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Kocher R, Sahni NR. Hospitals' race to employ physicians—the logic behind a money-losing proposition.  N Engl J Med. 2011;364(19):1790-179321449774PubMedGoogle ScholarCrossref
Hayden B. Hospital statistics chart rise in physician employment. H&HN Daily. January 6, 2012. Accessed August 20, 2012
Simon CJ, Born PH. Physician earnings in a changing managed care environment.  Health Aff (Millwood). 1996;15(3):124-1338854514PubMedGoogle ScholarCrossref
Minott J. What are the costs to physicians of administrative complexity in their interactions with payers?  Find Brief. 2010;13(2):1-320376979PubMedGoogle Scholar
The Physicians Foundation.  Health reform and the decline of physician private practice: a white paper examining the effects of the patient protection and affordable care act on physician practices in the United States. Accessed February 22, 2012
Boukus E, Cassil A, O’Malley AS. A snapshot of U.S. physicians: key findings from the 2008 Health Tracking Physician Survey.  Data Bull (Cent Stud Health Syst Change). 2009;(35):1-1119768851PubMedGoogle Scholar
Walton L, Noonan TC, Miley CF,  et al.  Hospitals employing physicians: a practical guide to buying physician practices and compensating employed doctors. Paper presented at: 10th Annual Conference on Emerging Issues in Healthcare Law; February 17, 2012; Orlando, FL. Accessed February 22, 2012
Casalino LP, November EA, Berenson RA, Pham HH. Hospital-physician relations: two tracks and the decline of the voluntary medical staff model.  Health Aff (Millwood). 2008;27(5):1305-131418780916PubMedGoogle ScholarCrossref
Strode R, Beith C. Something old is something new again: structuring physician practice acquisitions.  Healthc Financ Manage. 2009;63(7):78-8219588816PubMedGoogle Scholar
Iglehart JK. The emergence of physician-owned specialty hospitals.  N Engl J Med. 2005;352(1):78-8415635118PubMedGoogle ScholarCrossref
Kocher R, Sahni NR. Physicians versus hospitals as leaders of accountable care organizations.  N Engl J Med. 2010;363(27):2579-258221067374PubMedGoogle ScholarCrossref
Marder WD, Emmons DW, Kletke PR, Willke RJ. Physician employment patterns: challenging conventional wisdom.  Health Aff (Millwood). 1988;7(5):137-1453229712PubMedGoogle ScholarCrossref
Kletke PR, Emmons DW, Gillis KD. Current trends in physicians' practice arrangements: from owners to employees.  JAMA. 1996;276(7):555-5608709405PubMedGoogle ScholarCrossref
Lieberhaber A, Grossman JM. Physicians moving to mid-sized, single-specialty practices.  Track Rep. 2007;(18):1-517710764PubMedGoogle Scholar
Casalino LP, Pham H, Bazzoli G. Growth of single-specialty medical groups.  Health Aff (Millwood). 2004;23(2):82-9015046133PubMedGoogle ScholarCrossref
Felland LE, Grossman JM, Tu HT. Key findings from HSC's 2010 site visits: health care markets weather economic downturn, brace for health reform.  Issue Brief Cent Stud Health Syst Change. 2011;(135):1-821614861PubMedGoogle Scholar
Mathews AW. When the doctor has a boss: more physicians are going to work for hospitals rather than hanging a shingle. Wall Street Journal. November 8, 2010. Accessed February 15, 2012
Merritt Hawkins & Associates.  2008 review of physician and CRNA recruiting incentives. Accessed October 15, 2011
Blumenthal D. New steam from an old cauldron—the physician-supply debate.  N Engl J Med. 2004;350(17):1780-178715103006PubMedGoogle ScholarCrossref
Merritt Hawkins & Associates.  2007 survey of physicians 50 to 65 years old. Accessed January 22, 2012
 American Medical Student Association (AMSA) Student Debt Fact Sheet 2009. AMSA website. Accessed October 15, 2011
Poley S, Newkirk V, Thompson K, Ricketts T. Independent practice becoming increasingly rare among surgeons.  Bull Am Coll Surg. 2011;96(3):40-4121452671PubMedGoogle Scholar
Heneghan SJ, Bordley J IV, Dietz PA, Gold MS, Jenkins PL, Zuckerman RJ. Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.  J Am Coll Surg. 2005;201(5):732-73616256916PubMedGoogle ScholarCrossref
Cantlupe J. Physician alignment in an era of change. Health Leaders Media. September 14, 2010. Accessed October 15, 2011
Andriole DA, Jeffe DB, Schechtman KB. Is surgical workforce diversity increasing?  J Am Coll Surg. 2007;204(3):469-47717324784PubMedGoogle ScholarCrossref
American College of Emergency Physicians.  On-Call specialist coverage in U.S. Emergency departments: ACEP survey of emergency department directors: April 2006. Accessed January 15, 2012
Original Article
April 2013

The Employed Surgeon: A Changing Professional Paradigm

Author Affiliations

Author Affiliations: Department of Surgery, University of North Carolina School of Medicine (Drs Charles, Ortiz-Pujols, Fraher, Cairns, and Sheldon), American College of Surgeon Health Policy Research Institute (Drs Charles, Ortiz-Pujols, Ricketts, Fraher, and Sheldon and Mr Neuwahl), and Sheps Center for Health Policy Research (Dr Charles, Ricketts, Fraher, and Sheldon and Mr Neuwahl), Chapel Hill, North Carolina.

JAMA Surg. 2013;148(4):323-328. doi:10.1001/jamasurg.2013.1013

Objective To identify trends and characteristics of surgeon employment in the United States. Surgeons are increasingly choosing hospital or large group employment as their practice environment.

Design American Medical Association Physician Masterfile data were analyzed for the years 2001 to 2009.

Setting Surgeons identified within the American Medical Association Masterfile.

Participants Surgeons were defined using definitions from the American Medical Association specialty data and the American Board of Medical Specialties certification data and included active, nonfederal, and nonresident physicians younger than 80 years of age.

Main Outcome Measures Employment status and trends.

Results The number of surgeons who reported having their own self-employed practice decreased from 48% to 33% between 2001 and 2009, and this decrease corresponded with an increase in the number of employed surgeons. Sixty-eight percent of surgeons in the United States now self-identify their practice environment as employed. Between 2006 and 2011, there was a 32% increase in the number of surgeon in a full-time hospital employment arrangement. Younger surgeons and female surgeons increasingly favor employment in large group practices. Employment trends were similar for both urban and rural practices.

Conclusions General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance.