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IS THERE STRENGTH IN NUMBERS? CURRENT TRENDS IN U.S. GENERAL SURGERY PRACTICE CONSOLIDATION
S Anderson, J Pollock, J Hogan, J Hammond, V Jain, J Madura
Mayo Clinic, Phoenix

Background
While consolidation of physician practices is well-documented in recent years, minimal data exist regarding practice consolidation among general surgeons. The purpose of this study was to evaluate current trends in general surgery practice consolidation.

Methods
Practice data were obtained through the CMS Physician Compare database from 2012 and 2020. General surgeons were identified by primary specialty and classified by category of practice size (1 or 2, 3-9, 10-24, 25-49, 50-99, 100-499, 500+). Shifts in the number of surgeons and practices per size category were analyzed using the Cochran-Armitage test for trend. Data were further stratified by US region (Midwest, North, South, and West).

Results
From 2012-2020, the number of practicing general surgeons increased from 20,044 to 20,637 (+3.0%). The number of unique general surgery practices declined from 8,178 to 6,489 (-20.7%). The percentage of general surgeons in groups of 1 or 2 members declined from 19.2% to 11.8%, while surgeons in groups of 500 or more members increased from 19.7% to 31.1% (P < 0.001). The percentage of unique practices with 1 or 2 members decreased from 52.0% to 42.4%, while practices with 500 or more members increased from 1.7% to 3.7% (P < 0.001). Linear trend tests for consolidation at both the individual surgeon and unique practice levels remained significant when stratified by geographic region. The Midwest had the highest percentage of surgeons practicing in groups of 500 or more in both 2012 (24.7%) and 2020 (37.5%), while the South had the lowest percentage in both years (15.1%; 25.6%). The Midwest also had the lowest fraction of surgeons in the smallest size category (1-2) in years 2012 (11.5%) and 2020 (6.9%), whereas the West had the largest fraction in groups of 1 or 2 in both years (24.4%; 15.4%).

Conclusion
Consistent with trends in medicine overall, general surgery is experiencing substantial practice consolidation. As the surgeon workforce moves towards larger practices, more research is necessary to further elicit factors driving this trend and to assess its implications.


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