percent said a hospital had an ownership stake.

On the other hand, physicians in multispecialty groups were more likely to report that their practice was at least in part hospital-owned (43.6 percent) than wholly owned by physicians (39.6 percent). In fact, 25.5 percent of physicians in multispecialty practices reported that their practice was wholly owned by a hospital.

Among physicians in single specialty practices, hospital ownership was most often reported by internal medicine physicians (45.1 percent) and family physicians (37 percent).

Report authors were unable to ascertain whether hospital ownership of primary care practices was occurring at a faster rate than in other specialties because of a lack of comparable data from previous physician surveys.

Notably, for every practice size category, physicians in multispecialty practices were more likely to report hospital ownership than physicians in similarly sized single specialty practices.

Researchers concluded that the "wider scope of practice in multispecialty groups, not practice size, drives hospital ownership," and that "hospital interest in multispecialty practice is also driven by the need to have strong ties with primary care physicians."

Looking Forward

Researchers said the data suggested "that trends toward hospital employment observed in certain areas of the country are part of a national trend," but they were not able to estimate the percentage of change due to a lack of comparable information collected in earlier physician surveys.

Furthermore, "market level research suggests that hospitals focus on employing primary care physicians in order to maintain a strong referral base for high-margin specialty service lines," said the researchers. They added that the trend likely would continue because of increases in the demand for primary care services expected with full implementation of the Patient Protection and Affordable Care Act in 2014.

Researchers concluded that implementation of the Affordable Care Act coupled with reforms in payment and delivery methodologies would provide opportunities and challenges for U.S. physicians. Some physicians, they noted, would easily adapt to new payment and delivery models such as those provided by accountable care organizations. Health delivery structures that emphasize greater integration and care coordination, however, could prove challenging for other physicians.

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