Physicians who retire from small practices increasingly aren't replaced, as physicians new to medicine opt for hospital employment instead, according to research published Jan. 14 in the Annals of Internal Medicine.
Researchers studied 630,979 physicians who treated Medicare patients from 2008-17. They identified physicians who started and stopped treating Medicare patients during that time, and examined the size and ownership of those physicians' practices.
Charity organization Arnold Ventures funded the study.
1. Physicians who began treating Medicare patients during the study period were much more likely than physicians exiting Medicare to work in large, hospital-owned practices. The median age of exiting physicians indicated they were likely retiring.
2. Workforce turnover, as well as cost and spending increases, are driving higher employment in larger, hospital-owned physician practices.
3. In small physician practices, one physician entered for every three who exited. In contrast, practices with 50-plus physicians brought in at least two physicians for every one that left, and hospital-owned practices had 2.8 new physicians per exiting physician.
4. Employment by large, hospital-owned practices was more common among internal medicine, ophthalmology, neurology and dermatology specialists.
5. Study lead Hannah Neprash, PhD, said payment policies that make independent practice more appealing could promote competition in healthcare.