Physician Organization and the Role of Workforce Turnover
Authors: Hannah T. Neprash, J. Michael McWilliams, Michael E. Chernew
Journal: Annals of Internal Medicine (2020)

Letters21 April 2020Physician Organization and the Role of Workforce TurnoverHannah T. Neprash, PhD, J. Michael McWilliams, MD, PhD, and Michael E. Chernew, PhDHannah T. Neprash, PhDSchool of Public Health, University of Minnesota, Minneapolis, Minnesota (H.T.N.), J. Michael McWilliams, MD, PhDHarvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (J.M.M.), and Michael E. Chernew, PhDHarvard Medical School, Boston, Massachusetts (M.E.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2838 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Physicians increasingly work in large practices that are integrated into hospital systems (1, 2). Although the role of mergers and acquisitions in driving this trend has received much attention, changes in practice composition may also play a role if older physicians are more likely to leave small practices (3) and newer physicians are more likely to join larger ones (4). The practice settings of newer physicians may differ from those of their predecessors for many reasons, including increasing administrative costs of independent practice, pressure from payers to bear risk, preference for flexible call schedules, and changes in employment opportunities ...References1. Muhlestein DB, Smith NJ. Physician consolidation: rapid movement from small to large group practices, 2013-15. Health Aff (Millwood). 2016;35:1638-42. [PMID: 27605644] doi:10.1377/hlthaff.2016.0130 CrossrefMedlineGoogle Scholar2. Neprash HT, McWilliams JM. Provider consolidation and potential efficiency gains: a review of theory and evidence. Antitrust Law Journal. 2019;82:551-78. Google Scholar3. AMN Healthcare. 2016 survey of physicians 55 and older. Accessed at www.amnhealthcare.com/industry-research/survey/2016-physician-survey/ on 1 September 2019. Google Scholar4. Merritt Hawkins. 2017 final-year medical residents survey. Accessed at www.merritthawkins.com/news-and-insights/thought-leadership/survey/2017-final-year-medical-residents-survey/ on 1 September 2019. Google Scholar5. Neprash HT, Chernew ME, Hicks AL, et al. Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Intern Med. 2015;175:1932-9. [PMID: 26501217] doi:10.1001/jamainternmed.2015.4610 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: School of Public Health, University of Minnesota, Minneapolis, Minnesota (H.T.N.)Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (J.M.M.)Harvard Medical School, Boston, Massachusetts (M.E.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2838.Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Neprash (e-mail, [email protected]edu). Data set: Not available.This article was published at Annals.org on 14 January 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTrends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019Michael L. Barnett, MD, MS, Asaf Bitton, MD, MPH, Jeff Souza, MA, and Bruce E. Landon, MD, MBA, MScPhysician, Practice, and Patient Characteristics Associated With Biosimilar Use in Medicare RecipientsPreserving and Promoting Competition in the Post–Coronavirus Disease 2019 Healthcare Delivery System 21 April 2020Volume 172, Issue 8Page: 568-570KeywordsAnesthesiologyCritical careDermatologyDisclosureMedicareNeurologyOphthalmologyOutpatient clinicsQuality improvement ePublished: 14 January 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...