Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

Abstract

Objective To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021. Study Design Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services. Setting United States. Methods Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021. Results Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%. Conclusion The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.

Physician Turnover Among Otolaryngologists in the United States, 2014–2021

“…Solo practitioners were more likely to close their practices and physicians in large practices were less likely to turnover. These findings are consistent with recent work demonstrating practice consolidation within otolaryngology as market forces and regulatory requirements threaten the sustainability of small groups 12,13 …”

“…These findings are consistent with recent work demonstrating practice consolidation within otolaryngology as market forces and regulatory requirements threaten the sustainability of small groups. 12,13 Our study has limitations. Our findings may not be generalizable to otolaryngologists that provide limited care to Medicare beneficiaries, such as pediatric otolaryngologists.…”

Computation of the distribution of model accuracy statistics in machine learning: Comparison between analytically derived distributions and simulation‐based methods

“…The Heart Disease Prediction cohort from the England National Health Services database was used in this retrospective cohort study 21–23 . All methods in this research were carried out in accordance with guidelines detailed by the Data Alliance Partnership Board‐approved national information standards and data collections for use in health and adult social care.…”

A Needs Assessment for the Future of Otolaryngology Education

“…The landscape of medical practice has also evolved as employment patterns have trended toward practice consolidation. 1…”

“…Novel devices and broadening indications for both surgical and medical therapies have been discovered in every subspecialty domain. The landscape of medical practice has also evolved as employment patterns have trended toward practice consolidation 1 . These changes have created new learning opportunities but also new challenges as the time for surgical training is limited.…”