AAOS Now

Published 10/1/2013

Private Practices Still Going Strong

AMA survey shows 60 percent of physicians in physician-owned practices

Although recent reports give the impression that hospital employment of physicians may soon result in the disappearance of the private-practice model, a 2012 survey by the American Medical Association (AMA) seems to indicate otherwise.

Nearly 15,000 physicians were asked to participate in the survey, and 3,466 (28 percent) completed it. The results indicate that although there has been a shift toward hospital employment, 53.2 percent of respondents were self-employed and a full 60 percent of respondents worked in practices that were wholly owned by physicians. Only 23 percent of respondents worked in practices that were at least partly owned by a hospital and another 5.6 percent were directly employed by a hospital.

Practice ownership varied greatly among specialties, ranging from a low of 37.3 percent among pediatricians to a high of 71.9 percent among surgical subspecialists. The most common type of practice arrangement was the single specialty practice, cited by nearly half (45.5 percent) of respondents. These findings are comparable to data from the 2012 AAOS Orthopaedic Census, which found that 44 percent of respondents were in orthopaedic groups.

However, the percentage of solo practices continues to decrease. According to the AMA, 18.4 percent of physicians were in solo practice in 2012, a decrease of about 6 percentage points from the previous survey. According to the AAOS data, 18 percent of respondents were in solo practice.

Age and gender matter
Practice ownership was more common among male physicians, according to the AMA survey. Almost 60 percent of male physicians had an ownership stake, compared to only 38.7 percent among female physicians. Female physicians were also less likely to work in single specialty groups than male physicians (39.7 percent compared to 48.0 percent), but more likely to be in solo practice than male physicians (21.0 percent compared to 17.3 percent).

Solo practitioners were also more likely to be older. According the AMA survey, just 10 percent of physicians younger than age 40 were in solo practice. Among those age 55 and older, more than a quarter (25.3 percent) were in solo practice.

Among orthopaedists, the difference is even more striking. According to the 2012 AAOS Orthopaedic Census, just 5.4 percent of respondents younger than age 40 were in solo practices. That percentage, however, more than doubled (to 13.4 percent) among respondents ages 40 to 49 and continued to increase across older age groups.

“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,” said AMA President Ardis Dee Hoven, MD, in a press release.

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