New research published in Ophthalmology assessed the frequency of ophthalmologist (MD) turnover and its associated causes, as well as projected workforce numbers through the next 10+ years.
Let’s start with some background.
In recent decades, physician employment within healthcare has significantly changed, in part due to a consolidation of independent practices from private equity investment and larger hospital-based healthcare systems.
Other related factors causing a strain on this workforce include a decline in Medicare disbursements (causing a financial strain on physicians and healthcare organizations) and the COVID-19 pandemic (employment levels dropped by 5.2%).
Further, according to the U.S. Bureau of Labor Statistics, 37.2% of all healthcare employees have separated from at least one employer annually since 2017.
Now this research.
Investigators conducted a cross-sectional, retrospective study on the data of actively practicing MDs in the United States (Q4 from 2014-2021) who were included in the Centers for Medicare and Medicaid Services Physician Compare.
The data collected included:
- National Provider Identifier (NPI)
- Sex
- Age
- Location
- Medical school graduation year
- Practice name/identifier
- Practice size
- State/zip code
Any ophthalmologists excluded from the data?
Yes, actually.
Excluded were those MDs who may have been in training (completed residency or fellowship), practiced outside of the United States, and who billed fewer than 1,000 relative value units.
To note, the Medicare Physician and Other Supplier Public Use File was used to confirm the criteria.
And what was being assessed?
The primary outcome was turnover of an MD, which occurred when an MD’s NPI separated from one or more group practice affiliations from one year to the next, according to the study.
Additionally, researchers sought to determine the number of unique MD and practice combinations (according to NPI and group practice identification assignment).
MDs affiliated with 1+ practice were included as separate units for each practice pair.
So how was turnover calculated?
Researchers determined the rate by:
- Cumulatively as the total proportion of 2014 MD-practice positions turned over by 2021
- Annually as the proportion of practice separation in each year window: 2014 to 2015 through 2020 to 2021
These were then stratified by both physician and practice characteristics.
How many MDs were studied?
Researchers identified 13,264 MDs (associated with 3,306 unique practices; female MDs = 2,464) in 2014, with a small variable change observed each year (12,894 to 13,48).
This accounted for 75% of the 18,948 MDs actively practicing in 2021, according to the available data.
Gotcha. So what was the turnover?
By 2021, 34.1% of MDs had separated from at least one practice. However, this number declined as practice sizes increased:
- 68.0% for solo MD practices
- 19.9% for 11 to 19 MD practices, with the exception of practices with 20 members or more (29.3%)
Annual turnover varied from 3.77% in 2017 to 19.4% in 2018 (average rate = 9.4%).
Tell me more about these separation rates.
For university-affiliated practices, the separation rate was 38.3% compared to 33.8% (non-university-affiliated practices).
In the Northeast, separation rates were 38.9% vs. 29.7% (in the Midwest).
Female MDs also had a higher separation rate (40.4%) vs. males (32.7%).
MDs with 30+ years of practice experience had a lower cumulative turnover (25.9%) vs MDs with 5 years or less of experience (43.1%).
And the associated factors?
Based on the data, the study authors identified the following that were linked to higher turnover:
- Solo practice
- (adjusted odds ratio [aOR], 9.59; 95% confidence interval [CI], 8.36e11.01; P < 0.001)
- University affiliation
- (aOR, 1.55; 1.32e1.83 CI; P < 0.001)
- Practice location in Northeast
- (aOR 1.39; 95% CI, 1.25e1.54; P < 0.001)
- Practice size (2 to 4 members)
- (aOR, 1.21; 95% CI, 1.06e1.38; P 1⁄4 0.005)
How about for decreased turnover?
They identified the following:
- Male sex
- (aOR, 0.87; 95% CI, 0.78e0.96; P 1⁄4 0.006)
- 5+ years of practice experience
- 6 to 10 years (aOR, 0.63; 95% CI, 0.54e0.73; P < 0.001)
- 11 to 19 years (aOR, 0.54; 95% CI, 0.47e0.61; P < 0.001)
- 20 to 29 years (aOR, 0.36; 95% CI, 0.31e0.41; P < 0.001)
- 30 years or more (aOR, 0.18; 95% CI, 0.15e0.21; P < 0.001
Any limitations?
A few … the study authors noted that they were unable to determine every reason for an MD turnover as well as the inclusion criteria of including only those MDs who billed 1,000+ relative value units and a potential overestimation of true turnover rates (due to the data source).
Conclusions?
The authors concluded that, with one-third of MDs separating from at least one practice between 2014 and 2021—along with an aging population, increased demand for ocular health care, and a declining national density of MDs—“a stable workforce is essential to care for patients with eye disease.”
However, they recommend further investigation into ophthalmology-affiliated physician turnover in order to understand the impact on patient outcomes and healthcare delivery.