The share of physicians with an ownership stake in their medical practices fell below 50 percent in 2016, according to an American Medical Association (AMA) study released Wednesday.
The findings mark the first time since AMA began tracking practice arrangements in 2012 that a majority of physicians did not own their main practices.
For the study, AMA used data from its Physician Practice Benchmark Surveys, which draws from a sample of 95,262 post-residency physicians who provide at least 20 hours of patient care weekly in one of the 50 states or Washington, D.C., and are not employed by the federal government.
Overall, 35,000 active physicians responded to AMA's 2016 Benchmark Survey, which was conducted over a four-week period in September 2016.
AMA found 47.1 percent of patient care physicians reported having a membership stake in their main practices. AMA data show that percentage has steadily declined in recent years, falling from 53.2 percent in 2012 to 50.8 percent in 2014.
Meanwhile, the percentage of patient care physicians who were employees at their primary medical practices rose from 41.8 percent in 2012 to 47.1 percent in 2016. According to AMA, 2016 marks the first time the percentage of employed physicians matches those who had full or partial ownership of their practices.
The researchers found the share of physicians in hospital-owned practices, or those who were employed directly by a hospital, remained unchanged at 32.8 percent from 2014 to 2016. According to the study, 21 percent of physicians who were employed at hospital-owned practices said their medical practices had been acquired in the past five years, compared with 26.9 percent in 2012. Hospital ownership was most common among multispecialty practices that included primary care physicians.
AMA also found the percentage of patient care physicians who were independent contractors also increased slightly—rising from 5 percent in 2012 to 6 percent in 2016.
The study also showed a physician's ownership status varied greatly by specialty:
- Emergency medicine providers represented the highest share of independent contractors;
- Pediatrics providers represented the highest share of employed physicians; and
- Surgical sub-specialties represented the highest percentage of owners, followed by radiologists.
AMA also found that younger physicians were more likely to be employed than their older counterparts. According to the study, 65.1 percent of physicians under 40 were employees at their medical practices, compared with 51.3 percent in 2012. The researchers said more physicians over 40 were employees at their practices in 2016 as well, but the rate of growth was slower.
According to AMA, most of the shifts seen over the 2012 to 2016 period "were small but statistically significant changes." AMA said several factors contributed to the shifts, including a slowdown in hospital acquisitions. According to AMA, consultants say hospitals have "as many practices as they can handle at this point" and are focused on doing "a better job of organizing what they have" (Rosin, Becker's Hospital Review, 5/31; Kacik, Modern Healthcare, 5/31).
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Behind the flurry of M&A in recent years, a deeper trend of hospital integration is underway: the emergence of alternative partnerships that secure many of the same benefits of M&A without the financial and legal commitment: Clinical affiliation, regional collaborative, accountable care organization, and clinically integrated network.
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