Physician independence is declining. From 2012 to 2022, the share of physicians who were self-employed dropped nine percentage points –– from 53% to 42%. At the same time, the percentage of employed physicians grew from just under 42% to almost 50%, according to a 2023 American Medical Association release.
But the shift to larger practices and employed settings has been notably slower for orthopedic surgeons. The most recent data available on their employment settings is from the American Academy of Orthopaedic Surgeons in 2016, which indicated that 35% of the workforce was in private group practice and 15% were in solo private practice, while just 15% were employed by hospitals or medical centers.
While exactly how many orthopedic surgeons are independent versus employed is statistically unclear, a number of factors could be driving more orthopedic surgeons into employment at hospitals and other health systems.
Orthopedic surgeons are paid on average more in a hospital setting compared to a single-specialty or multispecialty group, according to Physicians Thrive's "2023 Physician Compensation Report." Hospital-employed orthopedic surgeons earned $675,000 while single-specialty group surgeons earned $650,000. Multispecialty physicians earned $663,000.
However, hospital settings pose their own set of challenges. Some physicians find that they have less autonomy and flexibility in the hospital setting, particularly as private equity interest grows in healthcare and consolidation continues to trend upward.
"The key to success with any partnership will be that the relationship will enhance patient care, access and quality. At the same time, physician partners need to have the ability to continue to innovate [and] improve care and achieve professional satisfaction," Brian Larkin, MD, an orthopedic surgeon and chief medical officer at Orthopedic Centers of Colorado (Denver) told Becker's in 2022.
"Historically, professional satisfaction has been linked to having autonomy and the ability to lead beneficial change," he added. "It will be interesting to see how physicians that have had previous autonomy react to a model where the business of medicine may be dictating the delivery of healthcare."